A nurse is reinforcing teaching about immunizations to a client who is pregnant. Which of the following immunizations should the nurse identity as contraindicated during pregnancy?

Rationale for correct choices:

• Compartment syndrome: The client demonstrates classic neurovascular compromise: severe escalating pain, numbness, inability to move toes, cool extremity, absent distal pulses, delayed capillary refill, and increasing edema. These findings reflect increased intracompartmental pressure compromising circulation and nerve function. This is a limb-threatening postoperative emergency following fractures and splinting.

• Osteomyelitis: The client has an open fracture with internal fixation, drainage at the surgical site, fever, and a marked rise in WBC count. Open fractures significantly increase the risk of bone infection due to direct contamination. Persistent fever and leukocytosis support developing osteomyelitis rather than normal postoperative inflammation.

Rationale for incorrect choices:

• Fat embolism syndrome: Fat embolism typically presents with acute respiratory distress, hypoxemia, altered mental status, and petechial rash. This client maintains adequate oxygen saturation and denies shortness of breath, making this condition less likely at this time.

• Deep vein thrombosis: DVT commonly presents with unilateral calf pain, warmth, erythema, and swelling, but does not cause absent pulses, motor loss, or sensory deficits. The acute neurovascular changes seen here point to arterial compromise rather than venous obstruction.

• Hemoglobin: Hemoglobin is within normal limits at 12.5 g/dL. HELLP syndrome involves hemolysis, which could lower hemoglobin, but in this case, there is no evidence of anemia yet. Preeclampsia may cause hemoconcentration, but the client’s hemoglobin is not abnormal.

• Platelet count: The client’s platelet count is 98,000/mm³, below the normal range. Thrombocytopenia is a hallmark of HELLP syndrome and can also occur in severe preeclampsia. Low platelets increase bleeding risk and indicate systemic endothelial dysfunction. Monitoring platelet trends is critical for anticipating complications and guiding treatment.

• Liver enzymes: AST and ALT are elevated (38 and 40 units/L), reflecting hepatocellular injury. Elevated liver enzymes are a defining component of HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) and are commonly seen in preeclampsia due to hepatic involvement.

• Fibrinogen: Fibrinogen is elevated at 500 mg/dL. HELLP syndrome involves a hypercoagulable state with microangiopathic hemolysis and liver involvement, often causing changes in fibrinogen levels. Elevated fibrinogen supports the presence of HELLP syndrome.