A nurse is teaching a client about skin cancer prevention. Which of the following statements by the client indicates an understanding of the teaching?

Rationale for Correct Choices:

• Compartment syndrome: The client shows hallmark signs: pain unrelieved by medication (rated 9/10), cool foot, 2+ edema, numbness, absent pedal pulses, delayed capillary refill, and inability to move the foot. These findings indicate increased pressure within a muscle compartment that compromises circulation and nerve function, requiring emergency intervention to prevent tissue necrosis or amputation.
• Osteomyelitis: A rapidly rising temperature (up to 38.9°C), elevated WBC count (28,000/mm³), and presence of drainage from the splint site suggest a localized bone infection. Osteomyelitis can develop from an open fracture, especially post-surgery, and early detection is critical for avoiding systemic infection or bone destruction.

Rationale for Incorrect Choices:

• Deep vein thrombosis (DVT): While immobilization increases DVT risk, the scenario lacks classic signs like unilateral calf swelling, warmth, erythema, or a positive Homan's sign. Additionally, pulses are absent in the foot, not consistent with a DVT presentation, which typically does not affect distal pulses.
• Fat embolism: The client does not exhibit hallmark signs such as acute respiratory distress, petechial rash, or altered mental status. Although long bone fractures pose a fat embolism risk, no findings suggest embolic movement or pulmonary compromise in this case.

Rationale:

A. Raise the head of the client's bed to a high-Fowler's: Placing the client in high-Fowler’s position increases hip flexion beyond 90 degrees, which raises the risk of dislocation following a hip arthroplasty. Proper positioning involves limited hip flexion.

B. Keep an abduction pillow between the client's legs: An abduction pillow maintains proper alignment by keeping the legs apart and preventing internal rotation or adduction of the hip, both of which increase the risk of dislocation after surgery.

C. Elevate the client's affected leg on a pillow when in bed: Elevating the affected leg on a pillow may cause external rotation or misalignment of the hip. Unless prescribed, this practice may inadvertently increase the risk of hip dislocation.

D. Position the client's knees slightly higher than the hips when up in a chair: Having the knees higher than the hips promotes hip flexion beyond 90 degrees, a common cause of prosthesis dislocation postoperatively. Proper chair height and posture help prevent this complication.