A nurse on an orthopedic floor is completing the morning assessments on several clients. Which of the following clients has the greatest risk for fat embolism syndrome (FES)

A. Providing a verbal report of the client's status to a paramedic performing the transfer: Sharing relevant health information with personnel directly involved in the client’s care is appropriate and necessary for continuity of care. This does not constitute a breach of confidentiality because it is directly related to the client’s treatment and transfer.

B. Faxing the client's medical records to the long-term care facility: Sending medical records to the receiving facility ensures that the client’s care can continue without interruption. As long as the transmission is secure and the information is limited to what is necessary, this is an appropriate and legally permissible action.

C. Discussing the client's reaction to the transfer with another staff nurse: Sharing personal information about the client’s emotional response outside of a care-related context is not necessary for treatment or transfer and constitutes a breach of confidentiality. Such discussions should be avoided to protect the client’s privacy.

D. Leaving a phone message for the provider regarding the status of the client's transfer: Communicating with the provider about the client’s care is appropriate. Leaving a message regarding transfer status is relevant to the client’s treatment and does not violate confidentiality, provided the information is limited to necessary clinical details.

A. Administer diphenhydramine 50 mg IM: The client exhibits signs of neuroleptic malignant syndrome (NMS), including hyperthermia, autonomic instability, altered mental status, and muscle rigidity. Diphenhydramine can help manage extrapyramidal symptoms and muscle rigidity while stabilizing the client, making it an appropriate intervention in the acute phase.

B. Arrange for transport of the client to the nearest emergency department: NMS is a life-threatening medical emergency requiring immediate hospitalization for monitoring, intravenous fluids, and intensive management. The client’s elevated temperature, tachycardia, and altered mental status necessitate urgent transfer to a facility for providing acute care.

C. Apply cool, wet washcloths to the client's forehead and axilla: Hyperthermia is a critical component of NMS. Applying cool, wet washcloths provides non-pharmacologic fever management to reduce core body temperature while awaiting transport and additional treatment interventions. This helps prevent further complications such as organ failure.

D. Administer fluphenazine decanoate in the client's deltoid: Administering antipsychotics is contraindicated during NMS because these medications are the precipitating agents. Giving fluphenazine could worsen symptoms, increase rigidity, and exacerbate autonomic instability, so it must be avoided.

E. Instruct the client to discontinue risperidone: While antipsychotics should be discontinued in NMS, simply instructing the client to stop taking risperidone is insufficient. Immediate medical intervention and supervised discontinuation in a hospital setting are required due to the risk of rapid deterioration and life-threatening complications.