The healthcare provider prescribes dalteparin 200 units/kg subcutaneously once day for a client who weighs 154 pounds. The medication is available in 25,000 units/mL vial. How many mL should the nurse administer? (Enter numerical value only. If rounding is required, round to the nearest tenth.)

A. IV site without redness or swelling: The IV site appears normal with no signs of infiltration or infection, so no immediate follow-up is required. This finding indicates proper IV insertion and maintenance.

B. Temperature: 98.8° F (37.1° C): This is within normal limits and does not indicate fever or infection, so it does not require immediate follow-up.

C. Respirations: 28 breaths/minute: This is above the normal adult range (12–20 breaths/minute) and may indicate respiratory distress due to pain, shallow breathing, or possible pulmonary complications such as atelectasis or pneumonia, requiring close monitoring and follow-up.

D. Heart rate: 92 beats/minute: Slightly elevated but within mild tachycardia range, which could be related to pain or anxiety. It should be monitored but does not require urgent follow-up.

E. Taking shallow breaths: Shallow breathing is concerning in a client with rib fractures, as it increases the risk for hypoventilation, atelectasis, and pneumonia. This requires immediate intervention, such as pain management and respiratory support.

F. Alert and oriented to person, place, time, and situation: Cognitive status is normal, so no follow-up is needed.

G. Pain 8 on a 0 to 10 scale: Severe pain limits deep breathing and mobility, increasing the risk of complications. Pain management should be addressed promptly to improve comfort and respiratory function.

H. Blood pressure: 138/82 mm Hg: Slightly elevated, likely related to pain or stress. Monitor trends, but it does not require immediate follow-up at this time.

• Chest pain: Blood clot embolism, especially pulmonary embolism, typically causes sudden chest pain due to obstruction of the pulmonary arteries. Fat embolism rarely causes chest pain as the primary symptom, though hypoxia may lead to discomfort. Chest pain is therefore more indicative of thrombotic embolism.

• Petechiae: Petechiae on the neck, upper chest, and conjunctiva are hallmark signs of fat embolism. They result from occlusion of dermal capillaries by fat globules and platelet aggregation. Blood clot embolism does not usually cause petechiae.

• Origin typically long bone fracture: Fat emboli commonly originate from fractures of long bones such as the femur, tibia, or pelvis. Trauma forces fat from the bone marrow into the bloodstream, creating emboli. Blood clot emboli generally do not arise from bone fractures.

• Altered mental status: Fat embolism can impair cerebral oxygenation, leading to confusion, lethargy, or agitation. This neurological involvement is a distinguishing feature of fat embolism. Blood clot embolism rarely affects mental status unless there is severe hypoxia.

• Dyspnea: Dyspnea occurs in both fat and blood clot embolism due to impaired oxygen exchange in the lungs. In fat embolism, hypoxia may develop gradually, while blood clot embolism often causes sudden shortness of breath. Both conditions require prompt respiratory support.

• Origin typically deep vein thrombosis: Blood clot emboli usually originate from deep veins in the legs or pelvis and travel to the lungs. Fat emboli are not associated with venous thrombi. Identifying the source helps differentiate between the two embolism types.

• Tachycardia: Tachycardia is a compensatory response to hypoxia or stress in both fat and blood clot embolism. It helps maintain oxygen delivery to vital organs. While nonspecific, its presence supports the need for urgent intervention in either condition.