The nurse is caring for a client who underwent a right lobectomy for lung cancer 24 hours ago and has a single chest tube on the right side. Which intervention(s) should the nurse plan to implement? Select all that apply.

A. Occupation of legal secretary: The client works as a legal secretary, which may involve extensive typing or repetitive hand movements. This can contribute to musculoskeletal stress or strain, potentially exacerbating symptoms like pain and stiffness in the hands.

B. Stiffness in hands for 3 months: The client reports stiffness in both hands and wrists for the past 3 months, which could suggest an inflammatory arthritis such as rheumatoid arthritis (RA). This warrants further evaluation, especially given her family history of arthritis.

C. Radial and pedal pulses 2+: A rating of 2+ for radial and pedal pulses is normal, indicating no circulation issues, and does not need further evaluation.

D. Pain in bilateral hands and wrists: Persistent, symmetrical pain in the hands and wrists, particularly with palpation, may indicate a condition like rheumatoid arthritis. This symptom, in combination with morning stiffness, needs further investigation.

E. History of asthma using albuterol inhaler PRN: The client's history of well-controlled asthma, managed with an albuterol inhaler as needed for exacerbations, does not directly relate to her current presentation of hand pain and stiffness.

F. Capillary refill 2 seconds: A capillary refill time of 2 seconds is within the normal range, indicating adequate peripheral perfusion. This finding suggests that there are no immediate circulatory issues contributing to her hand pain and stiffness and does not require further evaluation.

G. Body mass index (BMI) of 31 kg/m²: A BMI of 31 falls within the obese range, which can increase the risk for musculoskeletal issues and other chronic conditions. This factor should be evaluated further, as obesity may affect joint health.

H. Client's hobbies: The client enjoys hobbies like gardening and crocheting, which involve repetitive hand movements. These activities could exacerbate the pain and stiffness in her hands, making it important to evaluate whether these hobbies are contributing to her symptoms.

Rationale:

• Pain: The client is reporting intense pain (10 on a 0 to 10 scale) in his left arm, and he is unable to move it. This suggests a possible fracture or significant soft tissue injury. Managing this pain is the priority to ensure the client’s comfort and prevent further complications.
• Compartment syndrome: Given the swelling, bruising, and coolness to the touch in the left arm, compartment syndrome is a serious risk. This occurs when swelling or bleeding in a muscle compartment increases pressure, potentially compromising blood flow to muscles and nerves. Immediate interventions are required to prevent tissue damage.

Rationale for Incorrect Options:

• Swelling: While swelling is present, it is a natural part of the healing process and not the primary concern in this case. The risk of compartment syndrome is much more urgent than managing swelling.
• Mobility: The client’s mobility is impaired due to pain, but pain management must be prioritized before focusing on restoring mobility. Only once pain is controlled should mobility be addressed.
• Fat embolism syndrome: Although fat embolism syndrome is a risk in traumatic fractures, especially with long bone injuries, the symptoms of this client (swelling, bruising, cool arm) point more directly to the risk of compartment syndrome rather than fat embolism syndrome.
• Venous thromboembolism (VTE): VTE is a concern in immobilized patients, but in the acute phase, compartment syndrome poses a more immediate threat. The priority is to manage the current trauma and risk for compartment syndrome before considering VTE prevention.