The nurse is planning preoperative care for a client who has a fractured wrist. Which of the following should the nurse include in the client's plan of care?

Choice A reason:
Hypertension is not typically an early manifestation of fat embolism syndrome (FES). FES is more commonly associated with hypoxemia, which can lead to hypotension rather than hypertension².

Choice B reason:
While a swollen calf may indicate deep vein thrombosis, it is not an early sign of FES. FES primarily affects the lungs and neurological systems early on, rather than causing localized swelling such as in a calf².

Choice C reason:
Tachypnea, or rapid breathing, is indeed an early sign of FES. This symptom usually develops before others and is due to the fat globules causing respiratory distress by blocking the pulmonary microcirculation²³⁴.

Choice D reason:
Bradycardia, or a slower than normal heart rate, is not an early sign of FES. Instead, patients may experience tachycardia as a response to hypoxemia and respiratory distress².

Choice A reason: Hypotension
Hypotension, or low blood pressure, can be a consequence of dehydration, which is a common complication of DI due to the excessive loss of water. However, hypotension is not a direct neurological effect of DI. It is more of a circulatory system response to the changes in fluid volume within the body.

Choice B reason: Poor skin turgor
Poor skin turgor is an indicator of dehydration, which can occur in DI due to the large volume of urine excreted. Skin turgor refers to the skin's ability to change shape and return to normal (elasticity), and it becomes less elastic when the body is dehydrated. While this is an important sign to monitor, it is not a neurological effect.

Choice C reason: Ataxia
Ataxia, which is a lack of muscle coordination affecting speech, eye movements, the ability to swallow, walking, picking up objects, and other voluntary movements, can be a neurological effect of DI if severe dehydration and electrolyte imbalance affect the brain. Symptoms such as confusion and muscle cramps can also be associated with ataxia, making it a relevant neurological effect to monitor in a client with DI.

Choice D reason: Dilute urine
Dilute urine is a primary symptom of DI, not a neurological effect. It is the result of the kidneys' inability to concentrate urine due to a deficiency in the anti-diuretic hormone (ADH) or the kidneys' response to ADH. Monitoring urine concentration is crucial in managing DI, but it does not represent a neurological effect.