The nurse understands that certain patients are more susceptible to pressure ulcer development. Which clients should the nurse identify as being at an increased risk for this health problem? Select all that apply.

A. Inadequate immobilization: Proper immobilization is essential for fractured bones to heal correctly. Immobilization, often achieved through casts, splints, or other orthopedic devices, stabilizes the broken bone fragments, allowing them to fuse back together. If the immobilization is not sufficient or if the patient doesn't follow the prescribed immobilization protocol, there can be excessive movement at the fracture site, hindering the healing process.

B. Venous thromboembolism: Venous thromboembolism (VTE) refers to the formation of blood clots in veins, usually in the legs (deep vein thrombosis) that can travel to the lungs (pulmonary embolism). While VTE is a potential complication after a fracture, it is not a direct cause of delayed bone union.

C. Inadequate vitamin D intake: Vitamin D is essential for bone health as it helps the body absorb calcium, which is crucial for bone formation and maintenance. Inadequate vitamin D levels can weaken bones and impair the healing process, but it's not a common cause of delayed bone union unless there are severe deficiencies or underlying medical conditions.

D. Bleeding at the injury site: Bleeding at the injury site occurs immediately after the fracture and is a natural part of the body's response to injury. While excessive bleeding can lead to complications, it is not a likely cause of delayed bone union six weeks after the injury. In the early stages of healing, bleeding is replaced by the formation of a hematoma, which eventually transforms into a callus and aids in the bone healing process.

A. Malunion: Malunion happens when a fractured bone heals in an improper position, leading to deformity and functional impairment. While it is a concern, it typically develops over time during the healing process and is not an immediate early complication that the nurse would monitor for in the acute phase following a fracture.

B. Compartment syndrome: Compartment syndrome is a serious condition that can occur after an injury, such as a fracture. When there is increased pressure within a muscle compartment, it can lead to reduced blood flow, potentially causing tissue damage and nerve injury. Prompt recognition and intervention are crucial to prevent complications.

C. Fat embolism: Fat embolism occurs when fat particles from the bone marrow or other sources enter the bloodstream, often after a long bone fracture or major trauma. These particles can travel to the lungs and other organs, causing respiratory distress, confusion, and other symptoms. Fat embolism is a significant concern in orthopedic trauma patients and requires careful monitoring.

D. Deep vein thrombosis (DVT): DVT is the formation of blood clots in deep veins, usually in the legs. Patients with fractures, especially those immobilized for extended periods, are at increased risk for DVT. If a clot dislodges and travels to the lungs, it can cause a pulmonary embolism, which is a life-threatening complication.

E. Pulmonary emboli: Pulmonary emboli occur when blood clots, often originating from DVT, travel to the lungs and block pulmonary arteries. This condition can lead to sudden difficulty breathing, chest pain, and even cardiac arrest. Pulmonary embolism is a medical emergency and requires immediate intervention.