NCLEX-RNPhysiological AdaptationHard
A client sustains a fracture of the femur in a motor vehicle collision. Approximately 36 hours later, the client develops sudden dyspnea, confusion, and a petechial rash across the chest and neck. Oxygen saturation is 88% on room air. Which condition does the nurse suspect?
- APulmonary embolism from a venous thrombus
- BAcute exacerbation of asthma
- CCompartment syndrome of the affected limb
- DFat embolism syndrome
Show answer & explanationAnswer & explanation
Correct answer: D. Fat embolism syndrome
Fat embolism syndrome classically occurs 24–72 hours after a long bone fracture and presents with the triad of respiratory distress, neurologic changes (confusion), and a petechial rash on the chest, neck, and axillae, caused by fat globules entering the bloodstream and lodging in the pulmonary and cerebral capillaries.
Why the other options are wrong
- A. PE typically presents with pleuritic chest pain and does not classically cause a petechial rash.
- B. Asthma exacerbation would not explain the rash, confusion, or recent fracture history.
- C. Compartment syndrome causes localized limb pain and pallor, not systemic respiratory and neurologic findings.
Fat Embolism Syndrome
A complication of long bone or pelvic fractures where fat globules enter the circulation and lodge in pulmonary and cerebral capillaries, causing respiratory distress, altered mental status, and petechiae.
- Onset typically 24–72 hours after fracture
- Classic triad: hypoxemia, neurologic changes, petechial rash on chest/neck/axillae
- Management is supportive: oxygen, fracture stabilization, and monitoring for ARDS
Memory trick: Break a big bone, fat roams, rash and confusion come home