NCLEX-RNReduction of Risk PotentialHard
A client sustained a closed fracture of the femur 20 hours ago and is awaiting surgical repair. The nurse notes new-onset confusion, a respiratory rate of 32/min, oxygen saturation of 89% on room air, and a petechial rash across the chest and axillae. Which complication should the nurse suspect?
- ADeep vein thrombosis
- BCompartment syndrome
- CHypovolemic shock
- DFat embolism syndrome
Show answer & explanationAnswer & explanation
Correct answer: D. Fat embolism syndrome
The classic triad of fat embolism syndrome is hypoxemia, neurologic changes (confusion), and a petechial rash, typically occurring 12–72 hours after a long-bone fracture. Fat globules released from bone marrow travel to the pulmonary and cerebral circulation, causing these findings.
Why the other options are wrong
- A. DVT presents with unilateral leg swelling, warmth, and pain, not petechiae or confusion.
- B. Compartment syndrome causes localized limb pain and pallor, not systemic petechiae or confusion.
- C. Hypovolemic shock presents with hypotension and tachycardia, not a petechial rash.
Fat Embolism Syndrome
A complication of long-bone or pelvic fractures where fat globules enter the bloodstream, causing respiratory distress, neurologic changes, and petechiae, usually within 12–72 hours of injury.
- Classic triad: hypoxemia, altered mental status, petechial rash
- Occurs 12–72 hours after long-bone fracture
- Petechiae typically on chest, axillae, and conjunctivae
- Treatment is supportive: oxygen, early fracture stabilization, monitoring
Memory trick: 'Fat FLEES the bone: Fever/confusion, Lung hypoxia, Erythema/petechiae, 12-72hrs, Emergency Stabilize.'