The nurse is performing morning care for a patient who sustained a fractured pelvis and bilateral femur fractures yesterday in a motorcycle collision. The patient complains of shortness of breath

Question

Assessment reveals audible wheezes and oxygen saturation of 76%. What action should the nurse take first?
a. Establish a peripheral intravenous (IV) line.
b. Inform the charge nurse.
c. Explain the patient's change in status to his family.
d. Raise patient to high Fowler position.

Answer 1

D
Fat embolism is a rare but serious complication of a fracture of a bone that has an abundance of marrow fat (e.g., the long bones, pelvis, and ribs). In the early postinjury period, patients with multiple fractures resulting from severe trauma are at risk for this complication. Signs and symptoms of fat embolism include a change in mental status, respiratory distress, tachypnea, crackles and wheezes on auscultating the lungs, rapid pulse, fever, and petechiae (a fine red rash over the chest, neck, upper arms, or abdomen). The nurse should stay with the patient; put him in a high Fowler position, use a nonre-breather mask to give high-flow oxygen, and establish a pe-ripheral IV line. The nurse should also summon the provider immediately as there is about an 80% mortality rate from this complication. Raising the patient to high Fowler position is the best initial intervention as it can be done immediately. The nurse should then verify patent IV access, notify the charge nurse and provider, and update the family on the patient's status change.