The health care provider (HCP) suspects a fat embolism syndrome (FES) in a client who has had multiple long bone fractures. Which findings does the nurse expect to assess to support this diagnosis? Select all that apply.

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11ecbb05_ca0b_1fe2_b433_e92084cec026_MD0009_00 FES is a rare, but life-threatening complication that occurs in clients with long bone and pelvis fractures. It can also occur in nontrauma-related conditions, such as pancreatitis and liposuction. It usually develops 24-72 hours following the injury or surgical repair. There are no specific diagnostic tests to identify FES. However, the initial characteristic signs and symptoms include: Respiratory problems (eg, dyspnea, tachypnea, hypoxemia) after a fat embolus travels through the pulmonary circulation and lodges in a pulmonary capillary, leading to impaired gas exchange and acute respiratory failure. This pathophysiology is similar to that of a pulmonary embolus (Option E).Neurologic changes (eg, altered mental status, confusion, restlessness), which occur due to cerebral embolism and hypoxia (Option A).Petechial rash (eg, pin-sized purplish spots that do not blanch with pressure), which appears on the neck, chest, and axilla due to microvascular occlusion. This defining characteristic differentiates a fat embolus from a PE (Option D).Fever (>101.4 F [38.6 C]), which is due to a cerebral embolism leading to hypothalamus dysfunction. Respiratory problems (eg, dyspnea, tachypnea, hypoxemia) after a fat embolus travels through the pulmonary circulation and lodges in a pulmonary capillary, leading to impaired gas exchange and acute respiratory failure. This pathophysiology is similar to that of a pulmonary embolus (Option E). Neurologic changes (eg, altered mental status, confusion, restlessness), which occur due to cerebral embolism and hypoxia (Option A). Petechial rash (eg, pin-sized purplish spots that do not blanch with pressure), which appears on the neck, chest, and axilla due to microvascular occlusion. This defining characteristic differentiates a fat embolus from a PE (Option D). Fever (>101.4 F [38.6 C]), which is due to a cerebral embolism leading to hypothalamus dysfunction. (Options B and C) Increasing, severe pain unrelieved by opioid analgesia or pain that is disproportionate to the injury and paresthesia (eg, numbness, tingling, burning) of the affected extremity are assessment findings indicative of compartment syndrome. Educational objective: FES presents with a triad of respiratory distress, mental status changes, and petechial skin rash. Fever and thrombocytopenia can also be present.

The Health Care Provider (HCP) Suspects a Fat Embolism Syndrome