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A nurse is caring for a young adult client in the emergency department.

Exhibits

For each assessment finding below, click to specify if the assessment finding is consistent with Compartment Syndrome, Fat Embolism Syndrome, or Deep Vein Thrombosis. Each finding may support more than one disease process.

A.

Location of pain

B.

Temperature of extremity

C.

Respiratory assessment

D.

Skin assessment

E.

Nail bed assessment

F.

Location of edema

G.

Neurological status

Answer and Explanation

The Correct Answer is {"A":{"answers":"A,C"},"B":{"answers":"A,C"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"A"},"F":{"answers":"A,C"},"G":{"answers":"B"}}

Rationale:

  • Location of pain: Severe pain out of proportion to the injury, especially with passive stretch, is a classic sign of compartment syndrome. DVT also presents with localized pain in the affected limb, typically worsening over time due to venous congestion.
  • Temperature of extremity (Compartment Syndrome & DVT): A cool extremity in compartment syndrome indicates compromised arterial blood flow due to increased pressure within the fascial compartment. In DVT, the extremity may be warm early on, but impaired circulation can eventually result in coolness and cyanosis.
  • Nail bed assessment (Compartment Syndrome): Cyanotic or dusky nail beds reflect inadequate oxygen delivery from restricted blood flow, commonly seen in advanced compartment syndrome. This is a late and critical sign requiring urgent intervention to prevent permanent tissue damage.
  • Location of edema (Compartment Syndrome & DVT): Localized swelling occurs in compartment syndrome due to rising intracompartmental pressure. In DVT, venous obstruction leads to fluid accumulation and unilateral leg edema, often accompanied by warmth and discomfort.
  • Respiratory assessment (Fat Embolism Syndrome): FES often presents with sudden onset dyspnea, tachypnea, and hypoxemia due to fat globules entering the pulmonary circulation. These respiratory symptoms typically arise 24–72 hours after long bone trauma.
  • Skin assessment (Fat Embolism Syndrome): A petechial rash, especially on the chest, upper arms, and neck, is a distinguishing feature of FES. It results from occlusion of dermal capillaries by fat globules and is considered a hallmark sign of the condition.
  • Neurological status (Fat Embolism Syndrome): Altered mental status, confusion, and decreased alertness can occur in FES due to cerebral fat embolization. Neurologic involvement differentiates FES from other conditions like DVT or compartment syndrome, which typically do not cause cognitive changes.


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Related Questions

Correct Answer is C

Explanation

Rationale:
A. "Take a dose of loperamide each morning.": Loperamide is an antidiarrheal medication and is not appropriate for clients with constipation-predominant IBS (IBS-C). Using loperamide in these clients could worsen constipation.

B. "Increase your fluid intake to 1,000 milliliters per day.": A daily fluid intake of 1,000 milliliters (1 liter) is typically insufficient. Adequate hydration is essential for managing constipation, and clients are generally encouraged to consume at least 6 to 8 glasses (approximately 1.5 to 2 liters) of water daily to help soften stools and promote regular bowel movements.

C. "Take psyllium in the evening.": Psyllium is a soluble fiber supplement that can help alleviate constipation by increasing stool bulk and promoting bowel movements. Taking psyllium in the evening is appropriate, but it is crucial to take it with a full glass of water and maintain adequate hydration throughout the day to prevent potential side effects like bloating or gas.

D. "Consume a diet that is low in protein.": There is no specific recommendation for a low-protein diet in managing IBS-C. Dietary modifications for IBS-C typically focus on increasing soluble fiber intake and reducing fermentable carbohydrates (FODMAPs) rather than altering protein consumption.

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"C"}

Explanation

Rationale:

  • Pneumothorax: Pneumothorax presents with sudden respiratory distress, unilateral absent breath sounds, or tracheal deviation. This client has bilateral breath sounds and a functioning chest tube, making this condition less likely.
  • Atelectasis: Atelectasis is a common complication after thoracic surgery, especially when the client is hypoventilating. Shallow breathing, decreased oxygen saturation, crackles, and refusal to use the incentive spirometer all point to developing alveolar collapse.
  • Pulmonary embolism: PE often presents with sudden chest pain, dyspnea, and possibly hemoptysis or hypotension. This client’s symptoms have developed gradually and lack hallmark features of PE.
  • Sanguineous chest tube drainage: This is expected within 24–48 hours post-thoracotomy and does not indicate a specific respiratory complication unless the volume is excessive or suddenly increases.
  • Morphine use for pain management: Morphine can contribute to shallow respirations but is a routine part of postoperative care. It is not the most direct factor responsible for the client’s worsening pulmonary status.
  • Failure to use the incentive spirometer: This is a direct contributor to hypoventilation and secretion retention, leading to atelectasis. The client’s discomfort has prevented lung expansion, setting the stage for alveolar collapse and impaired gas exchange.

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