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Review the information in the electronic health record. Which potential complication does the nurse identify as high-risk for the patient?

Compartment syndrome.

Hypoglycemia

Fat embolism.

Hypovolemic shock

Infection.

Neurogenic shock

Answer and Explanation

Correct Answer : A,C,F

Rationale for correct choices

• Compartment syndrome: The client has multiple severe fractures with edema in the bilateral lower extremities. Swelling within the confined fascial compartments increases pressure, compromising circulation and tissue perfusion. Without prompt recognition and intervention, ischemia can lead to permanent muscle and nerve damage, making compartment syndrome a high-risk complication in this scenario.

• Fat embolism: The client has long bone fractures, including the femur and tibias, which are major sources of fat emboli entering the bloodstream. Fat embolism syndrome can develop 24–72 hours post-injury, presenting with respiratory distress, petechial rash, and neurological changes. Early recognition is essential to provide supportive care and prevent severe hypoxia or multisystem complications.

• Neurogenic shock: The MRI shows complete severance of the spinal cord at T8. Injury at this level can disrupt sympathetic nervous system pathways, causing hypotension, bradycardia, and warm, flushed skin below the injury. Neurogenic shock is a life-threatening complication following high spinal cord injuries and requires immediate hemodynamic monitoring and management.

Rationale for incorrect choices

• Hypoglycemia: There is no indication that the client has diabetes, endocrine disorders, or prolonged fasting that would place him at immediate risk for hypoglycemia. While blood glucose should be monitored in critically ill patients, it is not a high-risk complication specific to trauma or spinal cord injury in this case.

• Hypovolemic shock: Although the client has multiple fractures, the FAST exam was negative, and initial vital signs show only mild tachycardia with stable blood pressure. There is no evidence of massive blood loss at this time. While hypovolemic shock remains a general concern in trauma, the immediate high-risk complications are more directly related to neurovascular compromise and spinal injury.

• Infection: Infection is a potential concern due to open fractures, but it is not an immediate high-risk complication in the acute trauma phase. Prophylactic antibiotics and sterile wound care reduce early risk. The client’s urgent threats are more related to tissue perfusion, embolic events, and spinal cord–mediated shock.

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Correct Answer is C

Explanation

A. Erythrocyte count: The red blood cell count reflects oxygen-carrying capacity and anemia but does not indicate platelet destruction or immune-mediated reactions. HIT specifically affects platelets, so monitoring erythrocytes would not detect this complication.

B. Fibrinogen degradation products: Fibrinogen degradation products (FDPs) are elevated in disseminated intravascular coagulation or significant clot breakdown. While they reflect fibrinolytic activity, they are not specific or sensitive for heparin-induced thrombocytopenia.

C. Activated partial thromboplastin time (aPTT): Although aPTT is used to monitor therapeutic anticoagulation during heparin infusion, frequent platelet counts are the most direct laboratory marker for HIT. Monitoring aPTT ensures the patient is within the therapeutic range, but detection of a sudden drop in platelet count is crucial for early recognition of HIT.

D. Prothrombin time (PT): PT evaluates the extrinsic coagulation pathway and is primarily used to monitor warfarin therapy. It is not sensitive to heparin therapy or the development of HIT, which involves immune-mediated platelet activation and thrombocytopenia rather than changes in PT.

A. Initiate high-dose barbiturate therapy. B. Administer of IV furosemide. C. Prepare patient for immediate craniotomy. D. Type and cross-match for blood transfusion.

Correct Answer is C

Explanation

A. Initiate high-dose barbiturate therapy: High-dose barbiturates may be used in some cases to reduce cerebral metabolic demand and intracranial pressure, but they do not address the underlying cause of an epidural hematoma, which is a rapidly expanding arterial bleed. Definitive surgical intervention is required to prevent brain herniation.

B. Administration of IV furosemide: Furosemide is a diuretic that can reduce intracranial pressure indirectly, but it is not a primary treatment for epidural hematoma. Relying on diuretics alone will not stop arterial bleeding or relieve mass effect, which are life-threatening in this condition.

C. Prepare patient for immediate craniotomy: Epidural hematomas are often caused by arterial bleeding and can rapidly expand, leading to increased intracranial pressure and herniation. The priority intervention is emergent surgical evacuation of the hematoma via craniotomy to prevent irreversible neurologic damage and death.

D. Type and cross-match for blood transfusion: While blood products may be necessary if significant blood loss occurs, transfusion does not treat the primary threat of expanding intracranial pressure. Preparing for surgery takes precedence over obtaining blood products.

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Review the information in the electronic health record. Which potential complication does the nurse identify as high-risk for the patient?

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