A nurse is caring for a patient who suddenly develops severe dyspnea and chest pain 3 days after an open reduction and internal fixation of a femur fracture. The nurse notes petechiae across the anterior chest and conjunctiva, confusion, and hypoxemia. What is the most likely diagnosis?

Answer and explanation

Correct answer: C. Fat Embolism Syndrome (FES)

  1. Step 1: Fat Embolism Syndrome (FES) is a clinical triad of respiratory distress/hypoxemia, neurological dysfunction (confusion/encephalopathy), and a petechial rash across the non-dependent skin surfaces (axillae, neck, conjunctiva).
  2. Step 2: It occurs 24 to 72 hours following traumatic long bone fractures (such as femur or tibia) due to microvascular occlusion by marrow fat globules and subsequent inflammatory endothelial injury.
Answer
Fat Embolism Syndrome (FES).
Why not the others: 'Tension pneumothorax' produces unilateral hyperresonance, absent breath sounds, and tracheal deviation without a petechial rash; 'Aspiration pneumonia' presents with fever and purulent sputum without systemic petechiae; 'Cardiogenic edema' features crackles, S3 gallop, and orthopnea without bone fracture association.

Practise more Primary Nursing, Acute Patient Assessment and Triage.

Free questions with an explanation for every one, and full timed MOH Prometric mock tests.

All Primary Nursing, Acute Patient Assessment and Triage questionsTake a mock test

More Primary Nursing, Acute Patient Assessment and Triage questions