Correct
1. Fat embolism
The client most likely is experiencing fat embolism syndrome (FES). The average time of onset of FES is 18 to 24 hours after injury to long bones or crushing injury. Fat globules and tissue thromboplastin exit from bone marrow and local tissue as a result of injury. Fat molecules enter venous circulation, move to lungs, and embolize small capillaries. Petechial rash on neck, chest, conjunctivae, or axillae is a classic sign of FES
(occurs in 50%
to 60% of clients with FES). Increased temperature, pulse rate, and respirations are associated with FES; 75% of clients with FES exhibit neurologic signs, such as altered mental state, restlessness, agitation, lethargy, confusion, or coma. The client is not experiencing urinary retention because output indicates adequate hourly output of at least 50 mL/hr. The client is not experiencing hypovolemic shock. Although the client may experience tachypnea, tachycardia, and an increased temperature
with hypovolemic shock, the blood pressure will decrease and urine output will decrease to less than 30 mL/hr. The client is not experiencing a pulmonary embolism; this is more likely to occur 4 to 10 days after trauma. Although tachypnea, tachycardia, an increased temperature, restlessness, and agitation are common with pulmonary embolism, the client is not exhibiting sudden chest pain, dyspnea, cough, or hemoptysis, or areas of dullness or crackles when auscultating breath sounds.