. A nurse is caring for a client who develops a fat embolism after sustaining multiple fractures in a motor vehicle accident. Which of the following interventions should the nurse implement first?
Initiate intravenous fluid therapy
Prepare the client for emergency surgery
Administer high flow oxygen via a non-rebreather mask
Apply sequential compression devices (SCDs)
The Correct Answer is C
A. Initiate intravenous fluid therapy. While fluid therapy is essential to support circulation and reduce the risk of shock, oxygenation takes priority in fat embolism management.
B. Prepare the client for emergency surgery. Surgery is not typically the first-line intervention for fat embolism; management focuses on supportive care, particularly respiratory support.
C. Administer high-flow oxygen via a non-rebreather mask. High-flow oxygen is the first priority to address hypoxia caused by fat embolism and should be administered immediately to maintain adequate oxygenation.
D. Apply sequential compression devices (SCDs). SCDs are used to prevent venous thromboembolism, but they do not help with the treatment of fat embolism.
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Correct Answer is C
Explanation
A. "I should monitor my temperature regularly and report any fevers to my healthcare provider." This statement shows correct understanding. Fever may indicate worsening infection or complications, so it’s important to monitor and report any fevers.
B. "I need to inform my healthcare provider about any new symptoms, such as shortness of breath or chest pain." This statement shows understanding. New symptoms, especially respiratory or cardiac, could signify complications, and should be reported.
C. "I can stop taking my antibiotics once I feel better." This indicates a need for further teaching. Completing the full course of antibiotics is crucial to ensure the infection is completely eradicated, even if symptoms improve.
D. "I will need to take antibiotics before dental procedures." Patients with infective endocarditis often require prophylactic antibiotics before dental procedures to prevent bacterial entry into the bloodstream.
Correct Answer is D
Explanation
A. Warfarin. Warfarin (Coumadin) is an anticoagulant used to prevent blood clots, but it typically requires several days to achieve a therapeutic effect and needs close monitoring of INR (International Normalized Ratio) levels. While it can be used for long-term prevention of DVT, it's not the immediate choice for post-operative prophylaxis.
B. Alteplase (tPA). Alteplase is a thrombolytic agent, used to break down existing clots, not prevent their formation. It is typically used in emergency situations, such as for treating ischemic stroke.
C. Clopidogrel. Clopidogrel is an antiplatelet agent, often used to prevent arterial clots, not DVTs. It is more commonly used in conditions like stroke and heart disease.
D. Enoxaparin. Enoxaparin, a low molecular weight heparin, is commonly used to prevent DVT after surgery by inhibiting specific clotting factors. It’s frequently prescribed for DVT prevention in orthopedic surgery patients.