. 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 A
Explanation
A. Administering mannitol intravenously: Mannitol is an osmotic diuretic that helps reduce ICP by drawing fluid out of brain tissue and decreasing cerebral edema, making it a priority intervention.
B. Encouraging the patient to hyperventilate: Controlled hyperventilation may reduce ICP temporarily by lowering CO₂ levels and causing cerebral vasoconstriction. However, it should only be done cautiously under close monitoring, and other ICP management techniques like mannitol administration take priority.
C. Administering a high-dose corticosteroid: Corticosteroids are generally ineffective for reducing ICP in traumatic brain injury and are typically not recommended in this scenario.
D. Performing a lumbar puncture immediately: Lumbar puncture is contraindicated in cases of increased ICP because it may lead to brain herniation due to the sudden release of pressure.
Correct Answer is B
Explanation
A. High fluid intake: High fluid intake can help maintain blood flow and reduce the risk of venous stasis.
B. Immobility during and after surgery: Immobility contributes to venous stasis and is a primary risk factor for DVT, especially after prolonged surgery.
C. Low body temperature: Low body temperature does not directly cause venous stasis or increase the risk of DVT.
D. Increased physical activity: Increased physical activity promotes circulation and reduces the risk of DVT by preventing blood from pooling in the veins.