The nurse is caring for a patient after a closed reduction of a fractured humerus. While monitoring for a fat embolism, the nurse should be alert for which symptoms? 

Confusion and drowsiness
Hypoxemia and dyspnea
Petechiae on the chest and in the conjunctiva

Explanation

• Fat embolisms occur most commonly after fractures of long bones (such as humerus or femur). They are also more common after closed reductions of fractures (instead of open).

• Signs and symptoms of a fat embolism usually appear 24-72 hours after the injury. The triad of symptoms include respiratory changes (hypoxemia, dyspnea), neurological changes (confusion, drowsiness, and aphasia or apraxia), and a petechial rash seen in the conjunctiva, oral mucosa, or skin folds of the upper chest.

• Nausea and constipation after surgery are associated with an intestinal obstruction.

• Diminished pulses and pallor of the affected arm are associated with decreased perfusion, most likely from a clot in the arm.

• Chest pain that radiates to the arm is a classic symptom of myocardial ischemia (associated with heart attacks), not a fat embolism.

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