Question

A client had a left total knee replacement two days ago and is now having dyspnea and appears to be very apprehensive. Pulse rate is 110 and she is diaphoretic. Which problem does the nurse suspect? A. Infection B. Pneumonia C. Fat embolus D. Anaphylaxis

Short answer

The nurse suspects a fat embolus (C).

Step-by-step solution

- Identify Symptoms

Recognize and list the symptoms the client is experiencing: dyspnea (difficulty breathing), apprehension, increased pulse rate (110 bpm), and diaphoresis (sweating).

- Understand the Context

Note that the client had a total knee replacement surgery two days ago. Major surgeries can have complications, and certain conditions are more likely to occur post-operatively.

- Analyze Potential Problems

Compare the symptoms against the possible conditions: - Infection: Typically presents with fever, redness, warmth, and possible discharge around the surgical site.- Pneumonia: Often involves symptoms like cough, fever, shortness of breath, and chest pain.- Fat embolus: Can present with acute-onset dyspnea, tachycardia, mental status changes, and petechial rash.- Anaphylaxis: Involves rapid onset of symptoms including difficulty breathing, swelling, hives, and low blood pressure.

- Match Symptoms

Given the acute onset of dyspnea, high pulse rate, sweating, and apprehension, the symptoms correspond most closely with a fat embolus, which is a common complication following orthopedic surgery.

- Conclusion

The nurse should suspect a fat embolus (Choice C) based on the symptoms presented.

Key concepts

post-operative care

Post-operative care is essential in ensuring a smooth recovery following surgery. Effective care involves close monitoring of the patient’s physical and emotional state, adhering to medical guidelines, and addressing any complications immediately.

Key aspects of post-operative care include:

• Monitoring vital signs: Regularly check the patient's pulse, blood pressure, respiration rate, and temperature.
• Assessing the surgical site: Look for signs of infection or other complications, such as excessive bleeding or swelling.
• Promoting mobility: Encourage gentle movement to prevent blood clots and improve circulation, but always follow the doctor’s guidelines.
• Pain management: Administer prescribed pain medications and monitor their effectiveness.
• Ensuring adequate hydration and nutrition: Provide necessary fluids and nutritious meals to support healing.

By focusing on these key areas, nurses can help patients recover more comfortably and prevent potential complications.

Educating patients about post-operative care and what to watch out for once they go home is also crucial. This includes explaining how to care for their wound, recognizing signs of infection, and understanding any activity restrictions.

fat embolus

A fat embolus is a serious, but relatively rare, complication that can occur after orthopedic surgeries, such as a total knee replacement. This condition involves fat globules entering the bloodstream and potentially clogging small blood vessels. Here is a brief overview:

Fat embolism syndrome (FES) typically presents within 24 to 72 hours post-surgery. The classic signs include:

• Acute-onset dyspnea: Sudden difficulty breathing.
• Tachycardia: Abnormally fast heart rate.
• Mental status changes: Confusion, restlessness, or agitation.
• Petechial rash: A red or purple spotty rash, often seen on the chest, neck, or underarm areas.

Early recognition and treatment are crucial. Treatment for a fat embolus is mainly supportive and includes:

• Oxygen therapy: To maintain adequate oxygen levels in the blood.
• IV fluids: To support blood pressure and organ function.
• Medications: To manage symptoms, such as corticosteroids to reduce inflammation.

Nurses play a key role in monitoring and recognizing symptoms early. If a fat embolus is suspected, prompt medical intervention can make a significant difference in the patient's outcome.

nursing assessment

Nursing assessment is a critical process that involves the systematic collection of patient data to determine the health status and identify any problems. Here’s a breakdown of this essential practice:

Steps in a nursing assessment include:

• Initial Observation: Assess the patient’s general appearance and immediate signs of distress.
• Vital Signs: Measure and record pulse, blood pressure, respiratory rate, and temperature.
• Physical Examination: Conduct a head-to-toe assessment, looking for signs of issues such as infections, swelling, or poor circulation.
• Patient Interview: Talk to the patient and/or family to gather a detailed health history and understand their current concerns and symptoms.
• Document Findings: Record observations and findings accurately for use in care planning.

In the context of post-operative care, thorough nursing assessments are particularly important. They help in early detection of complications such as infections, pneumonia, and fat emboli.

Nurses should utilize their clinical judgment and compare the patient’s current status against expected post-operative recovery patterns. This allows them to identify abnormalities quickly and escalate care when necessary. Regular and accurate assessments ensure that appropriate and timely interventions are made, promoting better outcomes for the patient.