A client has an open reduction and internal fixation (ORIF) of a fractured hip. The nurse monitors this client for signs and symptoms of a fat embolism. Which client assessment finding reflects this complication?

• A. Fever and chest pain
• B. Positive Homans sign
• C. Loss of sensation in the operative leg
• D. Tachycardia and petechiae over the chest

Answer: (D)

Fat embolism syndrome can occur after orthopedic trauma or surgery when fat droplets from the bone marrow enter the bloodstream and travel to the lungs and other organs. It usually shows up 24–72 hours after injury or fixation and often presents with respiratory distress, neurologic changes, and a pinpoint petechial rash on the chest and upper body. Tachycardia is a common response to hypoxia and stress.

The finding of tachycardia with petechiae over the chest best reflects fat embolism because the chest rash is a classic sign of microemboli in the skin and the heart rate rise indicates systemic stress from the embolic process. The other options point to different issues—fever with chest pain could be infection or other cardiopulmonary problems, a positive Homans sign suggests deep vein thrombosis, and loss of sensation in the operative leg indicates nerve or vascular injury—not fat embolism.