A client suffered a fractured femur and is scheduled for surgery one day after sustaining the injury. The client develops acute respiratory distress syndrome (ARDS) and the healthcare provider suspects fat embolism (FES) based on which of the following clinical manifestations? (Select all that apply.)

A. Tidal fluctuation in the water seal chamber is an expected finding in a chest tube drainage system. It indicates that the pleural space is still connected to the atmosphere, and the lungs are expanding and contracting normally.

B. Continuous bubbling in the suction control chamber is normal when the chest tube is connected to suction. This shows that the suction system is functioning properly.

C. Chest tube eyelets not being visible is expected when the chest tube is properly positioned inside the pleural space. This finding does not require immediate notification.

D. Development of subcutaneous emphysema (air trapped under the skin) may indicate an air leak or improper chest tube placement. This finding requires immediate notification of the provider to address the underlying cause and prevent complications.

Rationale

• Obtain intravenous access: Anticipated. IV access is crucial for administering fluids, medications (like pain management), and potentially blood products if needed.
• Computed tomography (CT) of the chest: Anticipated. A CT scan provides a detailed image of the chest cavity and can confirm the diagnosis of pneumothorax, as well as identify the size and location of the air accumulation.
• Thoracentesis: Non-essential. A thoracentesis is a procedure to remove fluid from the pleural space. In a pneumothorax, the issue is air accumulation, not fluid. While a hemothorax (blood in the pleural space) can sometimes accompany a pneumothorax, the provided information does not indicate this. A chest tube is the appropriate intervention for air.
• Obtain ABGs (Arterial Blood Gases): Anticipated. ABGs provide essential information about the client's oxygenation, ventilation, and acid-base balance. Given the client's low O2 saturation and respiratory distress, ABGs are necessary to assess the severity of respiratory compromise.
• Pulmonary Function Tests (PFTs): Contraindicated. Pulmonary function tests are not appropriate in the acute setting of a pneumothorax as they can exacerbate the condition and are not useful for immediate management.
• Prepare for insertion of a chest tube: Anticipated. A chest tube is the definitive treatment for a pneumothorax. It allows for the evacuation of air from the pleural space and re-expansion of the lung. Given the client's symptoms (dyspnea, low O2 saturation, absent lung sounds), a chest tube is highly likely to be required