inactivity. This condition may occur with or without symptoms. If symptoms do occur,
they may present as substernal pain, dyspnea, apprehension, weak and rapid pulse,
shock, or simply a subtle deterioration of the patient's condition for no obvious reason.
The treatment ordered by the physician will be symptomatic and normally involves the
use of anticoagulant therapy and elastic stockings.
b. Fat Embolism. In fat embolism, fat droplets enter the circulatory system,
obstructing blood flow and causing inflammatory reactions in the affected vessels.
Onset usually occurs within 24-72 hours after injury. Fat emboli in the lungs may result
in defective transfer of respiratory gases, causing dyspnea and air hunger. Some
emboli may affect the central nervous system and cause restlessness and confusion.
Again, treatment addresses the signs and symptoms. Oxygen is normally administered
and, if necessary, the physician will order intubation and mechanical ventilation.
Anti-inflammatory and diuretic medications will often be used as well.
c. Gas Gangrene. Gas gangrene is a severe infection of skeletal muscle
caused by the bacteria Clostridium. These bacteria are anaerobes and spore formers
normally found in soil and in the intestinal tract of man. Gas gangrene occurs most
often in wounds that have been grossly contaminated at the time of injury, in wounds
that have a small but deep open wound area, and in wounds that have a compromised
blood supply and therefore a decreased oxygen supply. Gas gangrene causes
production of toxins and decomposition of tissue. Necrotic tissue will produce gas
bubbles, which are evidenced by crepitus (crackling) in the soft tissue, along with
severe pain and edema. Nursing personnel should observe for signs of apprehension,
fever, chills, increased pulse, increased respiratory rate, and frothy foul-smelling
drainage from the wound. Strict nursing observation is critical for patients with
susceptible wounds because gas gangrene will often progress to a severe stage deep
in the tissue before any signs or symptoms become evident. In treating gas gangrene,
the physician will open the wound for debridement and irrigation. Antibiotic therapy and
hyperbaric oxygen therapy will be initiated. Frequently, amputation of the affected
extremity is necessary.
d. Tetanus. Tetanus is an acute infection caused by the tetanus bacillus,
another anaerobic spore former. The bacteria is introduced through a wound that has
been contaminated with soil, feces, or dust. Toxins that have an affinity for nervous
tissue cause hyperirritability, restlessness, muscle rigidity, and tonic muscular spasms
of almost every muscle group. The patient may have difficulty opening the mouth due
to spasm of facial muscles. Tetanus is sometimes referred to as "lockjaw" for this
reason. Treatment is similar in nature to that of gangrene, with the addition of