A nurse is caring for a client who was in a MVA (motor vehicle accident) two days ago and sustained fractures to his tibia, ulna and ribs. The client is disoriented to time and place, has SaO2 of 87% and the nurse notices general petechiae over the client's chest. Which complication should the nurse suspect?

A. Osteomyelitis: Osteomyelitis is a bone infection that develops over days to weeks-not acutely-and it does not cause petechiae or low oxygen saturation. B. Thrombophlebitis: This usually causes localized swelling, warmth, and redness along a vein-not petechiae or respiratory distress. C. Hypovolemic shock: While this could cause confusion and low oxygen saturation, it is typically associated with hypotension and tachycardia, not petechiae. D. Fat embolism: This is a known complication following long bone fractures (e.g., tibia). Classic signs include: Respiratory distress, neurologic changes (confusion) and petechial rash (typically chest/axilla/conjunctiva). These appear 24–72 hours post-injury.