A client who underwent open reduction and internal fixation of a right tibial fracture 10 hours ago reports worsening leg pain that is unrelieved by PRN morphine. The nurse assesses that the client's right foot is cooler than the left. What is the nurse's priority action?

Question

Quizplus · Accepted Answer

Compartment syndrome (CS) results from compression of vascular structures by either external compression (restrictive dressings/casts) or increased pressure within a compartment (bleeding, inflammation, and edema). After an injury or trauma (eg, surgery), the vessels surrounding the injury site are compressed by swelling muscle and connective tissues. Muscle is encapsulated by a fibrous layer of fascia (ie, a compartment), which does not yield to swelling. Eventually, compression of tissues within the compartment restricts blood flow to the extremity. Signs of CS include the 6 Ps - pain (unrelieved by repositioning or analgesics), pallor, pulselessness, paresthesias, poikilothermia (coolness), and paralysis. The nurse should notify the health care provider immediately as CS is a limb-threatening emergency and requires immediate surgery (fasciotomy) (Option D). (Options A & B) If the client is in pain, blood pressure and pulse may increase. However, assessing the client's vital signs and giving the client more analgesic medication do not address the signs of CS. These actions delay emergency intervention. This client has enough evidence for suspicion of CS. (Option C) If CS is suspected, the nurse should place the extremity at heart level to promote venous return and limit swelling and loosen tight bandaging/casting material. If conservative measures fail, a fasciotomy (incision to open the fascia of the affected muscle compartment) may be required to relieve the compression. Educational objective: A client with signs of compartment syndrome (eg, pain, pallor, pulselessness) after a fracture or orthopedic surgery should be evaluated by the health care provider (HCP) immediately. After notifying the HCP, the nurse should position the affected extremity at heart level and loosen any restrictive bandaging/casting material.

A Client Who Underwent Open Reduction and Internal Fixation of a Right