A client in the postoperative period after an open reduction and internal fixation of a left wrist fracture reports constant, severe arm pain that is unrelieved by prescribed morphine administered 30 minutes ago. The client's nail beds appear dusky. What are the nurse's appropriate actions? Select all that apply.

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Compartment syndrome, a serious postoperative complication, is caused by decreased blood flow to the tissue distal to the injury. It results from either decreased compartment size (restrictive dressings, splints, or casts) or increased pressure within the compartment (bleeding, inflammation, and edema). Earliest symptoms may include pain or numbness that is unrelieved by medication. Subsequent findings include diminished/absent pulses, pallor, coolness, swelling, decreased movement, and cyanosis. Failure to treat this condition can lead to loss of limb function, paralysis, and tissue necrosis. The nurse should assess neurovascular status and report to the health care provider immediately (Options B and D). Removal of tight bandages/casts and fasciotomy (surgery) are required to relieve the pressure. (Option A) Heat should not be applied to a client experiencing altered sensation, as it may burn the client. Active range of motion will not resolve compartment syndrome and delays needed care. (Option C) Elevating the arm on pillows and providing additional analgesia may help reduce symptoms but may also reduce perfusion of the extremity. Instead, the extremity should be positioned at the level of the heart. (Option E) Documenting findings is important. However, reassurance and reassessment 1 hour later without immediate intervention delays needed care. Educational objective: Compartment syndrome is caused by decreased blood flow to the tissue distal to the injury and can cause ischemic necrosis. Acute compartment syndrome following surgery or casting is potentially limb-threatening and requires emergency evaluation by a health care provider.

A Client in the Postoperative Period After an Open Reduction