A nurse on an orthopedic unit is caring for four clients with a casted extremity. Which client does the nurse prioritize to see first?

Question

Quizplus · Accepted Answer

Clients with casted extremities after an acute injury are at risk for decreased peripheral perfusion due to increased edema and a cast that restricts the skin's ability to expand. Together, these create an impingement of the circulation, or acute compartment syndrome (ACS), which is a medical emergency. Nurses must prioritize clients demonstrating symptoms of ACS versus normal symptoms of a casted extremity. Expected responses include mild to moderate edema, warmth or throbbing secondary to edema, pain on movement or pain that improves with analgesics, itching (pruritus), and dry skin under the cast (Options B, C, and D). High-priority symptoms that may indicate ACS include: Severe pain unresponsive to analgesics Immobility of digits Changes in sensation-tingling or numbness (indicating early nerve ischemia) (Option A) Lack of pulses in distal extremity (not reliable for early ACS; absence of pulses indicates advanced/severe ACS) Cool and pale distal extremity Educational objective: Expected symptoms of a casted extremity include mild to moderate edema, warmth or throbbing secondary to edema, pain on movement or pain that improves with analgesics, itching (pruritus), and dry skin under the cast. Severe pain unresponsive to analgesics and changes in limb sensations (tingling or numbness) may indicate compartment syndrome.

A Nurse on an Orthopedic Unit Is Caring for Four