A child in the emergency department had a cast placed on the right arm for a nondisplaced fracture. The client is being discharged home with pain medications. Which statement by the parent indicates that additional teaching is required?

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Parents of children with casts are taught to check for emergency signs of circulatory impairment, including changes in sensation and motor function, which could indicate early signs of compartment syndrome due to swelling within the confined space of the cast. However, some swelling is expected, so this symptom alone is not indicative of compartment syndrome. The 6 Ps of compartment syndrome include: Pain: Increasing despite elevation, analgesics, and ice. Pain will also increase with passive stretching/movement. Increasing pain is an early sign and indicates muscle ischemia (Option C). Pressure: Affected extremity or digits are firm and tense; skin is tight and appears shiny. Paresthesia: Tingling, numbness, or burning sensation, which is also an early sign and indicates nerve ischemia (Option A). Pallor: Skin appears pale; capillary refill is >3 seconds. These indicate poor perfusion. Pulselessness: Pulse distal to injury or compartment is impalpable. Absent pulses are a late sign. Paralysis: Loss of function or inability to move extremity or digits. Muscle weakness occurs before paralysis which is also a late sign and indicates dead muscle tissue. (Option B) An itching sensation under the cast is expected, clients and parents are taught to avoid inserting anything into the cast to scratch the skin. Instead, they should use a hair dryer on the cold setting. (Option D) Arm elevation is indicated for the first 48 hours after cast placement to reduce edema. However, if compartment syndrome develops, the arm should be kept at torso level (not high or low). Educational objective: Compartment syndrome is a serious complication due to neurovascular compromise from swelling and increased pressure in a confined space. The characteristics (6 Ps) of compartment syndrome include: pain, pressure, paresthesia, pallor, pulselessness, and paralysis.

A Child in the Emergency Department Had a Cast Placed