Compartment Syndrome: NCLEX Review

Jul 1, 2024

Compartment Syndrome: NCLEX Review

Scenario

  • 55-year-old female arrives at the ER with a right leg fracture.
  • X-ray shows a closed tibia fracture.
  • Closed reduction and casting are performed.
  • Ordered morphine 2 mg IV every 4-6 hours for pain.
  • Patient reports pain medication is ineffective and pain increases with leg movement.

Response Options

  • A: Reassure and reposition cast - Not Correct
  • B: Readjust the cast - Not Correct
  • C: Perform neurovascular checks - Correct
  • D: Elevate the leg above heart level - Not Correct
  • E: Loosen and remove restrictive items - Correct
  • F: Notify the physician - Correct

Key Points

  • Complications: A bone fracture with a cast can lead to compartment syndrome.
  • Signs of Compartment Syndrome
    • Earliest sign: Pain not relieved by pain meds, increases with passive movement.
    • Six P's: Pain, Paresthesia, Pallor, Paralysis, Poikilothermia, Pulselessness.
  • Pathophysiology
    • Increased pressure within a muscle compartment.
    • Fascia does not expand, leading to potential blood flow and nerve function compromise.
    • If untreated within 6 hours, can cause irreversible muscle and nerve damage.

Six P's Examination

  1. Pain
    • Severe, unrelieved by opioids.
    • Increases with slight movement.
  2. Paresthesia
    • Pins and needles sensation.
    • Limb may feel like it’s asleep.
  3. Pallor
    • Affected extremity looks pale or dusky.
    • Capillary refill greater than 2 seconds.
  4. Paralysis
    • Inability to move the limb.
  5. Poikilothermia
    • Affected limb is cooler than the unaffected limb.
  6. Pulselessness (late sign)
    • No detectable pulse with Doppler.

Management Actions

  • Perform neurovascular checks frequently.
  • Loosen/remove restrictive items to alleviate pressure.
  • Notify the physician immediately.
  • Avoid elevating the limb above heart level to maintain arterial pressure.
  • Possible medical interventions:
    • Bivalving the cast or removing it.
    • Fasciotomy (cutting the fascia to relieve pressure).

Final Answers for Question

  • Neurovascular checks (C).
  • Loosen/remove restrictive items (E).
  • Notify the physician (F).

Conclusion

  • Recognize the signs of compartment syndrome early.
  • Understand the importance of prompt intervention to prevent permanent damage.
  • Effective management involves neurovascular assessment, relieving pressure, and medical consultation.