A patient in a cast for a right tibial fracture complains of increasing pain, unrelieved by analgesics. Assessment by the nurse reveals paresthesias and paleness of the right foot. What action should the nurse take first?
A) Administer analgesia for breakthrough pain, and reassess the patient in 30 minutes.
B) Elevate the leg above the heart, and reassess the patient in 30 minutes.
C) Notify the orthopedic physician immediately.
D) Ask the patient to do dorsiflexion and plantar flexion exercises of the foot.
C) Notify the orthopedic physician immediately.
Explanation: A) Compartment syndrome is a medical emergency, and the nurse should not wait to call the physician.
B) Compartment syndrome is a medical emergency, and elevating the leg above the heart will not reduce the pressure within the cast.
C) Compartment syndrome, a medical emergency, occurs when edema and swelling cause increased pressure in a muscle compartment, leading to decreased blood flow and possibly muscle and nerve damage. Symptoms of compartment syndrome include severe pain and tenderness, swelling, paresthesia, pallor, numbness or paralysis, and decreased or absent pulse and poikilothermia (normalization to room temperature) in the distal portion of the affected limb. Compartment syndrome should be suspected when complaints of pain and swelling are disproportionate to negative x-ray findings. It can result from a fracture, a muscle bruise, a crush injury, or a bandage that is too tight, such as a cast. The first step in treatment is to remove a tight cast. If internal pressure is causing the symptoms, it is generally treated by surgery to relieve the pressure.
D) Compartment syndrome is a medical emergency, and performing these exercises will not reduce the pressure in the compartment.
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