The nurse is caring for a patient with a fractured humerus in a long arm cast. Twelve hours after the cast was applied, the patient begins to complain of arm pain, which is unrelieved by analgesics
Which nursing action is most appropriate?
A) Preparing the patient for cast removal or bivalving of the cast
B) Obtaining an order for a different pain medication
C) Encouraging the patient to wiggle and move his fingers
D) Petaling the edges of his cast
Ans: A
Feedback: Pain distal to the fracture and not relieved with analgesics is an early sign of compartment syndrome, which occurs when pressure, caused by swelling and hematoma formation, is contained within a compartment of the extremity. A cast could create such a closed compartment. Venous and arterial circulation become impaired, resulting in ischemia. Irreversible nerve and muscle damage and tissue necrosis can occur. Removing or bivalving the cast relieves pressure. Ordering different analgesics doesn't address the underlying problem. Encouraging the patient to move his fingers or perform range-of-motion exercises won't treat or prevent compartment syndrome. Petaling the edges of a cast with tape prevents abrasions and skin breakdown, not compartment syndrome.
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