A 45-year-old patient is experiencing escalating pain, swelling, and decreased sensation after hip surgery, indicating possible compartment syndrome. What is the nurse's priority action to address this clinical situation?

C) Notify the healthcare provider immediately

A) Elevate the affected limb above heart level

B) Administer additional prescribed analgesics

C) Notify the healthcare provider immediately

D) Apply ice packs to the affected area

A 45-year-old construction worker is experiencing escalating pain, swelling, and decreased sensation in the left thigh following hip surgery, and the healthcare team suspects compartment syndrome. Which nursing action is the highest priority to prevent complications associated with this condition?

C) Prepare the patient for surgical fasciotomy to relieve pressure

A) Elevate the affected limb above heart level to reduce swelling

B) Apply ice packs to the affected thigh to decrease inflammation

C) Prepare the patient for surgical fasciotomy to relieve pressure

D) Administer additional analgesics to manage the patient's pain level

A patient in the post-anesthesia care unit (PACU) after a fasciotomy for compartment syndrome has an elevated serum creatine kinase (CK) level of 2,500 U/L. Which nursing intervention should take priority to prevent complications associated with this finding?

A) Administer prescribed prophylactic anticoagulation therapy.

C) Monitor the fasciotomy site for signs of infection.

D) Encourage early ambulation to prevent thromboembolism.

A patient in the post-anesthesia care unit (PACU) following a fasciotomy for compartment syndrome is being monitored closely. Which nursing intervention is most critical to prevent acute kidney injury due to elevated creatine kinase (CK) levels?

B) Initiating aggressive intravenous fluid therapy to maintain renal perfusion

A) Administering prophylactic anticoagulation to prevent thromboembolic events

B) Initiating aggressive intravenous fluid therapy to maintain renal perfusion

C) Implementing meticulous wound care to prevent infection

D) Encouraging early mobilization to improve circulation

A postoperative patient in the PACU has developed oliguria with tea-colored urine, and laboratory tests show an increased serum creatinine level, consistent with acute kidney injury due to rhabdomyolysis. Which nursing intervention is most critical to implement first to prevent further kidney damage?

A) Increase the rate of isotonic saline infusion to promote renal perfusion.

B) Administer sodium bicarbonate to alkalinize the urine.

C) Prepare to administer calcium gluconate to stabilize cardiac membranes.

D) Monitor serum potassium levels hourly.

A postoperative patient in the PACU is exhibiting signs of myoglobinuria and an elevated serum potassium level of 5.8 mEq/L. Which nursing intervention should take priority to address the patient's current condition?

A) Initiate continuous ECG monitoring to detect potential cardiac dysrhythmias.

B) Administer isotonic saline intravenously to maintain adequate renal perfusion.

C) Prepare the patient for dialysis to rapidly reduce serum potassium levels.

A patient recovering from a fasciotomy for compartment syndrome is exhibiting a serum potassium level of 6.1 mEq/L despite management efforts. Which nursing intervention should be prioritized to address the risk of cardiac complications associated with hyperkalemia?

A) Administer calcium gluconate as prescribed to stabilize cardiac membranes.

B) Increase intravenous fluid rate to promote renal excretion of potassium.

C) Monitor urine output closely to assess kidney function.

D) Prepare the patient for emergency dialysis to rapidly remove excess potassium.

A patient is recovering post-fasciotomy and presents with serum potassium levels of 6.1 mEq/L and elevated creatine kinase levels. The healthcare team has administered calcium gluconate, insulin, and dextrose. Which additional intervention should the nurse anticipate to support the management of this patient's condition?

C) Preparing the patient for hemodialysis

A) Administering sodium polystyrene sulfonate

B) Increasing the patient's oral fluid intake

C) Preparing the patient for hemodialysis

D) Initiating a low-potassium diet

compartment syndrome of thigh after hip surgery - Nursing Case Study

Pathophysiology

• Primary mechanism: Compartment syndrome occurs when there is increased pressure within the closed fascial compartments of the thigh, often due to bleeding or swelling post-hip surgery. This elevated pressure exceeds capillary perfusion pressure, leading to compromised blood flow and tissue ischemia.

• Secondary mechanism: Inadequate drainage or excessive intravenous fluids can exacerbate swelling in the thigh's compartments, further increasing pressure and reducing oxygen supply to muscles and nerves.

• Key complication: If untreated, prolonged ischemia can result in muscle necrosis and nerve damage, potentially leading to permanent functional impairment or limb loss. Early recognition and intervention are crucial to prevent these severe outcomes.

Patient Profile

Demographics:

45-year-old male, construction worker

History:

• Key past medical history: Hypertension, Type 2 Diabetes

• Current medications: Lisinopril, Metformin, Ibuprofen

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing pain and swelling in the left thigh post-hip surgery

• Key symptoms: Severe pain unrelieved by medication, swelling, firmness of the left thigh, tingling sensation in the foot, reduced range of motion

• Vital signs: Blood pressure 150/95 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 99.5°F, oxygen saturation 94% on room air

Section 1

As the healthcare team continues to monitor the 45-year-old construction worker post-hip surgery, there is a notable change in his status that prompts immediate attention. Over the course of several hours, the patient’s pain has escalated despite administration of prescribed analgesics, and he now describes the sensation as a deep, unrelenting pressure in the left thigh. The swelling has progressed, and there is an observable increase in thigh circumference compared to earlier measurements. On examination, the left thigh is palpably tense, with the skin appearing taut and shiny, indicative of worsening compartment syndrome. Additionally, there is a concerning decrease in sensation and strength in the patient’s left foot, as he reports an inability to fully dorsiflex the foot, suggesting possible nerve involvement.

Concurrently, there is a worrisome shift in the patient’s vital signs: his heart rate has risen to 120 bpm, indicating a possible compensatory response to pain or decreased perfusion, while blood pressure remains elevated at 155/100 mmHg. Oxygen saturation has decreased slightly to 92% on room air, raising concerns about adequate oxygen delivery in the context of increasing tissue pressure and oxygen demand. The patient's respiratory rate has also increased to 24 breaths per minute, potentially reflecting distress or the body's attempt to meet metabolic needs.

The clinical team recognizes the urgency of the situation, understanding that prolonged compartment syndrome can lead to irreversible damage. A decision is made to perform an immediate surgical fasciotomy to relieve the pressure and restore perfusion. This intervention is critical to prevent further complications such as muscle necrosis or permanent functional impairment. The team swiftly prepares for the procedure, with the goal of preserving limb function and preventing systemic complications. The unfolding scenario underscores the importance of timely intervention and the need for ongoing vigilance in postoperative care.

Section 2

Following the immediate surgical intervention, the patient is transferred to the post-anesthesia care unit (PACU) for close monitoring. The fasciotomy successfully alleviates the compartment pressure, and initial postoperative assessments indicate that perfusion to the left leg has improved. The skin appears less taut, and the patient reports a decrease in the deep, throbbing pain previously experienced. The medical team notes that while the patient's heart rate has decreased to 95 bpm, his blood pressure remains slightly elevated at 150/95 mmHg, likely reflecting ongoing physiological stress and postoperative pain. Oxygen saturation has improved to 95% with supplemental oxygen, suggesting a positive response to the intervention.

Despite these improvements, the team closely monitors the patient for potential complications. New lab results reveal a serum creatine kinase (CK) level of 2,500 U/L, indicating muscle breakdown, commonly associated with compartment syndrome. The elevated CK level prompts the healthcare team to initiate aggressive intravenous fluid therapy to prevent renal complications, such as acute kidney injury, which can result from rhabdomyolysis. Furthermore, serial neurological assessments reveal a gradual return of sensation and strength in the left foot, although the patient still exhibits some weakness in dorsiflexion, necessitating continued physical therapy involvement.

The healthcare team remains vigilant, aware that the patient is at risk for other postoperative complications, including infection at the fasciotomy site and potential thromboembolic events. The team implements strategies such as prophylactic anticoagulation and meticulous wound care to mitigate these risks. As the patient stabilizes, the focus shifts to long-term recovery and rehabilitation, requiring coordinated efforts among the surgical, nursing, and rehabilitation teams to optimize functional outcomes and facilitate a return to daily activities and work. The case underscores the critical role of early recognition and intervention in managing postoperative complications to optimize patient outcomes.

Section 3

As the patient progresses through the initial postoperative period in the PACU, a new complication arises that demands immediate attention. During a routine assessment, the nurse notes that the patient's urine output has decreased significantly over the past few hours, dropping to 15 mL per hour. Concurrently, the urine appears dark and tea-colored, a classic sign of myoglobinuria, which is a complication of rhabdomyolysis. The healthcare team promptly orders additional laboratory tests, revealing that the serum creatinine level has increased to 2.1 mg/dL, indicating a developing acute kidney injury. This change emphasizes the critical need for continued aggressive intravenous fluid therapy to promote renal perfusion and prevent further kidney damage.

In response to these findings, the medical team intensifies the fluid resuscitation strategy, adjusting the IV fluids to include isotonic saline and monitoring the patient’s fluid balance closely. The goal is to achieve a urine output of at least 0.5 mL/kg/hr to effectively flush out myoglobin from the kidneys, thereby reducing the risk of tubular obstruction and nephrotoxicity. The team also considers the use of sodium bicarbonate to alkalinize the urine, potentially reducing the nephrotoxic effects of myoglobin. Meanwhile, close monitoring of electrolyte levels is initiated to prevent complications such as hyperkalemia, which can result from both muscle breakdown and impaired renal function.

Despite these efforts, the patient begins to display signs of electrolyte imbalance, with a serum potassium level rising to 5.8 mEq/L. The elevated potassium level poses a risk for cardiac complications, prompting the healthcare team to implement interventions such as administering calcium gluconate to stabilize the cardiac membrane and insulin with glucose to facilitate intracellular potassium shift. These layered and timely interventions illustrate the interconnected nature of postoperative care, requiring the healthcare team to continuously adapt management strategies in response to the evolving clinical picture. The focus remains on stabilizing the patient's condition and preventing further deterioration, highlighting the importance of vigilant monitoring and proactive management in the face of complications.

Section 4

As the healthcare team continues to manage the patient's condition, a new complication surfaces, reflecting the intricate and dynamic nature of postoperative care. During a subsequent assessment, the nurse observes that the patient is experiencing increasing restlessness and confusion, which are concerning signs that may indicate a change in neurological status. Vital signs reveal a blood pressure of 145/90 mmHg, heart rate of 110 beats per minute, and a respiratory rate of 24 breaths per minute, suggesting a heightened sympathetic response. Furthermore, the patient is now complaining of severe pain in the affected thigh, despite receiving analgesics, and the limb appears swollen and tense upon palpation.

Given these symptoms, the team suspects an exacerbation of compartment syndrome, which could compromise both vascular and nerve function in the affected limb. The nurse promptly performs a neurovascular assessment, noting diminished dorsalis pedis pulse and reduced sensation in the toes. These alarming findings prompt the surgical team to consider urgent fascial decompression to relieve pressure and restore perfusion. The decision to proceed with fasciotomy underscores the critical importance of timely intervention to prevent irreversible muscle and nerve damage.

In parallel, the laboratory results indicate further elevation in creatine kinase levels, now at 25,000 U/L, confirming the progression of rhabdomyolysis. The healthcare team remains vigilant, continuously monitoring the patient's cardiac rhythm for any signs of arrhythmias due to ongoing hyperkalemia, which, although managed, presents a persistent threat. The interplay of these complications requires the team to maintain a holistic view of the patient's condition, balancing the immediate need for surgical intervention with ongoing medical management to stabilize systemic derangements. This stage of the patient's journey highlights the necessity for a coordinated approach, ensuring each aspect of care is addressed to optimize recovery and prevent further deterioration.

Section 5

As the healthcare team proceeds with the planned fasciotomy, they remain acutely aware of the potential for new complications arising during and after the intervention. Post-surgery, the patient's condition is closely monitored in the recovery room. Initially, there is cautious optimism as the patient begins to regain some sensation in the toes, and the dorsalis pedis pulse becomes palpable again, indicating a positive response to the decompression. However, the patient continues to exhibit signs of systemic stress, with vital signs showing a persistent tachycardia at 105 beats per minute and a slightly elevated blood pressure of 150/92 mmHg. The respiratory rate remains elevated at 22 breaths per minute, suggesting ongoing physiological distress or pain.

In the hours following the procedure, new diagnostic results arrive, revealing a concerning rise in serum potassium levels to 6.1 mEq/L, despite previous interventions to manage hyperkalemia. The elevated potassium level poses a significant risk for cardiac complications, prompting the team to initiate aggressive measures, including the administration of calcium gluconate for cardiac membrane stabilization, insulin and dextrose to drive potassium intracellularly, and continued monitoring of the patient's cardiac rhythm. Additionally, a repeat creatine kinase measurement shows a further increase to 28,000 U/L, indicating continued muscle breakdown, necessitating a reevaluation of the patient's hydration status and renal function to prevent acute kidney injury.

These developments underscore the complexity of the patient's condition, requiring the healthcare team to exercise vigilant clinical reasoning. They must balance the immediate need to address hyperkalemia and ongoing rhabdomyolysis with the necessity of supporting the patient's overall recovery from surgery. The team remains proactive in reassessing the patient's fluid management, pain control, and renal function, while also considering the potential need for renal replacement therapy should the patient's condition warrant further intervention. This stage of care emphasizes the importance of an adaptive and interdisciplinary approach, ensuring that every aspect of the patient's treatment is aligned to promote stabilization and recovery, setting the stage for the next critical phase of the patient's journey.