Based on the initial assessment findings, what is the primary nursing concern for this patient?

B) Potential for impaired circulation leading to compartment syndrome

A) Risk of infection due to open wounds

B) Potential for impaired circulation leading to compartment syndrome

C) Possibility of a fracture causing the swelling

D) Risk of allergic reaction to medication

What is the primary purpose of performing neurovascular checks on a patient with suspected compartment syndrome?

C) To monitor for signs of neurovascular compromise

A) To assess the patient's respiratory function

B) To evaluate the effectiveness of pain medication

C) To monitor for signs of neurovascular compromise

D) To check for signs of infection

Which of the following nursing actions is most appropriate when managing a patient with suspected compartment syndrome?

C) Perform regular neurovascular checks

A) Apply ice packs to the affected area

B) Elevate the affected limb above heart level

C) Perform regular neurovascular checks

D) Restrict fluid intake to prevent swelling

What is the primary nursing responsibility when caring for a patient with suspected acute compartment syndrome?

C) Perform regular neurovascular assessments

A) Apply ice packs to the affected area

B) Elevate the affected limb above heart level

C) Perform regular neurovascular assessments

D) Restrict fluid intake to decrease swelling

What is the primary reason for adjusting the elevation of the patient's affected limb to be level with the heart?

B) To optimize perfusion and reduce swelling in the affected limb

A) To completely eliminate the pain in the affected limb

B) To optimize perfusion and reduce swelling in the affected limb

C) To prevent the spread of infection to other parts of the body

D) To ensure the affected limb is in a comfortable resting position

What is the primary purpose of adjusting the elevation of the affected limb to be level with the heart in a patient with suspected neurovascular compromise?

B) To improve circulation and optimize perfusion

A) To reduce pain by decreasing pressure on the limb

B) To improve circulation and optimize perfusion

C) To prevent blood clots from forming in the affected limb

D) To increase sensation and motor function

What is the primary purpose of elevating a limb affected by compartment syndrome to the level of the heart?

B) To improve venous return and decrease swelling

A) To reduce blood pressure in the limb

B) To improve venous return and decrease swelling

C) To increase arterial blood flow to the limb

D) To enhance lymphatic drainage

What is the primary purpose of elevating the affected limb to the level of the heart in a patient with potential compartment syndrome?

B) To reduce swelling and improve venous return

A) To increase blood flow to the affected area

B) To reduce swelling and improve venous return

C) To enhance arterial circulation

D) To improve patient comfort by reducing pain

compartment syndrome - Nursing Case Study

Pathophysiology

• Primary mechanism: Increased pressure within a closed muscle compartment restricts blood flow, leading to insufficient oxygen and nutrient delivery to tissues (ischemia).

• Secondary mechanism: Swelling or bleeding within the compartment exacerbates pressure, further compressing nerves and blood vessels.

• Key complication: Prolonged ischemia can result in tissue necrosis and muscle damage, potentially leading to loss of function if not promptly treated.

Patient Profile

Demographics:

25-year-old male, construction worker

History:

• Key past medical history: No significant past medical history

• Current medications: None

• Allergies: None

Current Presentation:

• Chief complaint: Increasing pain in the right lower leg

• Key symptoms: Pain out of proportion to injury, swelling in the lower leg, tingling sensation in the foot

• Vital signs: Blood pressure 120/80 mmHg, heart rate 78 bpm, respiratory rate 16 breaths/min, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon initial assessment, the nurse notes that the right lower leg is visibly swollen and feels tense upon palpation. The skin is taut and shiny, indicative of the underlying pressure buildup. The patient rates the pain in the leg as an 8 out of 10, describing it as a deep, throbbing ache that worsens with movement. He also reports a tingling sensation in his right foot, which has become more pronounced over the past few hours. The nurse performs a neurovascular check, confirming that capillary refill is slightly delayed at 4 seconds in the right toes compared to the left, where it is less than 2 seconds. The dorsalis pedis pulse is slightly diminished on the affected side, although still palpable.

Recognizing these concerning signs, the nurse prepares to notify the attending physician. She understands that early recognition and intervention are critical to prevent further complications like permanent nerve and muscle damage. As part of the nursing care plan, the nurse elevates the patient's leg slightly to reduce swelling and ensures that the patient remains calm and comfortable. She emphasizes the importance of not applying ice or compressive bandages, as these could exacerbate the situation by further reducing blood flow to the already compromised area. This assessment will guide the next steps in the patient's care, likely involving further diagnostic testing and potential surgical consultation to alleviate the pressure.

Section 2

Response to Interventions:

Following the initial interventions, the patient reports a slight decrease in pain, now rating it as a 7 out of 10. The slight elevation of the leg appears to have provided some relief, though the tingling sensation in the foot persists. The nurse continues to monitor the patient closely, performing neurovascular checks every hour to detect any changes. Reassessing the capillary refill time, she notes a slight improvement, with the delay reducing to 3 seconds. The dorsalis pedis pulse remains palpable, though still diminished compared to the unaffected leg.

Vital signs are stable, with the patient's blood pressure recorded at 118/76 mmHg, heart rate at 84 beats per minute, respiratory rate at 16 breaths per minute, and oxygen saturation at 98% on room air. The patient's temperature is 98.4°F (36.9°C), indicating no signs of infection. The nurse documents these findings, ensuring accurate and timely communication with the healthcare team.

As the patient continues to rest, the nurse remains vigilant for any signs of deterioration, such as increased pain or further neurovascular compromise. She educates the patient on the importance of reporting any new or worsening symptoms immediately. The attending physician plans to review the patient's status shortly, considering the next steps, which may include imaging studies to assess the extent of compartment involvement and consulting with an orthopedic specialist to determine if surgical intervention is necessary. The nurse's proactive management and detailed documentation will be crucial in guiding the patient's ongoing care and preventing further complications.

Section 3

New Diagnostic Results:

As the attending physician reviews the patient's status, an order is placed for a compartment pressure measurement to further evaluate the extent of compartment syndrome. The procedure is performed promptly, and the results reveal an elevated intracompartmental pressure of 28 mmHg, confirming the suspicion of acute compartment syndrome. Although the pressure is not critically high, it still indicates a need for continued monitoring and possible intervention if the condition progresses.

In addition to the pressure measurement, an X-ray of the affected leg is obtained to assess for any underlying fractures or additional complications. The imaging study shows no fractures, providing some reassurance regarding the structural integrity of the bone. However, the soft tissue swelling is evident, aligning with the clinical picture of early compartment syndrome.

The nurse communicates these findings to the healthcare team, emphasizing the importance of maintaining close neurovascular assessments and educating the patient about potential warning signs. With the current diagnostic results, the team decides to continue conservative management while remaining prepared to escalate care if the patient's symptoms worsen. The patient's pain remains a priority, and adjustments to the pain management regimen are considered to enhance comfort and prevent further complications.

Section 4

As the day progresses, the nursing team conducts an initial assessment of the patient to establish a baseline for ongoing monitoring. The patient's vital signs are stable: blood pressure is 118/76 mmHg, heart rate is 84 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 97% on room air. Despite these stable vitals, the patient reports a pain level of 6 out of 10 in the affected leg, described as a persistent ache with occasional sharp twinges. The nurse notes the leg is swollen with tense, shiny skin, and the patient experiences some tingling in the toes, suggesting possible early neurovascular changes.

Palpation of the leg reveals increased firmness, and capillary refill time is slightly prolonged at 3 seconds, indicating compromised circulation. The nurse performs a neurovascular assessment, checking the patient’s ability to wiggle their toes and assess sensation. The patient reports a slight decrease in sensation compared to the unaffected leg, but motor function remains intact. These findings are communicated to the healthcare team, emphasizing the need for vigilant monitoring to detect any worsening of symptoms.

In response to the patient's discomfort and to improve circulation, the team decides to adjust the elevation of the affected limb slightly, keeping it level with the heart rather than elevated, to optimize perfusion. The analgesic regimen is also reviewed, and the physician orders an increase in the dosage of the current pain medication, ensuring it remains within a safe range. As the patient is educated about the importance of reporting any increase in pain or changes in sensation, the team remains poised to intervene swiftly should the patient's condition deteriorate. These steps are intended to ensure that the patient remains stable and comfortable while the team closely monitors for any changes.

Section 5

Response to Interventions

After the nursing team adjusts the elevation of the affected limb to be level with the heart and administers the increased dosage of pain medication as ordered, the patient reports some relief. The persistent ache in the leg diminishes slightly, and the sharp twinges become less frequent. However, the patient still describes a constant dull ache, rating the pain at 4 out of 10, indicating partial but notable improvement.

Throughout the afternoon, the nursing team continues to perform diligent neurovascular assessments on the affected leg every hour. They observe that the capillary refill time has improved slightly to under 2 seconds, suggesting that the adjustments have positively impacted circulation. The patient maintains the ability to wiggle their toes without difficulty, and sensation, although still slightly decreased, does not show any further decline.

Vital signs remain stable, with a blood pressure of 116/74 mmHg, heart rate of 82 beats per minute, respiratory rate of 18 breaths per minute, and oxygen saturation of 98% on room air. Encouraged by these findings, the team continues to educate the patient on early warning signs of worsening compartment syndrome, such as increasing pain, numbness, or color changes, and reassures them about the proactive measures in place. As the shift progresses, the healthcare team remains vigilant, poised to escalate care should the patient's condition require further intervention.