NCLEX-RNReduction of Risk PotentialMedium
A client has a long-leg cast applied after a tibial fracture. Two hours later, the client reports severe pain unrelieved by IV morphine and pain with passive extension of the toes. Which action should the nurse take first?
- AAdminister an additional dose of morphine
- BElevate the leg above heart level and reapply ice
- CLoosen the cast padding and recheck pain in 30 minutes
- DNotify the provider immediately of suspected compartment syndrome
Show answer & explanationAnswer & explanation
Correct answer: D. Notify the provider immediately of suspected compartment syndrome
Severe pain unrelieved by opioids and pain with passive stretch are early hallmark signs of compartment syndrome, a surgical emergency that can cause irreversible muscle and nerve damage if not treated promptly. The nurse must notify the provider immediately for possible cast removal/fasciotomy rather than delaying with additional interventions.
Why the other options are wrong
- A. More opioids will not relieve pain caused by compartment syndrome and delays treatment.
- B. Elevation and ice do not treat compartment syndrome and elevation above heart level may worsen perfusion.
- C. Waiting 30 minutes delays treatment of a time-sensitive emergency.
Acute Compartment Syndrome
Increased pressure within a muscle compartment compromising circulation and nerve function, often after fracture or cast application.
- 6 P's: Pain (out of proportion, unrelieved by opioids), Paresthesia, Pallor, Pulselessness, Poikilothermia, Paralysis
- Pain with passive stretch is an early key sign
- Requires prompt fasciotomy to prevent permanent damage
Memory trick: 'Pain out of proportion = pressure's on' — think compartment syndrome.