RN Nursing · Fractures · Practice question
A nurse is caring for a patient with a recent forearm fracture who is at risk for compartment syndrome. Which nursing intervention is most critical to promptly identify and minimize this complication?
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Perform frequent neurovascular checks assessing pain, sensation, movement, and pulses in the affected extremity,
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Apply a tight cast to immobilize the fracture and prevent further injury.
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Elevate the affected limb above the heart level to reduce swelling and pressure.
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Encourage the patient to perform an active range of motion exercises to promote circulation.
Answer & explanation
Correct: Perform frequent neurovascular checks assessing pain, sensation, movement, and pulses in the affected extremity,
Frequent neurovascular checks are the most critical nursing intervention for a patient at risk for compartment syndrome following a forearm fracture. Compartment syndrome occurs when pressure within a closed muscle compartment rises to a level that compromises perfusion, leading to ischemia, nerve damage, and potentially irreversible tissue loss. Early detection depends on systematic assessment of the five Ps: pain (especially pain out of proportion to injury or pain with passive stretch), pallor, paresthesia, paralysis, and pulselessness. Identifying these signs promptly allows for immediate escalation and possible fasciotomy to relieve pressure before permanent injury occurs. Applying a tight cast is directly contraindicated because it increases external pressure on the compartment, worsening the condition. Elevating the limb above heart level may reduce venous return but can actually lower arterial perfusion pressure in an already compromised compartment, potentially accelerating ischemia; elevation is appropriate for edema reduction but must be used cautiously in suspected compartment syndrome. Encouraging active range-of-motion exercises is inappropriate because movement can exacerbate swelling and pain in a fractured extremity and does not address the underlying pressure problem. Therefore, regular neurovascular assessment is the only option that enables timely identification and prevention of complications.
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