The nurse is caring for a client who sustained a crushed injury to the lower extremity and has developed compartment syndrome. What intervention should the nurse plan for next?

Insertion of central venous access

Phlebotomy

Fasciotomy

Insertion of arterial line

Answer and Explanation

The Correct Answer is C

A. Insertion of central venous access: This is not relevant to compartment syndrome management. Central venous access is used for fluid administration or monitoring central venous pressure.

B. Phlebotomy: This is unrelated to the management of compartment syndrome, as it involves drawing blood and does not address the increased pressure.

C. Fasciotomy: Compartment syndrome is a medical emergency where increased pressure within a closed compartment compromises circulation and tissue function. A fasciotomy involves surgically opening the compartment to relieve the pressure, prevent tissue necrosis, and save the limb. This is the definitive treatment.

D. Insertion of arterial line: While this may be useful for monitoring blood pressure in critical situations, it does not relieve compartment syndrome.

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Correct Answer is A

Explanation

A. 0.9% normal saline IV at 100 mL/hr continuous: This order requires clarification. In acute heart failure, fluid management is crucial. A continuous IV infusion of normal saline could exacerbate fluid overload and worsen heart failure. Typically, IV fluids are given cautiously or restricted in heart failure cases.

B. Bumetanide (Bumex) 1 mg IV bolus every 12 hr: This is a loop diuretic, which is appropriate for managing fluid overload in heart failure.

C. Laboratory testing of serum potassium upon admission: This is appropriate, as diuretics like Bumex can lower potassium levels, so it is important to monitor electrolyte levels.

D. Morphine sulfate 2 mg IV bolus every 2 hr PRN pain: This is appropriate for pain management and to help with anxiety and breathing difficulties in acute heart failure.

A. Compartment syndrome B. Hemorrhage C. Deep vein thrombosis D. Complex regional pain syndrome E. Fat embolism

Correct Answer is ["A","B","C","E"]

Explanation

A. Compartment syndrome: This is a serious complication that can occur with fractures, including femur fractures. It occurs when increased pressure in the muscle compartment impairs circulation and nerve function.

B. Hemorrhage: Fractures, particularly of long bones like the femur, can result in significant bleeding. Monitoring for hemorrhage is important.

C. Deep vein thrombosis (DVT): DVT is a common complication in clients with fractures and immobilization. The client is at risk for blood clots forming in the legs due to limited movement and prolonged bed rest.

D. Complex regional pain syndrome: While this can occur after fractures, it is less common and typically develops weeks to months after the injury.

E. Fat embolism: A fat embolism is a potential complication of long bone fractures, especially the femur. Fat globules can enter the bloodstream and cause respiratory distress, neurological impairment, and petechial rash.

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The nurse is caring for a client who sustained a crushed injury to the lower extremity and has developed compartment syndrome. What intervention should the nurse plan for next?

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