The nurse is caring for an immobilized client who is at risk for breakdown in skin integrity. Which pathophysiological process should the nurse note early in the development of a pressure injury?

A) Peripheral neuropathy:

Peripheral neuropathy involves damage to the peripheral nerves and is not directly related to the described crushing injury. While nerve injury can occur as a result of trauma, the signs and symptoms described in the scenario, such as unequal strength between the left and right thighs, are more indicative of a potential vascular or musculoskeletal issue rather than peripheral neuropathy.

B) Osteomyelitis:

Osteomyelitis is a bone infection that can occur secondary to trauma or as a complication of open fractures. While it is possible for a crushing injury to lead to osteomyelitis if there is bone involvement or an open wound, the scenario mentions that x-rays revealed no broken bones. Additionally, the signs and symptoms described, such as bruising and swelling of the thighs, are not specific to osteomyelitis.

C) Fat embolism:

Fat embolism occurs when fat globules enter the bloodstream, often following traumatic injury to long bones or orthopedic procedures. While a crushing injury can theoretically lead to fat embolism, the absence of long bone fractures in the x-rays makes this less likely. Additionally, fat embolism typically presents with respiratory symptoms such as dyspnea and hypoxemia, which are not described in the scenario.

D) Compartment syndrome:

Correct. Compartment syndrome is a serious condition that can occur following a crushing injury, especially in the extremities. It is characterized by increased pressure within a muscle compartment, leading to compromised blood flow and potential tissue damage. Signs and symptoms of compartment syndrome include severe pain, swelling, bruising, decreased or absent pulses, and neurological deficits. The unequal strength between the left and right thighs could indicate neurological deficits due to compromised blood flow or nerve compression, making assessment for signs of compartment syndrome crucial in this client's plan of care. If compartment syndrome is suspected, prompt medical intervention, such as fasciotomy to relieve pressure, may be necessary to prevent complications.

Tumor lysis syndrome (TLS) is a potentially life-threatening oncologic emergency characterized by the rapid release of intracellular contents into the bloodstream following the destruction of cancer cells. This release can lead to metabolic disturbances, including hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. Here's how the child's laboratory results are indicative of tumor lysis syndrome:

A) Wilm's tumor:

Wilms tumor is a type of kidney cancer that primarily affects children. However, it typically does not cause the metabolic disturbances seen in tumor lysis syndrome. Laboratory abnormalities in Wilms tumor are generally related to renal dysfunction and may include hematuria and proteinuria.

B) Tumor lysis syndrome:

Correct. Tumor lysis syndrome occurs when chemotherapy or radiation therapy causes a rapid breakdown of cancer cells, leading to the release of intracellular contents such as potassium, phosphorus, and uric acid into the bloodstream. The elevated potassium and phosphorus levels seen in the child's laboratory results are consistent with tumor lysis syndrome. Hyperkalemia (elevated potassium) and hyperphosphatemia (elevated phosphorus) are common metabolic disturbances in tumor lysis syndrome.

C) Superior vena cava syndrome:

Superior vena cava syndrome occurs when the superior vena cava, a major vein that carries blood from the upper body to the heart, becomes partially or completely obstructed. This obstruction can lead to symptoms such as facial swelling, dyspnea, and dilated neck veins. While superior vena cava syndrome may occur in cancer patients, it does not typically cause the metabolic disturbances seen in the child's laboratory results.

D) Hyperleukocytosis:

Hyperleukocytosis refers to an extremely high white blood cell count, which can occur in leukemia. While leukemia can lead to metabolic abnormalities, the child's laboratory results, particularly the elevated potassium and phosphorus levels, are more indicative of tumor lysis syndrome than hyperleukocytosis.