Editing Anatomy and Physiology – RN Practice Questions (section)

==Question 4==
A patient is 8 hours post open reduction and internal fixation of a tibial fracture. The patient reports severe deep pain in the calf that is not relieved by opioid analgesia, and the pain intensifies sharply when the nurse passively extends the toes. The pedal pulse is palpable and capillary refill is 2 seconds. Which action should the nurse take?
# Document the findings as expected postoperative pain and reassess in 1 hour.
# Elevate the extremity above the level of the heart and apply an ice pack.
# Loosen any constrictive dressing, keep the limb at heart level, and notify the surgeon immediately.
# Encourage active range of motion of the ankle to improve circulation.

'''Answer:''' 3 (C). Loosen any constrictive dressing, keep the limb at heart level, and notify the surgeon immediately.

''Rationale:'' Pain out of proportion to the injury and pain on passive stretch are the earliest and most sensitive findings in acute compartment syndrome, in which pressure inside a nonexpandable fascial compartment exceeds capillary perfusion pressure. A palpable pulse does not rule it out, because arterial pulses are supplied at a much higher pressure than the capillary bed and are lost only very late, after irreversible muscle and nerve injury. Removing external constriction and keeping the limb at heart level preserves arterial inflow. Option 1 delays care during a limited window before permanent damage. Option 2 is harmful: elevation above the heart lowers arterial perfusion pressure and ice causes vasoconstriction. Option 4 increases tissue pressure and pain.