The client is admitted following repair of a fractured tibia and cast application. Which nursing assessment should be reported to the doctor?
A. Pain beneath the cast
B. Warm toes
B. Warm toes
C. Pedal pulses weak and rapid
D. Paresthesia of the toes
Correct Answer: D. Paresthesia of the toes
Paresthesia is not normal and might indicate compartment syndrome. Acute compartment syndrome occurs when there is increased pressure within a closed osteofascial compartment, resulting in impaired local circulation. Acute compartment syndrome is considered a surgical emergency since, without proper treatment, it can lead to ischemia and eventually necrosis.
Option A: At this time, pain beneath the cast is normal. Pain is typically severe, out of proportion to the injury. Early on, pain may only be present with passive stretching. However, this symptom may be absent in advanced acute compartment syndrome. In the initial stages, pain may be characterized as a burning sensation or as a deep ache of the involved compartment.
Option B: Classically, the presentation of acute compartment syndrome has been remembered by “The Five P’s”: pain, pulselessness, paresthesia, paralysis, and pallor. However, aside from paresthesia, which may occur earlier in the course of the condition, these are typically late findings.
Option C: Pulses should be present. Beware that the presence or absence of a palpable arterial pulse may not accurately indicate relative tissue pressure or predict the risk for compartment syndrome. In some patients, a pulse is still present, even in a severely compromised extremity.