Compartment syndrome nursing NCLEX review practice question on the nursing interventions and neurovascular assessment for this condition.

Compartment syndrome occurs when too much pressure is exerted within the muscle compartments found within the fascia.

This can occur when there is hemorrhaging (bleeding) or swelling present after an injury, like with a bone fracture (or with external factors like a cast being too tight or traction). All this can increase the pressure within the compartments. As the pressure builds, this will cut off the blood supply and nerve function to this muscle. If not corrected within 6 hours, the damage is permanent.

Remember from anatomy and physiology that in the leg and arm there are individual compartments grouped together (but separated from one another) that contain bone, muscle, nerves, and vessels. Each compartment usually has its own muscle, nerve, and vessel supply. Fascia is what keeps all these structures in place and separated.

The important thing to remember about fascia when talking about compartment syndrome is that is does NOT expand when pressure increases within a compartment (so there will be no relief within the compartment from the fascia).

Instead the pressure stays within the compartment and causes blood vessel and nerve function to become compromised (diminished). So, ischemia is going to occur to the muscle and distal extremity to the fracture.

Nursing interventions include: keeping the extremity AT HEART level (NOT below....remember you want to maintain arterial pressure and elevating it above heart level will cause more ischemia), loosen and remove restrictive items, notify the physician, perform neurovascular checks (6 P's), prepare the patient for possible bivalvement of the cast, reduction of weight in the traction, or in severe cases fasciotomy.

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