Patient has plaster cast the nurse should assess patient extremity for detection to complication of compartment syndrome, except?

Appeared in: AIIMS Delhi NO - 2017

Explanation

Brown discoloration of an extremity is not a sign of acute compartment syndrome.
This color change is typically caused by chronic venous insufficiency, where hemosiderin (from old red blood cells) stains the skin over a prolonged period.
The acute skin color changes in compartment syndrome are pallor (paleness) or cyanosis (bluish tint) due to ischemia (lack of blood flow).

Option A: Assessing skin color below the cast is a crucial part of neurovascular checks. The nurse looks for pallor or cyanosis, which are signs of ischemia associated with compartment syndrome.
Option B: Numbness and tingling (paresthesia) is one of the classic '6 Ps' of compartment syndrome. It is an early sign of nerve compression due to increased pressure.
Option C: Pain due to ischemia that is severe and out of proportion to the injury is the earliest and most important sign of compartment syndrome.

Clinical Relevance

Nursing practice connection: Use the key finding related to Signs and symptoms of compartment syndrome to guide bedside assessment, documentation, and the next nursing action.
Early recognition of compartment syndrome is critical to prevent permanent muscle and nerve damage, which can occur within hours.
A nurse's primary responsibility is frequent and accurate neurovascular assessment of the affected limb. Any abnormal finding, especially pain unrelieved by analgesics, must be reported immediately.
What if? If the patient's pain is relieved by a dose of an opioid analgesic, it is less likely to be compartment syndrome. However, the nurse must continue to monitor closely, as the pain from compartment syndrome is characteristically relentless and unresponsive to standard pain relief measures.

How to Approach the Question

First, identify the core concept: complications of a plaster cast, specifically compartment syndrome.
Recognize the negative framing of the question ('except'). This means you are looking for the option that is NOT a sign of compartment syndrome.
Recall the classic signs and symptoms of compartment syndrome, often remembered as the '6 Ps' (Pain, Paresthesia, Pallor, Paralysis, Pulselessness, Poikilothermia).
Evaluate each option against the '6 Ps'.
Option A (Skin color) relates to Pallor. Option B (Numbness & tingling) is Paresthesia. Option C (Pain) is the primary symptom.
Option D (Brown color) does not fit any of the acute signs. Consider what causes brown discoloration (chronic venous stasis) to confirm it's the outlier.

Concept Tested & Keywords

Concept Tested: Signs and symptoms of compartment syndrome
Stem keywords: plaster cast, assess, complication, compartment syndrome
Lead-in keywords: except
Negative lead-in flag: The question asks for the exception, meaning the sign that is NOT associated with compartment syndrome.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 pp. 118-120, 122-124

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