KAT I E COON

F E RRI S S T AT E UNI VE RS I T Y
NURS I NG 441
COMPARTMENT SYNDROME
INTRODUCTION
Purpose statement
Topic
Reasoning
EVIDENCE FOR CARE
Compartment Syndrome is
pressure within closed fascia
a surgical emergency
developed in multiple areas
EVIDENCE FOR CARE
Theory
Dr. Patricia Benners From Novice to Expert
Education + experience
Research tested nurse knowledge

EVALUATION OF THE EVIDENCE
Study
Orthopaedic Nurses' Knowledge and Interrater Reliability of
Neurovascular Assessments With 2-Point Discrimination Test
Study Methods
Pre and posttest study
Neurovascular assessment with 2-PD
64 pediatric patients/ nurses/ nurse experts
Study Results
Statistically significantly improvement
Implemented at institution
EVALUATION OF THE EVIDENCE
Article Critique
Is this nursing research?
Author, journal, topic
Is the study approved by an IRB?
Is the study done within the last 5 years?
Current references
What is the level of evidence?
What is the level of measurement?
Are the results clearly stated?
What were limitations to the study?

PATIENT CARE DESIGN
The Role of the Nursing Leader
Early detection
5 Ps
Neurovascular checks
Urine output
Report abnormalities
Pain management
Hydration
Fasciotomy preparation
Wound care
Infection control

TRUEPIC
Case Study

Situation: 16 yo M pt. is two hours post op from ORIF after a L tib/fib fracture sustained
in a MVC. He is the quarterback of his high school football team. This is his first major
surgery, and first time with a cast. The nurse enters the room to perform ROM exercises
with the pt. The scheduled pain medications were given 15 minutes prior. Upon
dorsiflexion, the pt. cries out in excessive pain. The nurse administers the appropriate
prn pain medication, ices and elevates the leg, and says she will return in a while for
more ROM exercises. Upon return, the pt. complains of sustained pain despite the
pain medications. Upon assessment, there is a weak pedal pulse, and poor capillary
refill in the L foot. The pt. also complains of numbness and tingling in his L foot.

The nurse is a 40 year old BSN prepared RN with 5 years experience in the OR. She has
since worked on an orthopedic floor. She has never had major surgery or any invasive
procedure and has never had pain unrelieved by medications.

TRUEPIC
1.IDENTIFY
the variables in this
situation

16 yo M

Football player

Tib/fib fx from MVC

2 hours post op

Leg casted

Pain medications given

ROM exercises attempted

Increasing and unrelieved
pt. pain

Weak pulse, poor
capillary refill

Pt. complains of
numbness and tingling


2. RELATEOr put the variables together to form propositions.

Primary Proposition: Pt. is displaying symptoms of compartment
syndrome as pain in increased with ROM exercises and unrelieved
by pain medications, along with poor neurovascular assessment
findings.

Possible Assumptions: Pt. believes these signs and symptoms are normal
complications of surgery.


Possible Confounding Variables: Pt.s first major surgery and cast
placement; Injury to lower leg; Pt. is young, active male.
3. UNDERSTANDthe importance of the
propositions, assumptions, and confounding
variables.

Proposition: If nurse does not notify the
physician of compartment syndrome suspicion,
the pt. will have increased swelling and muscle
tissue will become necrotic.

Significance of Assumptions: Pt. does not
have understanding of compartment syndrome
or why they are in serious pain.

Possible Confounding Variables: Young age,
active lifestyle, and injury to lower extremity
contribute to compartment syndrome incidence.


TRUEPIC
4. EXPLAINthe significance
of the situation to those involved
based on their individual KSVME

Proposition: Call the physician with
pt.s signs and symptoms, suggesting
RNs assumption of compartment
syndrome

Assumptions: In a way meaningful
to the pt, explain what compartment
syndrome is and the predicted course
of immediate treatment with
surgery. use personal & prof.
KSVME & pts and familys
KSVME

Confounding Variables: Explain
possible reasons for this pt.s
compartment syndrome
5. PREDICTwhat will happen in this
situation if one or more variables are not
changed.

Proposition: If the physician does not take
your report seriously and evaluate the pt., an
emergency fasciotomy will not occur and the pt.
will loose his limb

Assumptions: If pt. and family does not
understand importance of medical emergency,
he may opt out of fasciotomy and his leg may
be amputated


Confounding Variables: The confounding
variables are not able to be changed



6. INFLUENCEsomeone to change one or more
variables in order to achieve a desired outcome or prevent
an undesirable one.

Proposition: RN explains her knowledge of compartment
syndrome complications and advocates for pt. to go to
emergency fasciotomy.

Assumptions: Encourage physician and surgeon to explain
importance of surgery to pt. so that he chooses the
treatment.

Confounding Variables: Educate pt. on safe driving to
prevent MVC incidents.

7. CONTROLone or more variables in order to achieve a desired outcome or
prevent an undesirable one. To control isnt an issue of wanting to dominate or do
what is unreasonable or unwanted, but simply a matter of changing one or more
variables in order to bring about a desired outcome when influence is not possible,
realistic, or advisable.

Pt. will receive fasciotomy and recover with no additional complications
NURSING DIAGNOSIS
Primary Nursing Diagnosis
Ineffective tissue perfusion r/t lack of oxygen to casted
extremity aeb poor neurovascular assessment (i.e. weak
pedal pulse, poor capillary refill, numbness and tingling)
Approach to Care
Place leg at heart level
Remove ice
Ensure normal blood pressure give fluids if hypotension
Loosen/remove cast
Notify physician receive urgent surgical consult
Complete fasciotomy

ADVOCATE ROLE
Providing Empathetic, Equitable Care
Education
Life long learning
Research Significance
Assessment tool
Implementation into practice
REFERENCES
Armola, R. R., Bourgault, A. M., Halm, M. A., Board, R. M., Bucher, L., Medina, J. (2009).
AACN levels of evidence: Whats new?. Critical Care Nurse, 29(4), 70-73.
Colley, S. (2014). NURS 441 Nursing Theory 3 [Syllabus]. p. 6.
Schoenly, L. (2013). Core curriculum for orthopaedic nursing (7
th
ed.). Chicago, IL: National
Association of Orthopaedic Nurses.
Nursing theories: A companion to nursing theories and models. (2013). From Novice to
Expert: Patricia E. Benner. Retrieved July 23, 2014 from http://currentnursing.com/
nursing_theory Patricia_Benner_From_Novice_to_Expert.html.
Turney, J., Noble, D., & Kim, S. (2013). Orthopaedic nurses knowledge and interrater
reliability of neurovascular assessments with 2-point discrimination test.
Orthopaedic Nursing, 32(3), 167172.