1. Compartment syndrome: an accumulation of fluid in the muscle compartment, resulting in an increase in pressure that reduces blood flow to the tissues. Can lead to neuromuscular deficit, amputation, and death.
    1. Pathophysiology: inability of the fascia surrounding the muscle group to expand to accommodate the increased volume of fluid —> compartment pressure increases —» venous flow impaired arterial flow continues, increasing capillary pressure —> fluid pushed into the extravascular space —> intracompartment pressure further increased —» prolonged or severe ischemia —> muscle and nerve cells destroyed, contracture, loss of function, necrotic tissue, infection, release of potassium, hydrogen, and myoglobin into bloodstream.
    2. Risk factors:
      1. Fractures.
      2. Burns.
      3. Crushing injuries.
      4. Restrictive bandages.
      5. Cast.
      6. Prolonged lithotomy positioning.
    3. Assessment:
      1. Subjective data:
        1. Severe, unrelenting pain, unrelieved by narcotics and associated with passive stretching of muscle.
        2. Paresthesias.
      2. Objective data:
        1. Edema; tense skin over limb.
        2. Paralysis.
        3. Decreased or absent peripheral pulses.
        4. Poor capillary refill.
        5. Limb temperature change (colder).
        6. Ankle-arm pressure index (API) decreased; 0.4 indicates ischemia.
        7. Urine output - decreased (developing acute tubular necrosis); reddish-brown color.
    4. Analysis/nursing diagnosis:
      1. Pain related to tissue swelling and ischemia.
      2. Risk for injury related to neuromuscular deficits.
      3. Impaired physical mobility related to contracture and loss of function.
      4. Risk for infection related to tissue necrosis.
      5. Altered urinary elimination related to acute tubular necrosis from myoglobin accumulation.
      6. Body image disturbance related to limb disfigurement.
    5. Nursing care plan/implementation:
      1. Goal: recognizes early indications of ischemia.
        1. Assess neurovascular status frequently (qlh): skin temperature, capillary refill, peripheral pulses, mobility, and sensation.
        2. Listen to patient complaints; report suspected complications.
        3. Report nonrelief of pain with narcotics.
        4. Recognize unrelenting pain with passive muscle stretching.
      2. Goal: prevent complications.
        1. Elevate injured extremity initially; if ischemia suspected, keep extremity at heart level to prevent compensatory increase in blood flow.
        2. Avoid tight bandages, splints, or casts.
        3. Monitor intravenous infusion for signs of infiltration.
        4. Prepare patient for fasciotomy (incision of skin and fascia to release tight compartment).
    6. Evaluation/outcome criteria:
      1. Relief from pain; normal perfusion restored.
      2. Neurovascular status within normal limits.
      3. Retains function of limb; no contractures or infection.
      4. Compartment pressure returns to normal (20 mm Hg.).
      5. No systemic complications (e.g., normal cardiac and renal function, acid-base balance within normal limits).