[Hellllllo Nurse]

Answers are poorly worded, but C would be best, imho.

[margaret cox]

Originally Posted by julsywulsy

Your patient just returned from having a cast set on their left arm. Your patient complains of worsening pain 30 mins after rec'g pain medication. What do you do?

A. Elevate the patients arm with pillows and apply an Icepack.
B. Offer them a cup of hot tea.
C. Call the Doctor and send for the cast-cutter.
D. Divert their attention from the pain with conversation.

How would you answer this question, based only on the information given? Please explain your rationale.

Thanks!

The answer is C. Increasing, unrelenting pain not relieved by narcotics is a symptom of compartment syndrome.

[dijaqrn]

Get that cast cutter to the bedside and call that DOC!!!!!!!!!!!!!!!
You are describing classic compartment syndrome which is a medical emergency. The question is asking you to recognize this... the answer choices do not state that YOU will cut the cast off. This is basic ortho nursing. Anytime pain increases suspect compartment syndrome!!!!!!!!!

[P_RN]

And have the batting/stockinette scissors too, along with a cast spreader. Simply cutting the plaster/fiberglas won't be enough usually if the inside stuff is still tight.

[outlierrn]

I agree that C is the correct answer. It's poorly worded so as not to lead you to the right answer. Look at it this way; what's the worse case scenario? Compartment syndrome. If so then A actively harms you pt, B&D delay care for no gain, that leaves you with the only answer that addresses the potential emergent situation. Sure IRL you get a full assesment, but it's not an option, there's only one option that prevents harm to your pt.

[84422]

Most definitely notify the ortho surgeon or his PA. Any other answer just doesn't address the obvious change of increased pain. More damage may result from elevating the extremity. Chances are the cast needs to be removed and replaced if indicated.
Keeping patients safe!

[Emmjay]

That is a typical nursing school exam question!! It is vague and doesn't really give you enough info in the stem to answer well.
There is no option for checking for PMS.....that is the first thing that I would do....if that checked out ok......I would choose A.....and if the pain persisted.....I'd call the doc.

[pangyaw]

My answer is C, call the MD coz pain was worsening after receiving pain meds.

[rashan1053]

I know you asked for experienced nurses to reply, but here is some advice from a new nurse. Your instructors are trying to prepare you to take the NCLEX exam. The questions my seem obsure, but you need to do your best to try and not read into questions. Pain meds were given and you would anticipate that pain would improve. I agree with the other responses that more information would be better and that before you call a doctor you would assess cmts and neuro status, but that was not an option!
I actually had this happen to me two months ago. Cast just placed that day, pain meds given. 30 minutes later pain immensly worse, skin cool, unable to wiggle toes. I consulted the charge nurse and called the md. Cast was beveled. I know that test questions get frustrating, but try to do your best in answering the question with what you have.

[Forcemaster]

I totally agree that the question is badly phrased and does not allow for much latitude.

Yes monitoring their peripheral neuro-vascular state should be the first port of call, as well as securing additional analgesia a close second.... Though I would like to hope that the patient received some analgesia before the cast was applied as some plaster techs can be a little rough when applying the cast to get the alignment correct.

At the end of the day though, the first 5 signs of compartment syndrome are

PAIN
PAIN
PAIN
PAIN
and PAIN

If you have an altered neuro-vasc state, it is actually getting quite late in the game and you are already sustaining tissue damage. Therefore I would get the plaster saw and bi-valve the cast (cut in along one line from proximal to distal end. This splits the cast just enough to provide additional room for swelling. If your patient gets pain relief from cutting the cast then consider yourself as having done the right thing.

Many of the nurses i work with are reluctant to cut a cast... but i always say to them "a cast can be replaced... an arm cannot"