A nurse is assessing a patient who has been immobilized in a full-body cast for 3 weeks following a spinal fracture. The patient reports nausea, abdominal discomfort, and bloating. The nurse also notes progressive weight boss and decreased appetite.
Which complication should the nurse suspect based on these findings?

Fat embolism syndrome

Deep vein thrombosis (DVT)

Compartment syndrome

Cast syndrome (Superior Mesenteric Artery Syndrome - SMAS)

Answer and Explanation

The Correct Answer is D

A. Fat embolism syndrome: Fat embolism syndrome (FES) typically presents with respiratory symptoms, such as dyspnea, petechiae, and confusion. Gastrointestinal symptoms like nausea and bloating are not characteristic of FES.

B. Deep vein thrombosis (DVT): DVT primarily presents with unilateral leg swelling, pain, and warmth, rather than gastrointestinal symptoms. While immobilization increases the risk of DVT, the patient’s symptoms do not align with this condition.

C. Compartment syndrome: Compartment syndrome involves severe pain, pallor, paresthesia, pulselessness, and paralysis in an affected limb. Gastrointestinal symptoms are not associated with compartment syndrome.

D. Cast syndrome (Superior Mesenteric Artery Syndrome - SMAS): SMAS occurs when the full-body cast compresses the superior mesenteric artery, leading to nausea, bloating, abdominal pain, and weight loss due to gastric obstruction. This condition is common in patients immobilized for prolonged periods.

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Correct Answer is A

Explanation

A. Stage I. A Stage I pressure ulcer is characterized by intact skin with non-blanchable erythema. The affected area may feel warmer or firmer than surrounding skin.

B. Stage II. A Stage II pressure ulcer involves partial-thickness skin loss, often presenting as a shallow open ulcer or intact/blistered skin. Since the skin is still intact in this scenario, it is not Stage II.

C. Stage III. A Stage III pressure ulcer involves full-thickness skin loss with visible subcutaneous tissue but no exposed bone, tendon, or muscle. This does not match the description of an intact but reddened area.

D. Stage IV. A Stage IV pressure ulcer involves full-thickness tissue loss with exposed bone, tendon, or muscle. This is much more severe than the described case.

A. “I will keep my cast dry and avoid inserting objects inside to scratch my skin." B. "If I notice increased swelling, numbness, or severe pain, I will elevate my leg and notify my provider immediately." C. "It's okay to use a blow dryer on a cool setting to help dry my cast if it gets wet." D. “I should expect to feel extreme pain under the cast that doesn't improve with pain medication."

Correct Answer is D

Explanation

A. “I will keep my cast dry and avoid inserting objects inside to scratch my skin.” Keeping the cast dry prevents it from softening or breaking down, which could lead to improper healing. Avoiding objects inside the cast prevents skin injuries and infections.

B. "If I notice increased swelling, numbness, or severe pain, I will elevate my leg and notify my provider immediately." Increased swelling, numbness, and severe pain can indicate compartment syndrome or impaired circulation. Elevating the leg and seeking medical attention is appropriate.

C. "It's okay to use a blow dryer on a cool setting to help dry my cast if it gets wet." A blow dryer on a cool setting can be used to help dry moisture inside the cast without causing burns or affecting the cast material.

D. “I should expect to feel extreme pain under the cast that doesn't improve with pain medication.” Extreme pain that is unrelieved by medication is abnormal and may indicate complications like compartment syndrome, infection, or pressure ulcers under the cast. The patient needs further education that severe pain should be reported immediately.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a bedridden patient and notes a reddened area on the sacrum that does not blanch when pressed. The skin is intact. Based on this finding, which stage of pressure ulcer should the nurse document?

Correct Answer is A

Explanation

The nurse is evaluating a patient's understanding of cast care before discharge. Which statement by the patient indicates the need for further teaching?

Correct Answer is D

Explanation

Which of the following actions should the nurse take immediately to prevent complications?

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