Pain Management with Morphine for Compartment Syndrome after Lower Limb Fracture

Running head: WRITTEN REPORT
WRITTEN REPORT
Name of the Student
Name of the university
Author’s note

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WRITTEN REPORT
Brief outline of the case
My placement was in the cardiovascular ward, where a patient has been admitted with a
compartment syndrome following a lower limb fracture. Mr X is an 88 years old man who lives
in a home on his own. While using the toilet she had suffered from a fall and was admitted in to
the emergency department with acute pain in the lower limb. Further examination revealed a
fracture in the lower leg. Mr. X denied the use of alcohol or drugs, his initial vital signs were
pulse of 76 beats per minute, oral temperature of 36.8 degree , blood pressure of 144/96 mmHg,
room air pulse oximetry of 100%, respiratory rate of 16 breaths per minute. Right leg revealed it
to be firm and tender to palpation and measured 4 cm larger in the circumference than the left
leg. The radial pulse was palpable and the fingertip capillary refill was less than two seconds.
The skin was reddish and swollen with no overlying erythema.
Compartment syndrome after lower limb fracture
A compartment is a group of muscles, blood vessels and the nerve fibers. Fascia is a
connective tissue that holds the walls of the compartments. ACS occurs when pressure and fluid
builds up in the muscles due to a limb fracture (Oprel et al. 2010). This pressure can decrease the
flow of the blood to and from the nerve and the muscle cells decreasing the access and the
nutrients to the affected tissue. The acute compartment syndrome (ACS) right after the fracture
of the lower leg can be a serious complication. ACS of the lower leg if not recognized and kept
undiagnosed can result in life threatening condition (Oprel et al. 2010). Prognosis for the full
recovery is dependent on the early diagnosis and treatment of the condition. The acute
intervention for tis is the fasciotomy because ACS can induce nerve and muscle damage

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WRITTEN REPORT
(Tosounidis 2015). A late diagnosis of the ACS of the lower leg and the failure to perform an
emergency facsiotomy can lead to the loss of the extremity. Early facsiotomy can be helpful in
preventing the neuromuscular damage. Prevention should be considered as the first step in the
treatment of the compartment syndrome. The classic sign of an acute compartment syndrome is
pain, especially when the muscle within the compartment is stretched. Using and the stretching
of the involved muscle induces pain.
Chosen aspect of care
Using morphine (opoids) for pain management
An approach the patients with acute pain begins with the assessment of the underlying
cause of the pain. Right after the fracture a patient experiences acute pain that has to be managed
by pharmacological interventions (Ahmadi et al. 2016). It is the pain status of the patient that
determines the time of the surgery. Hence he chosen aspect of care for this report is the pain
management. The scope of a registered nurse lies within the provision of medicines specifically
for relieving the pain. Many recent and emerging studies have clearly documented that persistent
pain exerts profound effect of the endocrine system, cardiovascular, neurologic, and immune and
the musculo-skeletal system of the body (Ahmadi et al. 2016). This provides the rationale for
choosing this aspect of care. Analgesics can be warranted in patient suffering from ACS.
Acetaminophen and non-steroidal anti-inflammatory drugs are also used for the management of
the pain. But if the pain is severe then opoids can be used.