Compartment Syndrome Nursing Guide

This course is intended as a Quick Reference for compartment syndrome and will cover an overview as well as nursing considerations utilizing the nursing process.

Etiology and Epidemiology 

Compartment Syndrome Definition

A compartment is a group of muscles, nerves, and blood vessels with a thin covering (fascia) that keeps the muscle in place and does not stretch or expand (Cleveland Clinic, 2021). 

Compartment syndrome occurs when an individual experiences an acute injury or prolonged physical exertion that causes swelling or bleeding within the compartment. The fascia does not expand or stretch, so there is increased pressure causing limited blood flow to the muscle and nerves. 

There are two types of compartment syndromes (Cleveland Clinic, 2021): 

• Acute compartment syndrome 
  • This type is normally caused from an injury such as a bone fracture or blood clot and is a medical emergency. 
• Chronic compartment syndrome 
  • This type occurs through intense physical exercise and is not a medical emergency. 

The incidence of acute compartment syndrome is 7.3 per 100,000 males and 0.7 per 100,000 females, with most cases occurring after trauma (Lopez et al., 2021). Individuals who have a bleeding disorder, such as hemophilia, are at risk for acute compartment syndrome. 

Compartment Syndrome ICD-10 Code (unspecified, initial encounter): T79. A0XA

Compartment Syndrome Diagnosis 

Compartment syndrome is diagnosed by a thorough history intake and physical examination by the healthcare provider. Signs and symptoms of compartment syndrome include: 

• Visible swelling of the muscle 
• Muscle pain 
• Severe pain when the muscle is stretched 
• Numbness 
• Tightness of the muscle 
• Tingling or burning 

The presentation of acute compartment syndrome can be remembered by the Five Ps, which include: 

• Pain 
• Pulselessness 
• Pallor 
• Paresthesia 
• Paralysis 

The healthcare provider may order the following diagnostic tests: 

• Comprehensive metabolic panel 
• Complete blood count 
• CPK 
• Intercompartmental pressure 
• X-ray 
• Ultrasound 

Management & Compartment Syndrome Treatment

Treatment and management of compartment syndrome will depend if it is acute or chronic. Acute compartment syndrome will need immediate treatment that may include: 

• Fasciotomy 
• Skin grafting 
• Supplemental oxygen 
• Medications for pain or infection 

Chronic compartment syndrome treatment may include: 

• Anti-inflammatory medications 
• Low-impact exercises 
• Physical therapy 
• Orthotics 

Compartment Syndrome Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for compartment syndrome are listed below. 

Assessment 

Assess for signs and symptoms, such as: 

• Swelling to the muscle 
• Severe pain when muscle is stretched 
• Decreased pulses to the area 
• Change in skin color 
• Burning or tingling sensation 

Nursing Diagnosis/Risk For 

• Acute pain related to compartment syndrome, evidenced by: 
  • Verbalization of pain 
  • Restlessness 
  • Tachycardia 
• Ineffective tissue perfusion related to decreased blood flow, evidenced by: 
  • Decrease pulse to area 
  • Pallor 
  • Skin cool to touch 
• Impaired physical mobility related to muscle pain, evidenced by: 
  • Inability to move extremity 
  • Verbalization of decreased range of motion 

Interventions 

• Administer analgesics for pain control. 
• Provide non-pharmacological interventions for pain. 
• Monitor pain control. 
• Surgical wound care, as ordered. 
• Administer IV fluids, as ordered. 
• Administer oxygen, as needed. 
• Keep extremity at heart level. 
• Monitor ventilation and oxygenation. 
• Educate on the importance of physical therapy. 

Expected Outcomes 

• Achieves and maintains: 
  • Adequate pain control 
  • Adequate tissue perfusion 
  • Increased range of motion and mobility to extremity 

Individual/Caregiver Education 

• Condition, treatments, and outcomes 
• Medications and side effects 
• Wound care, as ordered 
• Importance of healthcare provider follow-up 
• Importance of physical therapy 
• Notify the healthcare provider or seek medical attention for the following: 
  • Burning or tingling in the affected area 
  • Weakness in the affected area 
  • Severe pain in the affected area 

Content Release Date 

4/1/2022

Content Expiration

12/31/2025

Course Contributor 

The content for this course was created by Bobbi Whittington, RN, BSN. 

Bobbi started her nursing career as a CNA in long term care and developed a passion for working with older adults in the post-acute setting. She obtained her LPN certificate in 1997 from South Central Area Vocational Technical School in Missouri. Continuing her education, she earned her Associate degree in nursing in 2007 from Texas County Technical Institute in Missouri then obtained her Bachelor of Science degree in nursing from Chamberlain College of Nursing in 2013. Bobbi has over 24 years clinical and managerial experience in the skilled nursing industry. 

References 

• Cleveland Clinic. (2021). Compartment syndrome. https://my.clevelandclinic.org/health/diseases/15315-compartment-syndrome 
• Lopez, R., Torlincasi, A., & Waseem, M. (2021). Acute compartment syndrome. https://www.ncbi.nlm.nih.gov/books/NBK448124/