What is the priority nursing intervention in the care of a client in balanced suspension traction for a complete transverse fracture of the left femur?
1. Assessment of the pin site and movement of extremity distal to injury
2. Frequent checks regarding level of pain and sensation distal to the affected extremity
3. Maintaining abduction device between the legs to prevent external rotation of the affected leg
4. Increasing fluid intake to prevent the development of renal stone caused by urinary stasis
Answer: 2
Compartment syndrome is characterized by consistent pain and loss of sensation distal to the area of injury. The client can have an adequate peripheral pulse and still have a problem with compartmental syndrome. The client in balanced suspension traction has pins or wires exerting traction on the bone; pin site care is important, but evaluating for compartmental syndrome is a priority. Maintaining good fluid intake is also important, but assessing neurocirculatory status is more important. (Lewis 8 ed, p. 1591 & 1603).