The nurse is caring for a 6-year-old who is postoperative open right tibial fracture reduction with cast placement. Which finding requires priority action?

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Neurovascular integrity should always be tested first after cast application by performing circulation, motor, and sensory checks. The client should have no numbness or tingling. If pain is not relieved (especially with passive range of motion) by prescribed pain medication or is out of proportion to the injury, the nurse should notify the health care provider (HCP). Permanent damage to the circulatory and nervous systems (compartment syndrome) can occur if this is not addressed immediately (Option D). Pallor, pulselessness, and paralysis are late signs of compartment syndrome. (Option A) Blood stains on a cast after an open orthopedic surgical procedure are not unusual. The nurse should circle the stains and mark the date and time on the cast so further bleeding can be easily visualized. However, rapid enlargement of a stain needs to be reported to the HCP. (Option B) The skin on the affected extremity should be pink and warm. When blanched, it should return to normal color in <3 seconds. (Option C) Mild swelling/edema of the toes can occur from cast pressure and can be reduced with leg elevation using pillows. Increasing swelling should be reported to the HCP. Most clients report severe pain when the cause is compartment syndrome, which is a priority. Educational objective: Compartment syndrome is a limb-threatening emergency that can occur after fracture reduction. Neurovascular checks should always be performed first. The client should not have numbness or tingling. If pain is not relieved (especially with passive range of motion) by prescribed pain medication or is out of proportion to the injury, the nurse should notify the health care provider.

The Nurse Is Caring for a 6-Year-Old Who Is Postoperative