A patient with a fractured arm received a short-arm cast in the ED and is being discharged; what should the nurse plan when the patient returns?

• A. Perform a neurovascular assessment on the fingers
• B. Administer additional analgesia without assessment
• C. Schedule physical therapy
• D. Remove the cast immediately

Answer: (A)

Monitoring the distal neurovascular status after casting is essential because swelling or pressure from the cast can impair circulation and nerve function in the hand. When the patient returns, the nurse’s plan should include a thorough neurovascular assessment of the fingers—checking color, warmth, capillary refill, sensation, movement, edema, and pulses—to detect any signs of compromised perfusion or nerve injury early. This enables prompt communication with the provider and timely intervention if problems arise, preventing more serious complications such as ischemia or nerve damage. Administering analgesia without first assessing the limb overlooks important clues about the patient’s condition, scheduling physical therapy is not the immediate priority for a newly cast extremity, and removing the cast abruptly is not appropriate without provider guidance.