A 9-year-old child has a fractured tibia, and a full leg cast is applied. Which assessment finding would the nurse immediately report to the health care provider?

A 9-year-old child has a fractured tibia, and a full leg cast is applied. Which assessment finding would the nurse immediately report to the health care provider?

• A. Increased urine output
• B. Inability to move the toes
• C. Pedal pulse of 90 beats per minute
• D. Damp fiberglass cast after 4 hours

Answer: (B)

Neurovascular status of the injured leg is the critical thing to watch in a child with a leg cast. When swelling occurs inside a rigid cast, pressure can build and begin to compress nerves and blood vessels. If the toes can no longer move, that signals possible nerve impairment or reduced distal perfusion, which can progress rapidly to serious complications like compartment syndrome. This is why it’s reported to the health care provider immediately—the signs point to a potentially limb-threatening issue that needs prompt evaluation and action. Keep in mind that a normal pedal pulse doesn’t rule out trouble, because arterial flow can remain even when tissue pressure is rising. A cast that’s damp after several hours is a concern for skin irritation and cast integrity, and should be addressed, but it isn’t as urgent as a loss of movement or sensation in the toes. Increased urine output isn’t related to the limb’s immediate status.

Neurovascular status of the injured leg is the critical thing to watch in a child with a leg cast. When swelling occurs inside a rigid cast, pressure can build and begin to compress nerves and blood vessels. If the toes can no longer move, that signals possible nerve impairment or reduced distal perfusion, which can progress rapidly to serious complications like compartment syndrome. This is why it’s reported to the health care provider immediately—the signs point to a potentially limb-threatening issue that needs prompt evaluation and action.

Keep in mind that a normal pedal pulse doesn’t rule out trouble, because arterial flow can remain even when tissue pressure is rising. A cast that’s damp after several hours is a concern for skin irritation and cast integrity, and should be addressed, but it isn’t as urgent as a loss of movement or sensation in the toes. Increased urine output isn’t related to the limb’s immediate status.