If the 5 Ps of assessments for neurovascular status are present in a long-leg casted client, the nurse would plan for what action to improve the neurovascular status?

Question

1. Bi-valving the cast
2. Complete removal of the cast and replacement by skeletal traction
3. Elevation of the head of the bed (HOB)
4. Reassessment after the application of ice packs over the intact cast

Answer 1

Bi-valving the cast

Rationale: Bi-valving the cast will allow for expansion of tissue that is swollen and direct assessment of the extremity while maintaining bone alignment. The cast may be the source of a compartment syndrome by limiting the potential swelling and compressing blood vessels that diminish the blood supply to the distal portion of the extremity. Removal of the cast will decrease the risk for the restriction of tissue swelling but does not maintain bone alignment. Skeletal traction would keep the bones aligned but requires additional surgical placement and increases risk of infection that is unrelated to the swelling causing the neurovascular compromise. Elevating the HOB will increase dependent edema in the lower extremities and will not reduce the neurovascular compression that is caused by the swelling in the casted leg. Application of ice will reduce swelling in the leg but will not increase the blood flow to the lower extremity fast enough to prevent potentially permanent damage to the leg. Relief of the pressure inside the cast is needed immediately to prevent additional or permanent damage from compromised blood flow to the distal portion of the lower extremity.