Two hours after limb salvage surgery for a client with left leg bone sarcoma, the nurse notes that the toes of the left foot are more edematous, are cooler to the touch, and have a slower capillary refill. Which action does the nurse take first?
a. Apply ice to the distal extremity.
b. Check the splint for proper placement.
c. Elevate the left foot.
d. Loosen the pressure dressing.
B
Assessment of the neurovascular status of the affected extremity should be performed every 1 to 2 hours after surgery. Splinting or casting the limb may cause neurovascular compromise and needs to be checked for proper placement. Applying ice will cause vasoconstriction, which will further impair blood flow. Elevation of the foot will similarly decrease circulation to the area.
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