A parent calls the nursing call center stating that his child, who has a cast after surgical treatment of a clubfoot, is very fussy even after acetaminophen (Tylenol) administration and that the child's toes seem cool
What advice does the nurse give the parent?
A.
"Elevate the affected extremity and apply ice for 20 minutes."
B.
"Make four cuts to the top of the cast, each about 1 inch long."
C.
"Take your child to the nearest emergency department now."
D.
"Try giving your child a dose of ibuprofen (Pediaprofen) instead."
ANS: C
Parents always need to observe for complications of casting, including neurovascular compromise. A child who is excessively fussy and whose toes are cool should be seen by a health-care provider to assess circulation and possibly modify or change the cast. The parent should be told to take the child to the nearest emergency department (ED). The other answers are inappropriate. If circulation is compromised, elevation and ice will make the problem worse. The parent should not be instructed to modify the cast. Although ibuprofen may manage the child's pain better than acetaminophen, the priority instruction is to send the parent to the ED.
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