A nurse is performing a neurovascular assessment on a client who has a cast applied following a right arm fracture. What are appropriate interventions by the nurse? Use the ATI Active Learning Template: Basic Concept to complete this item to include the following:
A. Related Content: Identify the purpose of neurovascular assessment.
B. Underlying Principles: Identify the six components of a neurovascular assessment.
C. Nursing Interventions: Describe a nursing intervention related to each of the six components.
The Correct Answer and Explanation is:
Here is the completed ATI Active Learning Template: Basic Concept for a neurovascular assessment on a client with a cast following a right arm fracture:
A. Related Content
Purpose of Neurovascular Assessment:
The purpose of a neurovascular assessment is to monitor for signs of neurovascular compromise (also known as compartment syndrome or circulatory impairment) in clients with musculoskeletal injuries, especially after the application of casts or splints. It helps identify early signs of impaired circulation, nerve damage, or restricted mobility in the affected limb, which, if untreated, could lead to permanent damage or loss of limb function.
B. Underlying Principles
Six Components of a Neurovascular Assessment (“6 Ps”):
- Pain – Assessment of pain that is disproportionate to the injury or not relieved by analgesics.
- Pallor – Observation of color changes in the skin (pale or cyanotic appearance).
- Pulselessness – Assessment of distal pulses compared to the unaffected limb.
- Paresthesia – Monitoring for numbness, tingling, or a “pins and needles” sensation.
- Paralysis – Evaluation of the client’s ability to move the affected limb or digits.
- Poikilothermia (Temperature) – Comparison of limb temperature; affected extremity may be cool to touch.
C. Nursing Interventions
1. Pain:
Reassess pain level frequently and administer prescribed analgesics. Report pain that is severe, increasing, or unrelieved by medication, as it may indicate compartment syndrome.
2. Pallor:
Inspect the skin color of fingers and hand. Elevate the limb slightly and avoid positioning it above heart level if compartment syndrome is suspected.
3. Pulselessness:
Palpate radial and ulnar pulses in the affected arm. Use a Doppler device if pulses are difficult to detect and notify the provider of any diminished or absent pulses.
4. Paresthesia:
Ask the client to report any numbness or tingling. Lightly touch the fingers to assess sensation and document findings regularly.
5. Paralysis:
Ask the client to wiggle fingers or move the wrist. Inability to move may signal nerve or muscle impairment.
6. Poikilothermia (Temperature):
Use the back of the hand to assess temperature of the limb. Compare with the unaffected arm; report cool extremities immediately.
300-Word Explanation
A neurovascular assessment is critical in clients with fractures, especially after immobilization with a cast, to detect early signs of impaired circulation or nerve function. The assessment consists of six essential components—pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia—commonly referred to as the “6 Ps.” These help identify conditions such as compartment syndrome, which is a surgical emergency.
Pain that is out of proportion or unrelieved by analgesics may indicate increasing pressure within the muscle compartments. Pallor suggests decreased arterial perfusion, while pulselessness indicates potentially severe vascular compromise. Paresthesia reflects nerve compression or damage, paralysis signals significant nerve or muscle involvement, and a cool limb (poikilothermia) can be a sign of compromised circulation.
Nurses must be vigilant in performing neurovascular assessments frequently, especially in the first 24–48 hours post-casting when swelling peaks. Interventions include elevation of the limb (with caution), reporting abnormal findings, comparing bilateral limbs, and using tools like Doppler for pulse checks. Prompt recognition and intervention can prevent permanent damage, preserve function, and potentially save the limb.
