A nurse is caring for an adolescent following the application of a plaster cast for a fractured right tibia. Which of the following actions should the nurse take?

Choice A rationale Immobilization is necessary for bone healing, but total discouragement of ambulation is incorrect. Once the plaster cast is dry and the provider gives clearance, non-weight-bearing or touch-down weight-bearing ambulation with crutches is often encouraged to prevent complications of immobility like deep vein thrombosis or pneumonia. Prolonged stasis leads to muscle atrophy and decreased circulation. Movement promotes systemic health while the cast maintains the specific alignment required for the fractured tibia to knit together properly. Choice B rationale Maintaining a dependent position, where the leg hangs down, is contraindicated during the acute phase following cast application. This position increases hydrostatic pressure in the veins, leading to significant edema and increased pain. Instead, the extremity should be elevated above the level of the heart to promote venous return and reduce swelling. Excessive swelling within a rigid plaster cast can lead to compartment syndrome, a surgical emergency where tissue perfusion is compromised by high internal pressure. Choice C rationale Using a hair dryer on a hot setting is dangerous and can damage both the client and the cast. Heat trapped under the plaster can cause severe skin burns because the cast material retains heat. Additionally, rapid drying with high heat can cause the plaster to dry unevenly, leading to cracking or structural weakness of the cast. If a dryer must be used to speed up the process, it should be set to a cool, non-heated airflow setting. Choice D rationale Performing frequent neurovascular checks is the priority nursing action. This involves assessing the five Ps: pain, pallor, pulses, paresthesia, and paralysis. Because a plaster cast is rigid and the leg might continue to swell after a fracture, the nurse must ensure that circulation and nerve function remain intact. Normal capillary refill is less than 2 seconds, and the skin should be warm to the touch. Early detection of changes can prevent permanent nerve damage or limb loss.