A school nurse is caring for a teenage athlete with a newly casted fractured ankle. Which interventions should the nurse implement to reduce swelling and pain and promote healing? Select all that apply:

A. Apply a cold pack to the ankle for 20 minutes at a time during the first 24 to 48 hours: Cold therapy reduces local inflammation, swelling, and pain by constricting blood vessels and numbing nerve endings. Limiting application to 20 minutes prevents skin injury or frostbite, especially important in newly injured tissues. B. Elevate the affected extremity above the level of the heart: Elevation facilitates venous and lymphatic drainage, decreasing edema and pressure in the injured ankle. Maintaining the extremity above heart level is a key non-pharmacologic intervention to reduce swelling and promote comfort during the acute phase. C. Assess capillary refill, sensation, and movement of the toes: Frequent neurovascular assessment ensures early detection of complications such as compartment syndrome or impaired circulation. Monitoring perfusion, sensation, and movement is critical for timely intervention to prevent tissue damage. D. Apply a heating pad over the cast to improve circulation: Heat can increase swelling and inflammation in the acute phase and may damage the skin or underlying tissue under a cast. Heat therapy is not recommended immediately after a fracture and cast application. E. Encourage weight-bearing ambulation as tolerated during the first 24 hours: Weight-bearing before the fracture stabilizes can disrupt healing, worsen pain, and increase risk of displacement. Immobilization and adherence to physician-prescribed activity restrictions are essential during the initial post-cast period.