When assessing an older adult client, you note diminished peripheral pulses in the lower extremities. What should be the nurse's next step in assessment or intervention?

Assessment of diminished peripheral pulses in an older adult involves evaluating peripheral perfusion and vascular integrity of the lower extremities. Reduced pulses may indicate peripheral arterial disease, decreased cardiac output, or age-related vascular changes affecting circulation. The nurse must further assess tissue perfusion using objective bedside measures before initiating interventions or escalating diagnostics. Capillary refill provides quick information about distal blood flow and circulatory adequacy in the affected extremities. A. Administering oxygen is not indicated as a primary response to diminished peripheral pulses unless there are signs of systemic hypoxia. Oxygen therapy does not directly improve peripheral arterial circulation in localized vascular insufficiency. The priority is further assessment of perfusion status rather than immediate respiratory intervention. B. Documenting findings and sending the client for a CT scan is premature without completing additional bedside vascular assessments. Imaging may be required later if a vascular occlusion or structural abnormality is suspected, but initial nursing evaluation must include simple perfusion checks. Skipping further assessment could delay identification of reversible causes or worsening ischemia. C. Performing a capillary refill test on the toes is an appropriate next step to assess distal perfusion. This evaluates how quickly blood returns to the capillary bed after pressure is applied, providing information about peripheral circulation and vascular sufficiency. It helps determine whether diminished pulses are associated with impaired tissue perfusion or expected age-related changes. D. Immediately applying warm compresses is not appropriate without a clear understanding of the underlying cause of decreased pulses. In arterial insufficiency, heat may increase metabolic demand without improving blood flow, potentially worsening tissue oxygen imbalance. Further assessment is required before initiating thermal interventions to avoid potential tissue injury.