A nurse assesses an adolescent with a broken tibia who reports pain and tingling after a cast is applied. What should the nurse do first?

In the scenario where an adolescent has a broken tibia and is experiencing pain and tingling after a cast has been applied, the priority action is to assess for manifestations of circulatory impairment.

When a cast is applied, it can sometimes lead to complications such as compartment syndrome, which occurs when swelling within a closed fascial compartment increases pressure, potentially compromising circulation to the area. Symptoms of circulatory impairment may include increased pain, tingling, numbness, pale skin, or a feeling of coldness in the extremity. Identifying these signs quickly is crucial, as untreated compartment syndrome can lead to serious outcomes like muscle and nerve damage.

Performing a thorough assessment for circulatory impairment allows the nurse to gather critical information regarding the severity of the situation. It also provides a basis for deciding further interventions, such as notifying a physician if there are any alarming signs that indicate a need for immediate medical intervention.

While administering analgesics, contacting the physician, or reassuring the patient are important steps in patient care, they are secondary actions that may not adequately address the potential for a serious, underlying problem if circulatory compromise is present. Therefore, assessing circulation is the most critical first step in this scenario.