A nurse is caring for a client who is 6 hr. postoperative following application of an external fixator for a tibial fracture. Which of the following actions should the nurse take?
A.
Palpate the dorsalis pedis pulse.
B.
Adjust the clamps on the fixator frame.
C.
Wrap sterile gauze on the sharp point of the pins.
D.
Maintain the affected extremity in a dependent position
The Correct Answer and Explanation is:
The correct answer is A. Palpate the dorsalis pedis pulse.
Rationale:
When caring for a client who is 6 hours postoperative after the application of an external fixator for a tibial fracture, one of the nurse’s top priorities is to monitor for adequate blood circulation in the affected extremity. Palpating the dorsalis pedis pulse assesses peripheral circulation, ensuring that blood is flowing properly to the lower extremity. Impaired circulation can indicate complications such as compartment syndrome or vascular compromise, which could lead to tissue damage or even limb loss if left unchecked. Regular assessment of pulses, skin color, temperature, and capillary refill time is essential in postoperative care for fracture patients.
Let’s explore why the other options are not appropriate:
B. Adjust the clamps on the fixator frame:
It is not within a nurse’s scope of practice to adjust the clamps on the external fixator. Adjusting or manipulating the fixator should only be done by the orthopedic surgeon or a trained professional. Any incorrect adjustment could destabilize the fracture, delay healing, or cause further injury.
C. Wrap sterile gauze on the sharp point of the pins:
Although protecting the client from injury is important, sterile gauze wrapping is typically unnecessary for pin site care. Instead, focus on keeping the pin sites clean to prevent infection. Pin site care usually involves cleaning with a solution (such as chlorhexidine) and monitoring for signs of infection like redness, drainage, or swelling.
D. Maintain the affected extremity in a dependent position:
This is incorrect because keeping the extremity in a dependent position (hanging down) can increase swelling and delay healing. The correct practice is to elevate the extremity to help reduce swelling and improve venous return, especially in the immediate postoperative period.
In summary, palpating the dorsalis pedis pulse is a critical action for monitoring circulation and preventing complications after an external fixator application.