A nurse is caring for a client following application of a cast. Which of the following actions should the nurse take first?

Rationale:

A. Encourage physical activity prior to bedtime: Stimulating activity close to bedtime can increase agitation and make it harder for clients with Alzheimer’s disease to settle for sleep. Calming routines in the evening are more appropriate to reduce nighttime confusion and restlessness.

B. Wear clothing with zippers instead of buttons: Although zippers are often easier than buttons, clients with Alzheimer’s may have difficulty with any fasteners. Simple clothing with Velcro or elastic waists is typically more suitable to promote independence.

C. Replace the carpet with hardwood floors: Carpets provide traction and cushioning, which can help prevent injuries from falls. Hardwood floors may be slippery or cause confusion due to glare or unfamiliar patterns, increasing fall risk.

D. Place locks at the tops of exterior doors: Clients with Alzheimer’s are at risk for wandering. Installing locks at the tops of doors—out of the client's usual line of sight—helps prevent elopement while preserving safety in the home environment.

Rationale for Correct Choices:

• Compartment syndrome: The client shows hallmark signs: pain unrelieved by medication (rated 9/10), cool foot, 2+ edema, numbness, absent pedal pulses, delayed capillary refill, and inability to move the foot. These findings indicate increased pressure within a muscle compartment that compromises circulation and nerve function, requiring emergency intervention to prevent tissue necrosis or amputation.
• Osteomyelitis: A rapidly rising temperature (up to 38.9°C), elevated WBC count (28,000/mm³), and presence of drainage from the splint site suggest a localized bone infection. Osteomyelitis can develop from an open fracture, especially post-surgery, and early detection is critical for avoiding systemic infection or bone destruction.

Rationale for Incorrect Choices:

• Deep vein thrombosis (DVT): While immobilization increases DVT risk, the scenario lacks classic signs like unilateral calf swelling, warmth, erythema, or a positive Homan's sign. Additionally, pulses are absent in the foot, not consistent with a DVT presentation, which typically does not affect distal pulses.
• Fat embolism: The client does not exhibit hallmark signs such as acute respiratory distress, petechial rash, or altered mental status. Although long bone fractures pose a fat embolism risk, no findings suggest embolic movement or pulmonary compromise in this case.