A patient who fell in the bathroom of the hospital room reports pain in the upper right arm and elbow. Which action would the nurse take first in managing a possible fracture before splinting the injury?

Choice A reason: Checking capillary refill is the priority to assess neurovascular status in a client with a casted tibia fracture. Impaired circulation, indicated by delayed refill (>2 seconds), suggests complications like compartment syndrome or vascular compromise. Early detection prevents tissue ischemia, nerve damage, or limb loss, as casts can compress vessels, especially in the initial post-casting period. This assessment ensures adequate blood flow, critical for healing and preventing irreversible damage.

Choice B reason: Discussing cast care, such as keeping it dry or avoiding weight-bearing, is important for long-term management but not the first priority. Education prevents complications like infection or cast breakdown but does not address immediate risks like vascular compromise. Neurovascular assessment takes precedence to ensure limb viability before focusing on patient education about cast maintenance and care.

Choice C reason: Performing range of motion exercises helps maintain joint mobility and prevent stiffness but is not the initial priority. Moving a casted limb prematurely may exacerbate swelling or disrupt fracture alignment. Neurovascular status must be confirmed first to ensure circulation is intact, as compromised blood flow could worsen with movement, risking further tissue damage.

Choice D reason: Managing pain is important, as pain may indicate complications like swelling or pressure within the cast. However, pain assessment is secondary to checking capillary refill, which directly evaluates circulation. Unaddressed vascular compromise could lead to ischemia, making neurovascular assessment the priority to rule out life-threatening conditions before addressing pain with medication or other interventions.

Choice A reason: Hematoma forms immediately post-fracture, initiating the healing process by providing a matrix for inflammation and cell migration. By 4 weeks, the hematoma is typically replaced by soft callus, making it an outdated sign. X-rays at this stage show callus formation, not hematoma, as the primary evidence of healing.

Choice B reason: Granulation tissue forms early in soft tissue repair, not bone healing, and is not visible on x-ray. In fractures, it may precede callus formation but is not a distinct radiologic marker by 4 weeks. Callus, a bony precursor, is the expected x-ray finding, making this choice incorrect.

Choice C reason: Complete bony union occurs months after a fracture, typically 6-12 weeks for a humerus, depending on age and health. At 4 weeks, healing is in the callus formation stage, not full union. This sign is too advanced for the timeframe, making it an incorrect indicator.

Choice D reason: Callus formation, visible on x-ray by 4 weeks, indicates initial bone healing. Fibrocartilaginous callus bridges the fracture, stabilizing it as osteoblasts lay down new bone. This radiologic sign confirms progression from hematoma to early bone remodeling, making it the expected evidence of healing at this stage.