Checking pulses with a lower leg cast???

[NurseScholar]

my class had a question on a recent exam.

the stem read: when assessing a patient with a lower leg cast the nurse should assess? check all that apply. the answer choices were: pulse, pallor, paresis, parathesia, and pain (also known as the 5 p's)

i checked all of the answers, as i recognized that she was asking for all five of the p's and received full credit for the question, but a fellow student did not check pulse and missed the question. the student articulated that you could not check a pulse through a cast while on a lower leg as all lower leg casts wrap around the foot for support. the instructor refused to give her credit.

the instructor said that she did not tell in the stem whether or not the foot was enclosed, but it is my understanding that all lower leg casts enclose the foot and maintain the foot at a 90 degree angle.

what do you think? can you check a pulse with a lower leg cast? thanks in advance.

[jill48, ASN, RN]

The instructor is correct. You would check the pedal pulse; and actually, I think that is the most important "P" in this particular question. Have you learned about pedal pulses yet? You palpate for this pulse on the top of the foot, about an inch and a half (approx.) above the toes. Sometimes it is difficult to find, so there is usually something called a doppler in the facility for you to use. It works like the ultrasound thing you use on a pregnant belly; use a little gel and rub it around a little and it should pick up the pulse. Good luck.

[gt4everpn, BSN, RN]

From what I remember you check the pedal pulse, but this is a lower leg cast- I see the issue. When it comes to questions like these you have to remember not to read too much into the question. If a person has a cast it would be standard to check the pulse. The question does not specify on the cast except that its on the lower leg, therefore your answer should not be influenced by specifics of the cast, like your instructor was trying to say.

[CHATSDALE]

think that most casts allow for a pedal pulse, however if you have warmth but are unable to check pulse yo are probably not in trouble

[NurseScholar]

from what i remember you check the pedal pulse, but this is a lower leg cast- i see the issue. when it comes to questions like these you have to remember not to read too much into the question. if a person has a cast it would be standard to check the pulse. the question does not specify on the cast except that its on the lower leg, therefore your answer should not be influenced by specifics of the cast, like your instructor was trying to say.

but as the cast is a lower leg cast, shouldn't it by definition enclose the foot leaving only the toes? we didn't really cover much regarding cast application but would you be able to slide your fingers far enough under the cast to assess the pedal pulse? i am posting this on behalf of a peer. i never made the association myself regarding the lower leg cast enclosing the foot and just realized that the instructor was asking for the 5 p's. thank you so much for the quick response.

[jill48, ASN, RN]

but as the cast is a lower leg cast, shouldn't it by definition enclose the foot leaving only the toes? we didn't really cover much regarding cast application but would you be able to slide your fingers far enough under the cast to assess the pedal pulse?

actually, there is just enough room to stick your fingers in there. now, getting a doppler in there would be impossible.

[jill48, ASN, RN]

think that most casts allow for a pedal pulse, however if you have warmth but are unable to check pulse yo are probably not in trouble

I agree with this. If the toes are warm it would indicate good blood flow.

[CritterLover, BSN, RN]

actually, there is just enough room to stick your fingers in there. now, getting a doppler in there would be impossible.

i have seen some dopplers with a "flat" head that can be slipped under the edge of a cast. (they remind me of a flattened-out phone jack).

agree with above -- if the toes are warm with good color and cap refill, you should be ok even if you can't find the pulse.

however, i wouldn't haven given points back, either, had i been your instructor. it is rare for a cast to be down so far on the toes that a pulse can't be palpated. and they never should be so tight that you can't slip two fingers up to check for a pulse. i've seen ortho residents cut the cast to check for pulses when it had been either placed down too far or on too tight.

here's a litte trick i used when i worked in a trauma unit: put a pulse-ox probe on the big toe. good waveform indicates good perfusion. (not a substitute for the rest of the assesment, but a nice addition, and it can monitor "continuously" for those that are at risk for compartment syndrome, etc.)

[BittyBabyGrower, MSN, RN]

As a person who had a long leg cast on after an open tib/fib fracture above the malleous, and lost the pulse in my foot, thank goodness for the nurse that did her checks!

[VegRN]

For a lower leg cast, the toes at minimum are not going to be covered by a cast. In addition, you will be able to slide your fingers in to check pulses. If not, the cast will need to be cut away by the Md.

This is a very basic assessment. Your friend needs to realize her mistake, think about the rationale and move on instead of arguing with the instructor for more points.

[NurseScholar]

Thanks to all who replied.

[jill48, ASN, RN]

i have seen some dopplers with a "flat" head that can be slipped under the edge of a cast. (they remind me of a flattened-out phone jack).

you're kidding! i have never seen or even heard of such a thing. oh, i would love to see that, it sounds cool. thanks for my daily dose of education.