A postoperative client with a distal tibia fracture is on day 1 after open reduction and internal fixation and cannot move toes; the toes are dusky and cool to the touch. What action should the nurse take first?

• A. Call the health care provider immediately
• B. Elevate the leg and reassess
• C. Apply a warm compress to the toes
• D. Administer analgesic as prescribed for pain

Answer: (A)

When a postoperative distal tibia fracture shows toes that are dusky and cool, the priority is acute vascular compromise of the limb. This is a time-sensitive warning sign that may indicate reduced blood flow from vascular injury, edema causing compression, or evolving compartment syndrome. The nurse must notify the health care provider immediately so the patient can get urgent assessment and intervention to restore perfusion and prevent irreversible damage.

Elevating the leg or applying a warm compress might seem helpful for swelling or discomfort, but they do not resolve the underlying perfusion problem and can delay necessary treatment. Analgesics address pain but do not fix ischemia. While waiting for the clinician, continue to monitor neurovascular status, and avoid actions that could worsen circulation or mask the severity. If a constrictive dressing or cast is suspected, report it promptly so appropriate actions can be taken under orders.