Neurovascular

An injured extremity can lose blood flow or nerve function after a fracture, reduction, cast or splint application, surgery, vascular procedure, or increasing swelling. A tight cast, dressing, or splint can raise tissue pressure; venous drainage is impaired first, followed by capillary flow and nerve function. Irreversible injury can develop before a major artery becomes pulseless. The assessment therefore compares the affected limb with the opposite limb and with the client's previous findings. A new trend or cluster—such as escalating pain, increasing tightness, altered sensation, coolness, and a weaker pulse—matters more than one isolated borderline result. In Ontario, an RPN who has the required competence may perform circulatory checks such as pulse, capillary refill, skin temperature, and colour, as well as sensory checks using light touch or pin-prick, without a prescriber's order and within the CNO Scope of Practice. The REx-PN tests this assessment and prioritization skill; memorizing a fixed schedule is not a substitute for recognizing deterioration.