The nurse is planning the care of an infant after the surgeon applies corrective casting for congenital clubfoot. Which of the following is an appropriate nursing diagnosis for the infant?

Risk for ineffective tissue perfusion

Explanation

• Correction of clubfoot is best achieved if begun in the newborn period. A cast is applied while the foot is placed in an corrected position. Although the deformity involves the ankle, the cast extends above the knee to ensure firm correction.

• As with any cast, clubfoot casting can cause vascular compromise and diminished perfusion in the extremity.

• Signs and symptoms of vascular compromise are: pain disproportionate to the injury, diminished or absent pulses, poor capillary refill, and decreased movement of the extremity or digits.

Incorrect options:

• There is a potential for alteration in skin integrity, but this is not as harmful as altered tissue perfusion, so it is not the highest priority.

• Risk for infection is not an appropriate nursing diagnosis, as there is no incision with serial casting. Based on developmental considerations, fear of strangers would be important to consider if this patient were a toddler, but it is not a concern for infants.

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