If a client with a new cast reports feeling coldness in the toes, what should the nurse do first?

When a client with a new cast reports feeling coldness in the toes, the priority action is to check capillary refill time. This assessment helps determine the adequacy of blood flow to the extremities. Coldness in the toes could indicate compromised circulation, and checking the capillary refill is a quick and effective way to evaluate perfusion. A capillary refill time of more than two seconds may suggest that blood flow is insufficient and merits further investigation and intervention.

Understanding the physiological implications is crucial; if circulation is impaired, it could indicate complications such as compartment syndrome, which can occur after casting. Therefore, assessing capillary refill is essential for identifying potential issues early and ensuring appropriate interventions are taken to protect the client's limb.

Other options, while they may seem helpful, do not address circulation status as directly. Loosening the cast could potentially worsen the problem if it leads to inadequate support or could damage the cast. Providing a warm blanket, although it may ease comfort temporarily, does not resolve the underlying issue of potential reduced blood flow. Notifying the physician is necessary, but it should follow an initial assessment to gather pertinent information first. Thus, confirming capillary refill is the most immediate and responsible action to take when there's a concern about circulation.