A client is placed in wrist restraints at 1:00 pm. When should the skin integrity be assessed next?

A client is placed in wrist restraints at 1:00 pm. When should the skin integrity be assessed next?

• A. At the end of the current shift.
• B. At the beginning of the next shift.
• C. At 1:30 pm.
• D. At 3:00 pm.

Answer: (C)

After restraining, the skin and limb must be checked promptly to catch early signs of pressure, poor circulation, or nerve compression. The first assessment is done within a short window after application—typically 15 to 30 minutes—to examine color, temperature, sensation, edema, cap refill, and overall skin integrity where the restraint contacts the skin. If the restraint was applied at 1:00 pm, checking at 1:30 pm fits this guideline. After this initial check, routine monitoring continues every 2 hours (with more frequent checks if any concern arises) and release for range of motion as policy dictates.

After restraining, the skin and limb must be checked promptly to catch early signs of pressure, poor circulation, or nerve compression. The first assessment is done within a short window after application—typically 15 to 30 minutes—to examine color, temperature, sensation, edema, cap refill, and overall skin integrity where the restraint contacts the skin. If the restraint was applied at 1:00 pm, checking at 1:30 pm fits this guideline. After this initial check, routine monitoring continues every 2 hours (with more frequent checks if any concern arises) and release for range of motion as policy dictates.