What assessment should be included in the plan of care for a client who is being treated with an Unna's paste boot?

• A. Check capillary refill of toes on lower extremity with Unna's paste boot
• B. Check arterial blood gas
• C. Measure toe temperature
• D. Assess skin color of the leg

Answer: (A)

When a client is treated with an Unna's paste boot, the plan of care must focus on monitoring distal circulation because the boot provides compression and immobilization that can affect blood flow to the toes. The most important assessment is capillary refill of the toes. Capillary refill tests how quickly blood returns to the nail bed after blanching and directly reflects distal arterial perfusion. A normal refill is typically under 2 seconds; a slower response can indicate reduced blood flow or compression-related ischemia from the boot. This bedside measure is quick, noninvasive, and specifically helps detect early changes in perfusion that the boot might cause.

While toe temperature and skin color can offer additional clues about circulation, they are less specific and can be influenced by external factors or broader conditions. Arterial blood gas measures systemic oxygenation and acid-base status, not the local perfusion status of the leg under the boot, so it isn’t the most relevant monitoring in this context.