In developing a care plan for a client with an ORIF of a fraction with a post cast application, what is the priority nursing diagnosis?

• A. Impaired skin integrity
• B. Risk for infection
• C. Acute pain
• D. Activity intolerance related to immobilization

Answer: (D)

The key idea is that immobilization from a cast after an ORIF directly limits the patient’s ability to perform activities. This makes activity intolerance the most immediate and central concern, because it shapes how you plan the rest of the care—gradual, safe progression of movement, energy-conserving strategies, and coordination with physical therapy to prevent deconditioning. While managing pain, monitoring skin under the cast, and reducing infection risk are important, they are addressed within the broader plan that first aims to restore and maintain acceptable activity levels during recovery. So focusing on activity intolerance related to immobilization best guides the nursing interventions and priorities in this scenario.