A patient in wrist restraints is at risk for impaired circulation in the distal upper extremities. Therefore, the most important physical exam finding to accurately assess and document is distal capillary refill time. Secondarily, a patient must be continually re-assessed for the need for restraints, however ensuring proper circulation is always the first priority. Brachial pulses are proximal to the wrist restraints so are less helpful in gauging adequate distal circulation. Although a patient in restraints may have limited mobility and be at a greater risk for skin breakdown over bony prominences, it is a less important assessment than distal circulation.