A nurse is assisting with the care of a client

Exhibits

Select the 3 findings that require immediate follow-up.

Rationale:
• Compartment syndrome: Casts can restrict swelling, increasing pressure within the compartment. Moderate toe edema and capillary refill slowing from brisk to 3 seconds are warning signs. Without prompt intervention, tissue perfusion may decline, leading to ischemia.

• Edema of toes: Progressive edema signals impaired venous return or rising intracompartmental pressure. It reflects worsening limb status under the cast. This change, with slowed refill, supports risk for compartment syndrome.

• Malunion: Malunion develops over weeks due to misalignment during healing. No imaging or prolonged healing time is reported. Acute symptoms like swelling and pain don’t indicate this long-term issue.

• Physeal damage: Growth plate injury would affect long-term limb development. The adolescent shows intact toe movement and normal limb function otherwise. No evidence of joint or bone disruption is presented.

• Inability to ambulate: The femur fracture and cast already restrict ambulation. Lack of walking is expected at this stage. It doesn't suggest any specific complication like infection or compartment syndrome.

• Infection: Fever is low-grade and expected post-injury or from opioids. No redness, drainage, or systemic illness is present. Pain is stable and localized, not escalating or spreading.

• Decreased dorsalis pedis pulse: Pulses are 2+, meaning circulation is present and adequate. Decreased or absent pulse would indicate severe compromise, but that is not seen here. It does not reflect early compartment syndrome.

Rationale:

A. Heparin 5000 U subcutaneous every 8 hr: Using "U" for units can be misread as zero, potentially causing a tenfold overdose. The correct transcription uses the full word "units" to prevent errors.

B. M50, 10g PO delly: This prescription contains multiple errors: "M50" is unclear, "10g" may be excessive or incorrect dosing, and "delly" is an incorrect abbreviation for daily. This transcription is inaccurate and unsafe.

C. Lorazepam 0.5 mg PO PRN at bedtime: Although mostly correct, "PRN at bedtime" can be confusing. It is clearer to specify "PRN for anxiety at bedtime" or "PRN as needed at bedtime" to clarify the indication and timing.

D. Doxazosin 5 mg PO at bedtime: This transcription is clear, uses accepted abbreviations, specifies route and time, and includes no dangerous abbreviations, making it an accurate and safe prescription transcription.