A nurse is assisting with the care of a client following electroconvulsive therapy for the treatment of a depressive disorder, which of the following findings should the nurse expect 15 min following the procedure?

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:

• Naloxone: The client received fentanyl and is now showing signs of opioid-induced respiratory depression. Respiratory rate has decreased to 10/min and oxygen saturation to 87%. Naloxone will reverse the opioid’s effects and restore adequate respiratory effort.

• An additional dose of propofol: The client’s level of sedation is already too deep, as shown by low respiratory rate and blood pressure. Additional propofol would worsen central nervous system depression. It may cause complete apnea or cardiac compromise in this situation.

• Oxygen 10 L/min via face mask: The current oxygen flow via nasal cannula is insufficient given the client's low oxygen saturation. A face mask delivers higher oxygen concentration and flow. This is critical to correct hypoxia until the cause is reversed.

• Acetaminophen: There is no fever or current complaint of pain requiring antipyretics or analgesics. Administering acetaminophen now would not address the acute respiratory issue. It would delay more urgent and appropriate interventions.

• An additional dose of fentanyl: Administering more opioid would increase the risk of further respiratory depression. The client is already showing hypoventilation and declining oxygenation. More fentanyl would worsen sedation and endanger airway and breathing.

• Propranolol: The client is already hypotensive with a BP of 80/51 mm Hg and a heart rate of 68/min. Giving a beta blocker could severely depress cardiac output. This would increase the risk of organ hypoperfusion and cardiac arrest.