A nurse is monitoring a client following the insertion of a peripheral intravenous catheter. Which of the following findings should indicate to the nurse that the client is experiencing phlebitis at the insertion site?

Rationale:

• Heart rate: A heart rate of 118/min indicates tachycardia, which may be a compensatory response to hypovolemia or blood loss. Combined with low blood pressure and low hemoglobin/hematocrit, it raises concern for active gastrointestinal bleeding and hemodynamic instability.
• Stool results: A positive hemoccult test confirms gastrointestinal bleeding, especially when paired with the client’s report of dark, tarry stools (melena). This requires prompt evaluation and may indicate upper GI bleeding, such as from a peptic ulcer.
• Current medications: The client is taking high-dose ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), which can cause or worsen gastric ulcers and bleeding. Continued use should be stopped immediately and replaced with safer alternatives.
• WBC count: The WBC count is within the normal range and does not indicate an active infection or inflammatory process at this time. It does not require urgent follow-up compared to other findings.
• Hemoglobin and hematocrit: The client’s hemoglobin (9.1 g/dL) and hematocrit (27%) are significantly low, suggesting blood loss likely due to GI bleeding. These values warrant urgent follow-up and possible transfusion depending on symptoms and stability.
• Temperature: The client’s temperature of 37.5°C (99.5°F) is slightly elevated but within normal limits and not a priority concern. There are no signs of infection or fever that require immediate follow-up.
• Blood pressure: A BP of 90/50 mm Hg indicates hypotension, which is concerning in the context of GI bleeding and low hemoglobin. This may reflect hypovolemia and requires prompt fluid management and monitoring.
• Respiratory rate: A respiratory rate of 18/min is within normal limits and does not indicate respiratory distress. It does not require immediate follow-up in this context.

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.