A nurse is planning to transfer a client who weighs 136 kg (300 lb) from a bed to a chair. The client is unable to assist in the transfer. Which of the following actions should the nurse plan to take?

Rationale:
A. The client exhibits a flat affect: A flat affect reflects blunted emotional expression and is typically a symptom of depression. Its persistence suggests the condition has not yet improved.

B. The client can express angry feelings: The ability to identify and express emotions, including anger, indicates improved emotional responsiveness and progress in managing depressive symptoms. This reflects increased insight and healthier coping.

C. The client experiences self-doubt when making decisions: Persistent self-doubt is a common feature of depression and suggests that the client still struggles with confidence and decision-making.

D. The client looks down when speaking to others: Avoiding eye contact and looking down are associated with low self-esteem and social withdrawal, which are characteristic of depression and indicate the condition is not yet improving.

Rationale for Correct Choices

• Compartment syndrome: The child’s nondisplaced midshaft fracture of the radius and ulna places them at risk for compartment syndrome, whereby increased pressure within the muscle compartments impairs circulation and tissue perfusion. Early recognition is crucial to prevent permanent nerve or muscle damage.

• Paresthesia: The child reports tingling in the fingers, which indicates nerve involvement or compression—an early warning sign of compartment syndrome. Monitoring for paresthesia helps the nurse identify worsening neurovascular compromise promptly.

Rationale for Incorrect Choices

• Osteomyelitis: Infection of the bone is unlikely immediately after a closed nondisplaced fracture without open wounds or surgical intervention. There is no evidence of systemic infection at this stage.

• Nonunion: Fracture nonunion is a long-term complication that occurs if healing fails over weeks to months. The child’s fracture is recent, so immediate risk is low.

• Physical damage: While trauma caused the fracture, “physical damage” is a broad term and does not specify a complication requiring acute monitoring.

• Ecchymosis: Bruising indicates soft tissue injury but does not predict compartment syndrome or other severe complications.

• Type of fracture: While important for diagnosis and treatment planning, the fracture type (nondisplaced) does not directly indicate the acute risk for neurovascular compromise.

• Location of fracture: The midshaft location contributes to fracture management but is not as clinically relevant as the early signs of compartment syndrome, such as paresthesia.