A nurse is reinforcing teaching with a guardian about manifestations of the impending death of a child. Which of the following manifestations should the nurse include?

Rationale:

A. Urinary frequency: As death approaches, urinary output typically decreases due to reduced kidney perfusion. Urinary frequency is not a common sign of impending death and may suggest other unrelated conditions.

B. Difficulty swallowing: Difficulty swallowing is a common manifestation of impending death. As muscle tone declines, the child may struggle to manage secretions or food, increasing the risk of aspiration and signaling the body is shutting down.

C. Decreased sleep: Clients nearing death often exhibit increased sleep or lethargy, not decreased sleep. Diminished responsiveness and longer periods of unresponsiveness are expected in the final stages of life.

D. Increased senses: Sensory function generally declines as death nears. Vision, hearing, taste, and touch may all diminish, and the child may become less responsive to external stimuli. Increased senses are not expected at this stage

Rationale:

A. Decreased skin turgor: Decreased skin turgor is a sign of dehydration or fluid imbalance and is not related to compartment syndrome. It does not reflect changes in perfusion or nerve compression caused by increased compartment pressure.

B. Sensation of tingling: Tingling or paresthesia is an early sign of nerve compression due to rising pressure within a muscle compartment. It indicates compromised nerve function and is a key symptom of evolving compartment syndrome.

C. Diminished capillary refill: Delayed or diminished capillary refill suggests impaired perfusion. In a newly placed cast, this can indicate increased pressure restricting blood flow—an early and critical sign of compartment syndrome.

D. Pale-colored toes: Pallor in the extremities is a sign of decreased arterial blood flow. Pale-colored toes after cast placement suggest compromised circulation, which is consistent with compartment syndrome.

E. Pain relieved by analgesia: Pain that is unrelieved by analgesia especially pain out of proportion to the injury is a hallmark of compartment syndrome. Pain that is relieved by medication does not indicate compartment syndrome and may reflect expected postoperative discomfort.