A nurse is assessing a 1-month-old infant at a pediatric office. Which of the following findings requires a referral for further care?

Rationale:

A. Tachypnea: An increased respiratory rate is not commonly associated with epidural anesthesia and is not a typical adverse effect. It may result from anxiety or pain but does not directly indicate a problem with the epidural.

B. Hyperreflexia: Epidurals often reduce sensation and reflexes, not heighten them. Hyperreflexia is not expected and would not be a direct adverse effect of epidural administration during labor.

C. Hypothermia: While mild temperature changes may occur, hypothermia is not a common or significant adverse effect of epidural anesthesia. It is not typically monitored as a key complication.

D. Hypotension: Epidural anesthesia can cause vasodilation by blocking sympathetic nerve fibers, leading to a drop in maternal blood pressure. This is a well-known and common adverse effect requiring close monitoring and potential intervention.

Rationale for Correct Choices:

• Pain medication: Pain control is a primary concern in fracture management, especially in pediatric clients. This child reports a pain score of 4/10, indicating discomfort. Administering pain medication will reduce suffering and help prevent complications such as anxiety or guarding, which may impair healing.
• Limb immobilization: Immobilization stabilizes the fracture site and prevents further injury to soft tissues or neurovascular structures. With a nondisplaced fracture of both radius and ulna, the nurse should expect a splint or cast order to limit movement and aid in bone alignment and healing.

Rationale for Incorrect Choices:

• Bed rest: Bed rest is not required for isolated upper limb fractures, particularly when the child is developmentally appropriate, alert, and ambulatory. Encouraging mobility is important to reduce the risk of complications like deconditioning or thromboembolism.
• Surgical consultation: A nondisplaced fracture typically does not require surgical intervention unless complications develop. Surgical consultation is more often necessary for open, displaced, or unstable fractures that require reduction or fixation.
• Antibiotics: There are no signs of systemic or localized infection. The child has a superficial knee abrasion but no open fracture or wound that would necessitate prophylactic antibiotics. Therefore, antibiotic use is not indicated in this situation.