A nurse is assessing a client who is in active labor and just received an epidural. Which of the following findings should the nurse document as an adverse effect?

Rationale for Correct Choices:

• Right forearm and fingers are edematous: Swelling of the forearm and fingers can indicate a possible fracture or soft tissue injury with vascular compromise. Edema in a closed injury raises concern for compartment syndrome, especially when accompanied by other neurovascular changes.
• Ecchymotic area on outer aspect of forearm: A single bruise near the site of injury is expected after trauma and not alarming by itself. However, the chils is presenting with other multiple injuries, thus need for further assessment.
• Child reports a mild "tingling" sensation: Paresthesia can signal early nerve compression or involvement, which may progress if not addressed. Combined with swelling and coolness, this finding suggests a risk of compartment syndrome.
• Pain level of 4/10: Although moderate, a pain level of 4 in a child presenting with multiple injuries warrants further investigations.
• Multiple areas of bruising in various stages of healing: Bruising at different stages of healing raises concern for non-accidental trauma (child abuse). This pattern is inconsistent with a single fall and warrants immediate follow-up under child protection protocols.

Rationale for Incorrect Choices

• Radial pulse +2: A normal radial pulse suggests adequate arterial blood flow to the extremity. Although useful, this does not exclude compartment syndrome and is not an urgent finding on its own.
• Respirations easy and unlabored and stable vital signs: These are all normal findings that indicate no immediate respiratory, gastrointestinal, or hemodynamic distress. They do not warrant urgent intervention at this time.
• Vital signs: Temperature, blood pressure, respiratory rate and oxygen saturation are all within normal for the child’s age and support physiologic stability, hence no evidence of immediate systemic compromise.

Rationale:

A. Administer a dose of atomoxetine to decrease anxiety: Atomoxetine is a non-stimulant medication used primarily for ADHD, not for acute anxiety or panic attacks. It is not effective for treating panic symptoms and is not appropriate in this situation.

B. Sit with the client to provide a sense of security: Remaining with the client during a panic attack helps reduce fear, provides emotional support, and ensures safety. Calm presence and reassurance are essential to help the client regain a sense of control.

C. Encourage the client to watch television: Watching television requires attention and focus, which may be impaired during a panic attack. This suggestion does not address the immediate need for safety, calm, and emotional support.

D. Teach the client how to meditate: Teaching new coping techniques during a panic attack may be ineffective, as the client is overwhelmed and unable to concentrate. Such strategies are better introduced when the client is calm and receptive.