Which client is at the highest risk for insufficient vascular perfusion?

The client with the newly casted leg is at the highest risk for insufficient vascular perfusion due to several critical factors associated with immobilization and potential complications of casting. When a limb is immobilized in a cast, there is a significant concern for the development of compartment syndrome, a condition resulting from increased pressure within a closed anatomical space, which can lead to reduced blood flow and, consequently, insufficient perfusion to the tissues.

In a pediatric patient, the potential for inadequate perfusion is heightened because their blood vessels may be more susceptible to compression from the cast compared to adults, and their overall smaller anatomy means even slight changes in pressure can have significant impacts. The risk of edema also increases with immobilization, further exacerbating any risk of vascular compromise.

While growth spurts in adolescents can lead to rapid physical changes, they do not inherently result in vascular complications. The adult with a sprained ankle may experience discomfort and some limitations to mobility, but these do not pose the same high risk for vascular insufficiency as a recently casted limb. Lastly, while age can influence various health risks, urinary incontinence in an older adult does not directly relate to vascular perfusion issues in the same way that a casted limb does. Thus, the likelihood of