The nurse reviews recovery findings after endoscopic retrograde cholangiopancreatography. Which findings require immediate follow-up? Highlight the findings associated with possible perforation.

Nurses' Notes 1630: The client returned from ERCP 40 minutes ago. The client reports mild throat soreness that improves after an ice chip. At 1640, the client describes severe epigastric pain that radiates to the back and worsens. The client is sleepy after sedation but awakens to name and follows commands. Oxygen saturation is 97% on the prescribed nasal oxygen. The nurse records that sedation level is improving with repeated verbal stimulation. The abdomen initially has mild fullness that began after the endoscopy procedure. The client now has the abdomen is rigid with involuntary guarding. The earlier bloating was relieved slightly after passing flatus. The blood pressure remains within the documented preprocedure range. At 1650, temperature is 38.4 °C and heart rate is 122/min as fever developed with new tachycardia. The client denies nausea at this time. The intravenous site is soft and dry. The client has no new rash or facial swelling. The procedure note documents biliary sphincterotomy. The nurse keeps the client fasting while contacting the endoscopy clinician. Emergency imaging has not yet been performed. No discharge teaching has begun.