A home health nurse is teaching a new parent about caring for his 1-week-old infant. Which of the following statements by the client indicates an understanding of the teaching?

Rationale for Correct Choices:

• A change in mood: Isotretinoin can cause psychiatric effects such as depression, mood swings, and suicidal ideation. These symptoms may appear suddenly and progress rapidly without warning. Immediate reporting is necessary to ensure patient safety and initiate intervention.
• Visual disturbances: Isotretinoin may cause night blindness, blurred vision, or other changes in visual acuity. These effects can be irreversible if not addressed promptly by an ophthalmologic evaluation. Sudden onset visual changes require immediate discontinuation and assessment.

Rationale for Incorrect Choices:

• Nausea: This is a mild, nonspecific gastrointestinal symptom that may occur with many oral medications. It is not considered a hallmark of isotretinoin toxicity unless severe or persistent. Supportive measures are usually sufficient unless other symptoms emerge.
• The development of dry eyes: This occurs due to isotretinoin’s suppression of sebaceous and meibomian gland activity. It is a common, expected effect that can be relieved with lubricating eye drops. Urgent evaluation is not required unless accompanied by vision changes.
• Dry mouth: This is a frequent mucocutaneous effect related to reduced salivary gland activity during isotretinoin therapy. It does not indicate a dangerous reaction and is usually managed with hydration and sugar-free lozenges. Medical review is only needed if severe.
• Photosensitivity: Isotretinoin increases skin sensitivity to sunlight due to thinning of the epidermis. While uncomfortable, it is a predictable effect that can be prevented with sunscreen and protective clothing. It does not require stopping treatment unless severe burns occur.
• Dry skin and lips: This is the most common side effect, resulting from reduced sebaceous gland activity. It is usually managed with moisturizers and lip balm throughout therapy. It is not a sign of toxicity and rarely requires dose adjustment.

Rationale:

A. Discuss the client's preferences for determining a repositioning schedule: While involving the client in care planning is important, the schedule for repositioning is primarily determined by clinical needs to prevent complications such as pressure injuries, not solely by preference.

B. Evaluate the client's ability to help with repositioning: Assessing the client’s strength, mobility, and coordination after a stroke determines the level of assistance and equipment required. This ensures safety for both the client and the nurse during repositioning.

C. Raise the side rails of the client’s bed during repositioning: Side rails can create entrapment hazards if used incorrectly and should not be relied upon during repositioning. Their purpose is more for safety positioning after the move, not as a primary tool during the maneuver.

D. Reposition the client with the assistive devices: Assistive devices should be used if needed, but this step follows an assessment of the client’s capabilities. Selecting equipment without first evaluating the client may lead to unnecessary interventions.