A nurse in a pediatric clinic is providing teaching to the guardian of an infant who has a new prescription for digoxin. Which of the following manifestations should the nurse include as an indication of digoxin toxicity?

Choice A Reason:

Partial thromboplastin time (PTT): PTT is a test that evaluates the blood's ability to clot properly. While rheumatic fever can involve inflammation affecting various systems, it's not directly associated with significant changes in coagulation parameters like PTT.

Choice B Reason:

Blood urea nitrogen (BUN): BUN measures the amount of nitrogen in the blood that comes from urea, a waste product of the liver's metabolism of protein. It's commonly used to assess kidney function and hydration status. Rheumatic fever primarily involves inflammatory processes affecting the heart, joints, skin, and nervous system, and it typically doesn't have a direct impact on BUN levels.

Choice C Reason:

Erythrocyte sedimentation rate (ESR): Elevated ESR is a non-specific marker of inflammation and can be elevated in rheumatic fever due to the inflammatory response.

Choice D Reason:

C-reactive protein (CRP): Similar to ESR, CRP is an acute-phase reactant and tends to rise in response to inflammation, so elevated CRP levels can indicate an inflammatory process like rheumatic fever.

Choice E Reason:

Antistreptolysin O (ASO) titer: This test measures antibodies produced by the body against streptolysin O, a toxin produced by Streptococcus bacteria. Elevated ASO titers can indicate a recent streptococcal infection, which is a predisposing factor for rheumatic fever.

Choice A Reason:

Increased expectoration is correct. Increased expectoration (coughing up and clearing mucus) could indicate improved airway clearance, which is a primary goal of chest physiotherapy in cystic fibrosis. Effective therapy would facilitate the removal of mucus from the airways, making it easier for the child to clear secretions.

Choice B Reason:

Reduced pain is incorrect. While reducing pain is important for overall comfort, chest physiotherapy's primary goal in cystic fibrosis is to improve airway clearance and lung function. Pain reduction might not be the primary indicator of the therapy's effectiveness in this context.

Choice C Reason:

Increased heart rate is incorrect. An increased heart rate might not directly indicate the effectiveness of chest physiotherapy for cystic fibrosis. The focus is primarily on improving respiratory function and airway clearance rather than affecting heart rate.

Choice D Reason:

Increased urine output is incorrect. Increased urine output is not typically a direct indicator of the effectiveness of chest physiotherapy in cystic fibrosis. Chest physiotherapy aims to improve respiratory function rather than affecting urine output.