A nurse in an urgent care clinic is caring for an infant who presents with vomiting, diarrhea, and decreased oral intake. Which of the following manifestations should the nurse expect?

A. Soy. While soy can have mild estrogen-like effects and may influence thyroid function or interact with certain medications, it is not typically associated with hypotension or increased surgical bleeding risk.
B. Black cohosh. Black cohosh is often used to manage menopausal symptoms but is known to cause vasodilation and hypotension in some individuals. Its use can increase the risk of low blood pressure during anesthesia and surgery.
C. Flaxseed. Flaxseed is commonly used for digestive health and cardiovascular support. It may have mild blood pressure–lowering effects but is not strongly linked to significant hypotension during surgery.
D. Probiotics. Probiotics support gut flora and immunity but do not affect blood pressure significantly. They are not associated with intraoperative complications like hypotension.

• Fever: Fever is a nonspecific but common symptom found in all three conditions—epiglottitis, RSV, and streptococcal pharyngitis. However, it is more severe and abrupt in epiglottitis and low to moderate in RSV and strep throat. In this case, the toddler has had a persistent fever over 38°C, consistent with both RSV and strep.
• Exudate on pharynx: Pharyngeal exudate is a hallmark sign of acute streptococcal pharyngitis, resulting from the inflammatory response to GABHS. It is not typical in RSV or epiglottitis, where erythema and swelling may occur but without purulent exudate.
• Wheezing upon auscultation: Wheezing is a classic sign of RSV, a lower respiratory viral infection leading to bronchiolitis and airway obstruction. It is not a feature of epiglottitis or strep throat, which involve the upper airway and oropharynx, respectively.
• Drooling: Drooling is strongly associated with epiglottitis, due to inflammation and swelling of the epiglottis which makes it painful and difficult to swallow. It is not typical in RSV or strep pharyngitis unless there is severe oral involvement or dehydration.
• Hypoxia: Hypoxia may occur in both epiglottitis and RSV due to airway obstruction or inflammation compromising oxygenation. In epiglottitis, it results from upper airway narrowing; in RSV, from lower airway inflammation and mucus plugging. It is not common in uncomplicated streptococcal pharyngitis.
• Tachypnea: Tachypnea is a sign of respiratory distress and is often present in both epiglottitis and RSV, as the body attempts to compensate for impaired gas exchange. It is not a primary feature of strep pharyngitis unless accompanied by systemic infection or high fever.