A nurse is assessing a 3-month-old infant whose parents report starting cow's milk feedings 1 week ago. Which of the following actions should the nurse take?

Rationale for correct choices:

• A change in mood: Isotretinoin is associated with serious neuropsychiatric side effects, including depression, mood swings, and suicidal ideation. Adolescents are particularly vulnerable, and any mood changes should be reported immediately to prevent potential harm.
• Decreased night vision: Isotretinoin can cause visual disturbances, including impaired night vision, which may develop suddenly and without warning. This adverse effect can pose safety risks, especially when driving or navigating in low-light conditions, and requires prompt provider evaluation.

Rationale for incorrect choices:

• Dry mouth: Dry mucous membranes are a common and expected side effect of isotretinoin due to its drying effects on the skin and mucosa. While it may cause discomfort, it is not typically urgent or dangerous unless accompanied by other systemic symptoms.
• The development of dry eyes: Dry eyes are a frequent and expected adverse effect of isotretinoin. This symptom can usually be managed with artificial tears or lubricating eye drops and does not require immediate provider notification unless severe or worsening.
• Sunburn: Isotretinoin increases photosensitivity, making clients more prone to sunburn. However, this is a manageable and anticipated side effect. The client should be advised to use sunscreen and protective clothing rather than treat it as an emergency.
• Engagement in sexual activity: Sexual activity becomes relevant only if pregnancy is a risk, due to isotretinoin’s severe teratogenicity. Since the client currently tests negative on hCG and is not sexually active, it is not a priority concern unless that status changes.
• Worsening of acne: A temporary worsening of acne, known as an initial flare, is common in the first few weeks of isotretinoin therapy. It is not considered dangerous and does not warrant immediate discontinuation or urgent evaluation unless accompanied by severe systemic symptoms.

Rationale:

A. Subdural hematoma: This condition increases the risk of complications during electroconvulsive therapy (ECT) due to potential elevated intracranial pressure. The seizure activity induced by ECT can further increase pressure and pose a risk of brain herniation or worsening of the hematoma.

B. Renal calculi: Kidney stones may cause pain and hematuria, but they do not directly increase the risk of complications during ECT. Unless there is severe renal impairment or electrolyte imbalance, ECT is generally safe for these clients.

C. Hyperthyroidism: While hyperthyroidism may increase sensitivity to stress or elevate the risk of arrhythmias during procedures, it does not present the same level of direct neurological risk as intracranial pathology like a subdural hematoma.

D. Diabetes mellitus: Diabetes requires careful monitoring during ECT, especially regarding fasting, blood glucose levels, and anesthetic recovery. However, it is not a contraindication and does not present as high a procedural risk as a brain bleed would.