A nurse is assisting in the care of a client on a labor and delivery unit.

Exhibits

Which of the following findings require further evaluation by the nurse?

Select all that apply.

A. Peeling of the hands and feet is not a common manifestation of pertussis. This symptom is typically associated with other conditions, such as Kawasaki disease or toxic shock syndrome, rather than an infection caused by Bordetella pertussis.
B. Beefy, red tongue is usually seen in conditions like scarlet fever or certain nutritional deficiencies, such as vitamin B12 deficiency. It is not characteristic of pertussis and does not align with the typical clinical presentation of this respiratory illness.
C. Fever is a common manifestation of pertussis, especially in the early stages. The child may present with a mild to moderate fever as the immune system responds to the infection. Fever can help in distinguishing pertussis from other respiratory illnesses, especially in conjunction with the classic coughing fits.
D. Facial erythema is not typically seen in pertussis. While some flushing may occur during intense coughing episodes, it is not a primary symptom. Pertussis is more characterized by severe coughing fits, the distinctive "whoop" sound during inspiration, and potential vomiting after coughing.

Rationale for Correct Options:

• Yellowing of the eyes: Indicates hepatotoxicity, a serious adverse effect of isoniazid, rifampin, and pyrazinamide. These drugs can cause liver damage, leading to jaundice, which presents as yellowing of the eyes and skin. Liver function tests should be monitored closely.
• Blurred vision: Can result from optic neuritis, a known adverse effect of ethambutol. Ethambutol can damage the optic nerve, causing visual disturbances, including decreased visual acuity and color blindness. Patients should undergo routine eye exams.
• Abdominal pain: May indicate hepatotoxicity from TB medications, particularly isoniazid, rifampin, and pyrazinamide. Liver inflammation or damage can manifest as right upper quadrant pain, nausea, and loss of appetite. Monitoring liver enzymes is essential.
• Increased bruising: Can result from thrombocytopenia, a hematologic side effect of rifampin. Rifampin can suppress bone marrow function, leading to reduced platelet production, increasing the risk of spontaneous bruising and prolonged bleeding.
• Increased bleeding tendency: Suggests liver dysfunction, as the liver is responsible for producing clotting factors. Rifampin-induced hepatotoxicity can impair clotting mechanisms, increasing the risk of excessive bleeding from minor injuries.
• Darkening of the urine: A common but harmless side effect of rifampin. Rifampin is excreted in bodily fluids, causing orange or red discoloration of urine, sweat, and tears. Patients should be educated on this expected effect to prevent unnecessary concern.

Rationale for Incorrect Options:

• Dry eyes: Not associated with TB medications and may be due to environmental factors or dehydration.
• Weight gain: Unlikely with TB treatment, as these medications typically cause weight loss rather than weight gain.
• Insomnia: Not a significant adverse effect of first-line TB drugs and may be related to the client’s illness or other factors.
• Urinary frequency: Not a common reaction to TB medications, as these drugs do not significantly affect renal function or bladder activity.