The nurse is completing a health history with the parents of a 6-month-old infant with retinoblastoma. Which symptom should the nurse expect that the parents have observed?

Rationale:

A. Bradycardia: Bradycardia is a late sign of increased ICP and typically appears after other symptoms like changes in behavior or consciousness have developed. Early detection focuses more on neurological changes rather than vital sign alterations.

B. Restlessness and confusion: These are early neurological signs indicating altered cerebral function due to increased ICP. Changes in behavior, such as irritability, restlessness, and confusion, often precede vital sign changes and are key for prompt intervention.

C. Large amounts of very dilute urine: This finding suggests possible diabetes insipidus or fluid imbalance, which can occur with severe brain injury but is not an early indicator of increased ICP specifically. It is not a primary sign for monitoring ICP.

D. Widened pulse pressure: Widened pulse pressure is part of Cushing’s triad, a late and serious sign of increased ICP that occurs after the brainstem is compromised. Early signs are more subtle and neurological rather than cardiovascular.

Rationale:

A. Antacids and milk increase absorption: Calcium in milk and the alkaline nature of antacids actually interfere with iron absorption. Taking iron with these can significantly reduce its effectiveness in correcting anemia.

B. May turn stool a bright red or dark red color: Iron supplements do not cause bright red or dark red stools; those findings could indicate gastrointestinal bleeding. Iron may darken stools to a black or dark green hue, which is harmless and expected.

C. Short Term: Only 1 to 2 months to replenish iron stores: Iron deficiency anemia often requires several months (typically 3–6 months or longer) of supplementation to replenish both hemoglobin levels and iron stores. Stopping too soon increases the risk of relapse.

D. Orange Juice (Vitamin C) increases absorption: Vitamin C enhances the solubility and absorption of non-heme iron from supplements, making orange juice a beneficial choice to take with the iron pill. This can help improve treatment outcomes.

E. Antacids and milk decrease absorption: Both interfere with iron uptake in the gut calcium in dairy products binds with iron, and antacids raise stomach pH, reducing iron solubility. The patient should avoid taking these within a couple of hours of their iron dose.

F. Can cause constipation- Add a stool softener: Iron supplements frequently cause gastrointestinal side effects, especially constipation. Encouraging stool softeners, hydration, and dietary fiber can improve adherence and comfort.

G. Best absorbed on full stomach - Take with meals: Although taking with food may reduce gastrointestinal upset, it also decreases absorption by up to 50%, so this is not the preferred method unless stomach irritation is severe.

H. Best absorbed on empty stomach- Take 1 hr before meals: Iron is most effectively absorbed on an empty stomach when stomach acid levels are higher. Taking it about an hour before meals maximizes absorption, provided the patient tolerates it without excessive stomach discomfort.