The nurse is continuing to care for the child.

Exhibits

After reviewing the discharge instructions with the family, which of the following statements by a parent indicate an understanding of the teaching? For each statement by the parent, click to specify if the statement reflects an understanding or indicates a need for reinforcement of the discharge teaching.

Rationale:

A. A client who moved to an apartment located on higher ground than her previous home: Relocating for safety is a rational coping mechanism and does not, on its own, indicate PTSD. This action reflects adaptation rather than signs of trauma-related distress.

B. A client who has frequent nightmares about the hurricane: Recurrent nightmares related to the traumatic event are a hallmark symptom of PTSD and suggest that the client is experiencing persistent re-experiencing of the trauma.

C. A client who expresses a realization that life will not return to the way it was before the hurricane: This statement reflects acceptance and realistic processing of the event, not necessarily indicative of emotional distress or dysfunction associated with PTSD.

D. A client who describes having persistent feelings of anger about the hurricane: Chronic irritability or anger following trauma is a recognized symptom of PTSD and may indicate the client is struggling with emotional regulation due to unresolved trauma.

E. A client who describes feeling disconnected from those around him following the hurricane: Emotional numbing or detachment from others is a common symptom of PTSD, often associated with difficulty in re-establishing interpersonal connections after trauma.

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.