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?

Rationale:

A. Apply direct pressure to the wound with thick dressing material: Direct pressure is the first-line intervention for controlling active external bleeding. Applying firm pressure with thick, sterile dressing helps tamponade the bleeding vessel and minimizes blood loss while awaiting further treatment.

B. Apply a transparent dressing to the wound: Transparent dressings are used for minor wounds or IV sites, not for managing active bleeding. They do not provide the necessary compression to control hemorrhage from a deep or penetrating injury.

C. Irrigate the wound with sterile water: Wound irrigation is appropriate for cleaning minor wounds or after bleeding is controlled. Irrigating during active bleeding can delay hemostasis and increase blood loss.

D. Tie a tourniquet around the leg distal to the wound: A tourniquet, if necessary, must be placed proximal not distal to the bleeding site to effectively restrict arterial flow. Distal placement worsens bleeding and can compromise tissue perfusion unnecessarily.

Rationale for Correct Choices:

• Blurred vision: Amitriptyline causes anticholinergic effects such as blurred vision by impairing lens accommodation. This effect is common in the early stages of treatment and may improve over time.
• Orthostatic hypotension: Amitriptyline reduces peripheral vascular resistance, which can cause blood pressure to drop when a client changes position. This increases the risk for falls, especially in older adults.
• Urinary retention: Anticholinergic effects from amitriptyline reduce bladder contractility, leading to urinary retention. This is especially concerning in clients with prostate enlargement or existing urinary difficulties.
• Constipation: Decreased gastrointestinal motility caused by anticholinergic activity makes constipation a common and expected side effect. Clients should be advised to increase fiber and fluid intake.

Rationale for Incorrect Choices:

• HEENT: Hearing loss is not associated with tricyclic antidepressants like amitriptyline, which do not affect the auditory system. Photophobia typically results from conditions like migraines or uveitis, not from tricyclic antidepressant use.
• Cardiovascular: Hypertension is not a known side effect of amitriptyline. The medication more commonly lowers blood pressure through vasodilation. Bradycardia is not expected with amitriptyline. In fact, the drug may cause tachycardia due to its effect on cardiac conduction.
• Genitourinary: Urinary incontinence is not typical with amitriptyline. The drug’s anticholinergic properties reduce bladder contractility, increasing the risk of retention instead. Increased libido is not a side effect of tricyclic antidepressants. These medications are more likely to decrease libido and may contribute to sexual dysfunction.
• Gastrointestinal: Dry mouth is a common anticholinergic effect but does not directly impact gastrointestinal motility, making it a less appropriate answer in this system category. Diarrhea is not expected with anticholinergic drugs like amitriptyline, which slow bowel movements and increase the risk for constipation.