A nurse is assessing a client who has endometritis. Which of the following findings should the nurse expect?

Rationale for Correct Choices:

• Intravenous antibiotic: The client shows multiple signs of endometritis: uterine tenderness, foul-smelling lochia, fever, tachycardia, and elevated WBC count. IV antibiotics are the first-line treatment for postpartum uterine infections, particularly after cesarean delivery with risk factors like prolonged rupture of membranes.
• Increase in daily fluid intake: Clients with infection and fever require increased hydration to support perfusion, manage elevated metabolic demands, and help clear the infection. Fever and poor bowel motility may also contribute to mild dehydration, making fluid support essential.

Rationale for Incorrect Choices:

• Intrauterine tamponade balloon: This is used to control postpartum hemorrhage due to uterine atony or trauma. Although the fundus was boggy, it firmed with massage, and there is no indication of active or excessive bleeding, making tamponade unnecessary.
• Kleihauer-Betke test: This test detects fetal blood in the maternal circulation and is used after trauma or suspected fetal-maternal hemorrhage, especially in Rh-negative mothers. It is not relevant to this postpartum infection scenario.
• Tocolytic medication: Tocolytics are used during pregnancy to suppress preterm labor by relaxing the uterus. In the postpartum period, they are not indicated and would be contraindicated in the presence of infection, as they can reduce uterine tone and worsen involution.

Rationale for correct choices:

• A change in mood: Mood changes, including depression, irritability, or suicidal thoughts, are serious adverse effects associated with isotretinoin use. Adolescents are particularly vulnerable to these side effects, and any mood alterations during treatment warrant immediate provider notification.
• Decreased night vision: Isotretinoin can lead to visual disturbances, including decreased night vision, which may be sudden and irreversible. This adverse effect is rare but serious, and any signs of visual impairment should be reported promptly to prevent injury or permanent damage.

Rationale for incorrect choices:

• The development of dry eyes: Dry eyes are a common and expected side effect of isotretinoin, often due to mucous membrane dryness. While uncomfortable, it is not typically dangerous and can usually be managed with lubricating eye drops or supportive care without immediate provider contact.
• Dry mouth: Dry mouth occurs frequently with isotretinoin due to its drying effects on mucosal surfaces. It is bothersome but not dangerous, and clients can manage it with increased fluid intake and sugar-free lozenges. It doesn’t require urgent medical attention unless severe.
• Nausea: Nausea is not a common or concerning side effect of isotretinoin. If persistent or severe, it may require evaluation, but it is not a priority symptom for immediate provider contact unless accompanied by other warning signs like abdominal pain or jaundice.
• Sunburn: Increased photosensitivity is an expected effect of isotretinoin, and clients should be advised to wear sunscreen and protective clothing. Sunburn, while uncomfortable, is not an emergency and does not require immediate medical consultation unless it becomes severe.
• Worsening of acne: An initial acne flare is a known and expected part of isotretinoin therapy as pores begin to purge. This typically improves after several weeks and does not indicate treatment failure or require immediate provider notification unless accompanied by signs of infection.
• Engagement in sexual activity: While not a symptom, sexual activity is significant for female clients due to isotretinoin's teratogenicity. However, since this client has a negative hCG and is not sexually active, this is part of routine risk counselling not an immediate concern unless pregnancy is possible.