A nurse is assisting with the care of a client who is requesting pain medication. The nurse returns to the bedside to administer the pain medication within the timeframe given to the client. Which of the following ethical principles did the nurse follow?

A. Deliver 2 L of oxygen via partial nonrebreather mask: While supplemental oxygen may support oxygenation, it does not treat the underlying life-threatening allergic reaction. Oxygen alone is insufficient for anaphylaxis and should not delay definitive treatment.

B. Give epinephrine intramuscularly: Epinephrine is the first-line treatment for anaphylaxis and rapidly counteracts airway constriction, hypotension, and vascular permeability. Intramuscular administration in the mid-outer thigh provides rapid absorption and is essential to prevent respiratory compromise and shock.

C. Notify the radiology department: Notifying radiology is unrelated to the acute management of an allergic reaction. Immediate intervention to secure the airway and treat anaphylaxis takes priority over nonessential notifications.

D. Administer diazepam PO: Diazepam is an anxiolytic and has no role in managing anaphylaxis or airway obstruction. It does not reverse histamine-mediated effects and would delay critical emergency treatment.

Rationale for correct choices:

• Yellowing of the eyes: Yellowing of the sclera indicates jaundice, which can occur with hepatotoxicity caused by isoniazid, rifampin, or pyrazinamide. These medications are metabolized by the liver and can cause liver inflammation or failure. Early recognition of jaundice is critical to prevent progression to severe hepatic injury.

• Blurred vision: Ethambutol is associated with optic neuritis, which can present as blurred vision or changes in visual acuity. This adverse effect can be irreversible if not identified early. Regular visual assessment is essential during therapy. Any report of visual changes requires immediate provider notification.

• Abdominal pain: Abdominal pain may indicate liver irritation or hepatitis related to antitubercular medications. Isoniazid, rifampin, and pyrazinamide commonly cause hepatotoxic effects. Abdominal discomfort, especially in the right upper quadrant, can signal worsening liver function. Prompt assessment helps prevent serious complications.

• Increased bruising: Increased bruising can indicate impaired liver synthesis of clotting factors due to hepatotoxicity. Rifampin and isoniazid may contribute to coagulation abnormalities. This finding suggests compromised hepatic function and increased bleeding risk.

• Increased bleeding tendency: A tendency to bleed reflects potential liver dysfunction affecting clotting factor production. Antitubercular therapy–related hepatotoxicity can lead to coagulopathy. This is a serious adverse reaction requiring immediate evaluation. Early detection reduces the risk of hemorrhage.

• Darkening of the urine: Dark urine can be a sign of elevated bilirubin levels from liver injury. Rifampin may also discolor urine, but when combined with other hepatic symptoms, it raises concern for hepatotoxicity. Monitoring urine color helps differentiate benign effects from serious complications. This finding warrants further liver assessment.

Rationale for incorrect choices:

• Dry eyes: Dry eyes are not associated with serious adverse reactions to tuberculosis medications. This finding does not indicate optic nerve involvement or liver toxicity. It is related to environmental or minor irritative causes.

• Weight gain: Weight gain is not a known adverse effect of first-line tuberculosis medications. In fact, weight loss is more common due to infection and medication side effects. This finding does not indicate toxicity.

• Insomnia: Although sleep disturbances may occur with illness or stress, insomnia is not a serious adverse reaction related to the prescribed medications. It does not signal organ toxicity. Other findings are more clinically significant.

• Urinary frequency: Urinary frequency is not associated with antitubercular medication toxicity. Genitourinary adverse effects typically involve urine discoloration rather than changes in frequency. This finding does not suggest a serious reaction.