A nurse is monitoring a client who is 36 hr postoperative following gastric banding. Which of the following findings should the nurse expect?

A. Contemplation: In the contemplation stage, individuals or groups are aware of a problem and are thinking about making a change but have not yet taken any action. The focus remains on weighing the pros and cons of changing behavior.
B. Action: The action stage involves actively modifying behaviors, environments, or systems. Since the group is already in the process of reducing pesticide use, they are implementing change, which aligns with the action phase of behavior change.
C. Maintenance: Maintenance is the stage in which individuals or groups work to sustain changes that have already been fully implemented. This group has not yet reached that point, as they are still actively working on the change.
D. Preparation: In the preparation stage, individuals or groups intend to take action soon and may begin making small changes. However, this does not fit the scenario because the group has moved beyond planning and is already enacting the change.

Rationale for Correct Choices:

• A change in mood: Isotretinoin is associated with serious neuropsychiatric side effects, including depression, suicidal ideation, and other mood changes. Adolescents are at higher risk, and any mood alterations should be promptly reported to prevent adverse outcomes.
• Decreased night vision: Isotretinoin can cause visual disturbances, including decreased night vision. This side effect may impair safety (e.g., driving at night), and persistent or worsening symptoms warrant immediate medical evaluation.

Rationale for Incorrect Choices:

• Nausea: While nausea can be a side effect of isotretinoin, it is not typically an urgent concern unless accompanied by signs of liver toxicity or pancreatitis. Mild nausea alone does not require immediate provider notification.
• The development of dry eyes: Dry eyes are a known and relatively common side effect of isotretinoin. They can typically be managed with over-the-counter lubricating eye drops and do not require immediate provider contact unless severe or persistent.
• Dry mouth: Dry mouth is not a significant or common concern with isotretinoin and, if present, can usually be managed with increased hydration and sugar-free lozenges. It is not an urgent finding.
• Worsening of acne: Acne often temporarily worsens during the initial weeks of isotretinoin therapy before improvement occurs. This is expected and not an indication to discontinue treatment or contact the provider urgently.
• Sunburn: Isotretinoin increases photosensitivity, making sunburn more likely. Clients should use sun protection, but sunburn itself does not typically require immediate provider contact unless severe.
• Engagement in sexual activity: Although sexual activity itself is not a side effect of isotretinoin, it is highly relevant for female patients due to isotretinoin’s teratogenicity. However, in this scenario with a negative hCG and no indication of sexual activity, this is a preventive counseling point rather than a reportable adverse effect.