A nurse is reinforcing discharge teaching with a client who has heart failure. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

Rationale for Correct Options:

• Yellowing of the eyes: Indicates hepatotoxicity, a serious adverse effect of isoniazid, rifampin, and pyrazinamide. These drugs can cause liver damage, leading to jaundice, which presents as yellowing of the eyes and skin. Liver function tests should be monitored closely.
• Blurred vision: Can result from optic neuritis, a known adverse effect of ethambutol. Ethambutol can damage the optic nerve, causing visual disturbances, including decreased visual acuity and color blindness. Patients should undergo routine eye exams.
• Abdominal pain: May indicate hepatotoxicity from TB medications, particularly isoniazid, rifampin, and pyrazinamide. Liver inflammation or damage can manifest as right upper quadrant pain, nausea, and loss of appetite. Monitoring liver enzymes is essential.
• Increased bruising: Can result from thrombocytopenia, a hematologic side effect of rifampin. Rifampin can suppress bone marrow function, leading to reduced platelet production, increasing the risk of spontaneous bruising and prolonged bleeding.
• Increased bleeding tendency: Suggests liver dysfunction, as the liver is responsible for producing clotting factors. Rifampin-induced hepatotoxicity can impair clotting mechanisms, increasing the risk of excessive bleeding from minor injuries.
• Darkening of the urine: A common but harmless side effect of rifampin. Rifampin is excreted in bodily fluids, causing orange or red discoloration of urine, sweat, and tears. Patients should be educated on this expected effect to prevent unnecessary concern.

Rationale for Incorrect Options:

• Dry eyes: Not associated with TB medications and may be due to environmental factors or dehydration.
• Weight gain: Unlikely with TB treatment, as these medications typically cause weight loss rather than weight gain.
• Insomnia: Not a significant adverse effect of first-line TB drugs and may be related to the client’s illness or other factors.
• Urinary frequency: Not a common reaction to TB medications, as these drugs do not significantly affect renal function or bladder activity.

A. Encourage the family to be with the child during mealtimes. While having family present can provide support and create a positive mealtime atmosphere, it is not the first step in addressing poor dietary intake. Understanding the underlying reasons for the child's poor intake is more critical initially.
B. Instruct the family to praise the child when they eat. Encouraging praise can help create a positive association with eating, but this action is more effective after understanding the child's dietary habits and preferences.
C. Obtain the child's dietary history. Obtaining the child's dietary history is the most important first step. This allows the nurse to identify specific concerns, such as food preferences, patterns of intake, and any potential food allergies or intolerances. Understanding the child's current dietary habits is essential for developing an effective plan to improve nutritional intake.
D. Offer the child nutritious snacks between meals. Offering nutritious snacks can help increase caloric intake, but this should be done after assessing the child's dietary history to ensure that the snacks are appropriate and tailored to the child's needs and preferences.