A client who started isoniazid, rifampin, ethambutol and pyrazinamide for pulmonary tuberculosis 6 weeks ago is seen at the clinic. Which of the client's reports should the nurse communicate to the provider promptly? Select all that apply.
A"The vision in my left eye looks blurry, and I can't tell red from green."✓ Correct
Correct. Ethambutol can cause optic neuritis with decreased visual acuity and color blindness, and any change in vision is reported promptly.
B"My fingers and toes have been numb and tingling for a week."✓ Correct
Correct. Isoniazid can cause peripheral neuropathy, so persistent numbness and tingling in the hands and feet is reported.
C"My skin and the whites of my eyes look yellow, and I have no appetite."✓ Correct
Correct. These are signs of liver damage, a serious risk with antitubercular drugs that must be reported immediately.
D"My urine and tears have turned orange-red."✗ Incorrect
Incorrect. Rifampin can tint urine, sweat and tears orange-red. Clients are warned about this ahead of time because it is an expected effect, not a sign of toxicity.
E"My soft contact lenses have taken on an orange tint."✗ Incorrect
Incorrect. Rifampin can permanently stain soft contact lenses; this is an expected effect rather than a sign of toxicity.
Answer
A. "The vision in my left eye looks blurry, and I can't tell red from green." · B. "My fingers and toes have been numb and tingling for a week." · C. "My skin and the whites of my eyes look yellow, and I have no appetite."
Rationale
Antitubercular drugs can injure the liver, nerves and eyes. Jaundice and loss of appetite suggest hepatotoxicity, persistent numbness and tingling in the hands and feet suggests isoniazid neuropathy, and a change in visual acuity or color discrimination suggests ethambutol optic neuritis. Each is reported promptly because the drug may need to be changed. Rifampin can tint body fluids red-orange and may permanently stain soft contact lenses; clients are forewarned about both because they are expected effects rather than signs of toxicity.
RememberReport jaundice, numb or tingling extremities and vision changes; orange body fluids from rifampin are expected.
Sources
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