An 11-year-old with juvenile rheumatoid arthritis is to be kept on continued aspirin medication at home. Before discharge, the nurse should teach the child and parents to closely monitor for the toxic effects of this drug, including?

1. A

   Jaundice

2. B

   Tinnitus

3. C

   Hypothermia

4. D

   Diarrhea

Appeared in: JSSH Staff Nurse - 2019

Explanation

• Tinnitus, or ringing in the ears, is a classic and often the earliest symptom of salicylate toxicity (salicylism).
• It is a sign that the level of aspirin in the blood is approaching toxic levels, affecting the auditory nerve (cranial nerve VIII).
• The appearance of tinnitus is used as a clinical guide to determine the maximum tolerated dose of aspirin, especially in long-term therapy for conditions like juvenile rheumatoid arthritis.
• Patient education emphasizes reporting tinnitus immediately so the dosage can be reduced to prevent more severe toxicity.

Why Other Options Were Wrong

• Option A: Jaundice (yellowing of the skin and eyes) is a sign of liver damage (hepatotoxicity). While high doses of aspirin can be toxic to the liver, jaundice is a later and more severe sign, not the initial warning symptom of salicylism.
• Option C: Aspirin toxicity does not cause hypothermia (low body temperature). Instead, it disrupts cellular metabolism, leading to hyperthermia or hyperpyrexia (high fever) in moderate to severe cases.
• Option D: While gastrointestinal upset like nausea and vomiting is common with aspirin, and diarrhea can occur, it is not the specific hallmark sign of early salicylism. Tinnitus is a more specific neurotoxic effect.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Monitoring for adverse effects of long-term aspirin therapy, specifically salicylate toxicity (salicylism) in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• A nurse's primary role in discharge planning is patient education to ensure safety at home. For chronic medications like aspirin, teaching about key adverse effects is critical for early intervention.
• Empowering parents to recognize early signs of toxicity like tinnitus can prevent life-threatening complications.
• What if? If this child on aspirin developed a fever and flu-like symptoms, the nurse must instruct the parents to stop the aspirin immediately and consult a provider. This is to prevent Reye's syndrome, a potentially fatal condition linked to aspirin use during viral illnesses in children.

How to Approach the Question

• First, identify the key elements of the question: an 11-year-old on long-term aspirin for juvenile rheumatoid arthritis and the need to monitor for toxicity.
• The core of the question is asking for a classic sign of aspirin toxicity (salicylism).
• Recall the pharmacological effects and side effects of salicylates (aspirin).
• Evaluate each option based on this knowledge:
• Jaundice: Relates to the liver. Is it an early sign? No, it's a later, more severe sign.
• Tinnitus: 'Ringing in the ears.' This is a well-known, classic early sign of aspirin toxicity.

Concept Tested & Keywords

• Concept Tested: Monitoring for adverse effects of long-term aspirin therapy, specifically salicylate toxicity (salicylism).
• Stem keywords: juvenile rheumatoid arthritis, aspirin, toxic effects, monitor
• Lead-in keywords: monitor for
• Clinical cues: 11-year-old
• Clinical cues: continued aspirin medication

Question ID

QuzoaFzSSVbYJtPw_P5WSw

Copy ID

Reference Book

E6 Pharmacology Nursing Lilley 11e Part 3 pp. 69-71, 67-69, 64-66