As a staff nurse you are caring a patient with Psoriasis. Salicylic acid is prescribed to the patient. Which finding indicates that presence of systemic toxicity from this medication?

Appeared in: Chitranjjan National Cancer Institute Kolkata - 2021

Explanation

Salicylic acid is a salicylate, and its systemic absorption can lead to a condition called salicylism.
Tinnitus, or ringing in the ears, is a hallmark and often one of the first signs of chronic salicylate intoxication (salicylism) in adults.
This symptom occurs due to the drug's effect on the auditory pathways in the central nervous system.
Recognizing tinnitus as an early warning sign is critical for preventing the progression to more severe toxicity.

Option A: Early salicylate toxicity typically causes hyperventilation (increased respiratory rate) due to direct stimulation of the respiratory center in the brain.
Option C: Constipation is not a recognized symptom of salicylate toxicity.
Option D: While gastrointestinal upset like nausea and vomiting can occur with salicylate toxicity, diarrhea is less specific and not considered a primary indicator of systemic toxicity.

Clinical Relevance

Nursing practice connection: Use the key finding related to Signs of systemic salicylic acid toxicity (salicylism) to guide bedside assessment, documentation, and the next nursing action.
Nurses must educate patients using topical salicylic acid, especially for chronic conditions like psoriasis, about the risk of systemic absorption and the specific signs of toxicity to report.
Application should be limited to the prescribed area, avoiding large body surfaces or occlusive dressings unless directed by a provider, to minimize systemic absorption.
Patient safety depends on recognizing early signs like tinnitus, which allows for prompt intervention (e.g., discontinuing the medication) before severe, life-threatening complications develop.

How to Approach the Question

First, identify the core of the question: it's asking for a sign of systemic toxicity from a specific drug, salicylic acid.
Recall or look up the drug class. Salicylic acid is a salicylate, the same class as aspirin.
Think about the classic signs of toxicity for that drug class. For salicylates, this is known as salicylism.
Evaluate the given options against the known symptoms of salicylism. Tinnitus is a well-known, classic early sign.
Differentiate between early and late signs. Note that respiratory rate increases initially (hyperventilation) and only decreases in severe, late-stage toxicity. This rules out 'Respiration decreased' as an early sign.
Eliminate non-specific or unrelated symptoms like constipation and diarrhea, focusing on the most specific indicator.

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 3 p. 60-62

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 755-757

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