Antimicrobial Drugs

M34_ADAM9811_03_SE_CH34.QXD 12/30/09 1:16 PM Page 502
502 Unit 5 The Immune System
NURSING PROCESS FOCUS
PATIENTS RECEIVING ANTITUBERCULOSIS DRUGS
Assessment
Potential Nursing Diagnoses
Baseline assessment prior to administration:
■ Understand the reason the drug has been prescribed in order to assess for
therapeutic effects.
■ Obtain a complete health history including neurologic, cardiovascular,
respiratory, gastrointestinal hepatic or renal disease, and the possibility of
pregnancy. Obtain a drug history including allergies, including specific reactions
to drugs, current prescription and OTC drugs, herbal preparations, and alcohol
use. Be alert to possible drug interactions.
■ Assess signs and symptoms of current infection noting symptoms, duration, or
any recent changes. Assess for concurrent infections, particularly HIV.
■ Evaluate appropriate laboratory findings (e.g., CBC, AFB C&S, hepatic and renal
function studies).
Assessment throughout administration:
■ Assess for desired therapeutic effects (e.g., diminished signs and symptoms of
infection, fever, night-sweating, increasing ease of breathing, decreased sputum
production, improved radiographic evidence of improving infection).
■ Continue periodic monitoring of CBC, and hepatic and renal function.
■ Assess for adverse effects: nausea, vomiting, abdominal cramping, diarrhea,
drowsiness, dizziness, paresthesias, tinnitus, vertigo, blurred vision, changes in
visual color sense, and increasing fatigue. Eye pain, acute vision change, sudden
or increasing numbness or tingling in extremities, decreased hearing or
significant tinnitus, and increase in bruising or bleeding should be immediately
reported.
Planning: Patient Goals and Expected Outcomes
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Infection
Fatigue
Imbalanced Nutrition, Less than Body Requirements (related to
fatigue, adverse drug effects)
Deficient Knowledge (drug therapy, infection control measures)
Risk for Noncompliance (related to adverse drug effects, deficient
knowledge, length of treatment required, or cost of medication)
Risk for Social Isolation (related to disease, length of treatment)
The patient will:
■ Experience therapeutic effects (e.g., diminished signs and symptoms of infection, decreased fever and fatigue, increased appetite).
■ Be free from, or experience minimal, adverse effects.
■ Verbalize an understanding of the drug’s use, adverse effects, and required precautions.
■ Demonstrate proper self-administration of the medication (e.g., dose, timing, when to notify provider).
Interventions and (Rationales)
Ensuring therapeutic effects:
■ Continue assessments as described earlier for therapeutic effects. (Diminished
fever, cough, sputum, and other signs and symptoms of infection should be
noted.)
■ Recognize that tuberculosis treatment requires long-term compliance and many
reasons exist for noncompliance. (Noncompliance may increase the risk to the
patient’s health, family and community health, and promotes the development
of resistant organisms. Monitoring of drug administration may be required to
ensure therapy is continued.)
Minimizing adverse effects:
■ Continue to monitor vital signs, breath sounds, and sputum production and
quality. Immediately report undiminished fever, increases in sputum production,
hemoptysis, or increase in adventitious breath sounds to the health care
provider. (Increasing signs of infection may signify drug resistance or significant
noncompliance with drug regimen.)
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Continue to monitor periodic lab work: hepatic and renal function tests, CBC, and
sputum culture for AFB. (Antituberculosis drugs are hepatic and/or renal toxic.
Periodic C&S tests may be ordered if infections are severe or are slow to resolve
to confirm appropriate therapy. Drug levels will be monitored on drugs with
known severe adverse effects.)
Implementation
Patient Education/Discharge Planning
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Teach the patient to not stop drugs when “feeling better” but to
continue prescribed course of therapy; do not share doses with other
family members with similar symptoms; and return to provider if
adverse effects develop to ensure drug therapy is maintained.
Discuss with the patient concerns about cost, family members who
have similar symptoms or may need prophylactic treatment, and how
to manage adverse effects to help encourage compliance.
Teach the patient to promptly report a fever that does not diminish
below 100°F; continued symptoms of disease (e.g., night sweating,
fatigue); or increase in sputum production to the health care provider.
Instruct the patient on the need for periodic lab work.
# 102887 Cust: PE/NJ/CHET Au: ADAMS Pg. No. 502
Title: Pharmacology for Nurses Server: Jobs2
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