NURSING PROCESS FOCUS: Patients Receiving Amphotericin B (Fungizone, Abelcet)

Transcription

1 NURSING PROCESS FOCUS: Patients Receiving Amphotericin B (Fungizone, Abelcet) ASSESSMENT Prior to administration: Obtain complete health history including allergies, drug history, and possible drug interactions. POTENTIAL NURSING DIAGNOSES Risk for Injury, related to adverse effects of drug Risk for Infection, related to drug-induced leukopenia Deficient Knowledge, related to drug therapy Obtain a culture and sensitivity of suspected area of infection to determine need for therapy. Obtain baseline vital signs, especially pulse and blood pressure. Obtain renal function including blood tests (CBC, chemistry panel, BUN, and creatinine). PLANNING: PATIENT GOALS AND EXPECTED OUTCOMES The patient will: Report fewer symptoms of fungal infection Demonstrate an understanding of the drug s action by accurately describing drug side effects and precautions Immediately report effects such as fever, chills, fluid retention, dizziness, or decrease in urine output

2 IMPLEMENTATION Interventions and (Rationales) Monitor vital signs, especially pulse and blood pressure, frequently during and after infusion. (Cardiovascular collapse may result when drug is Patient Education/Discharge Planning Advise patient to report dizziness, shortness of breath, heart palpitations, or faintness immediately. infused too rapidly, which is caused by the drug binding to human cytoplasmic sterols.) Monitor kidney function, including intake and output, urinalysis, and periodic blood work. (Amphotericin B is nephrotoxic. This medication is excreted in the urine and causes significant electrolyte loss from the kidneys.) Instruct patient to: Keep all laboratory appointments for blood work (CBC, electrolytes every 2 weeks; BUN, creatinine weekly) Keep an accurate record of intake and output Drink at least 2.5 L of fluids daily Report a decrease in urinary output, change in the appearance of urine, or weight gain or loss Monitor for GI distress. Instruct patient to: Take an antiemetic prior to drug therapy, if needed Report GI distress such as anorexia, nausea, vomiting, extreme weight loss, and headache Monitor for fluid overload and electrolyte imbalance. (Patients with cardiac disease are at high risk.) Advise patients with any form of cardiac disease to report any palpitations, chest pain, swelling of extremities, and shortness of breath. Monitor for signs/symptoms of toxicity and hypersensitivity. Instruct patient to report the following: IV: malaise, generalized pain, confusion, depression, hypotension tachycardia, respiratory

3 failure, evidence of otoxicity such as hearing loss, tinnitus, vertigo, and unsteady gait Topical: irritation, pruritus, dry skin, redness, burning, and itching Monitor IV site frequently for any signs of extravasation. (Medication is irritating to the vein. Use a central line if possible.) Advise patient to report any pain at the IV site. EVALUATION OF OUTCOME CRITERIA Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

4 Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug interactions. Obtain a culture and sensitivity test of suspected area of infection to determine need for therapy Nursing Process Focus: Patients Receiving Nystatin (Mycostatin) Potential Nursing Diagnoses Injury, Risk for (rash) related to adverse effects of medication Altered Nutrition: Less than body requirements, Risk for, related to nausea and vomiting secondary to drug therapy Knowledge, Deficient related to drug therapy and side effects Planning: Patient Goals and Expected Outcomes The patient will Exhibit a clearing of fungal infection. Demonstrate an understanding of the intended effect of drug therapy and the lifestyle modification necessary for that effect. Follow instructions necessary for completion of drug therapy Implementation Interventions and (Rationales) Patient Education/Discharge Planning Monitor for possible side effects or hypersensitivity. Monitor for proper use of the different formulations of this medication. Observe for proper application of dressings. (Occlusive dressings increase the moisture in these areas and encourage development of additional yeast infections.) Strictly follow standard precautions when applying medication to affected areas (to decrease spread of infection). Instruct patient to report any burning, stinging, dryness, itching, and local irritation to their health care provider. Advise patient to: Swish and swallow the oral suspension. Make sure patient understands the importance of coating all mucous membranes before swallowing medication Allow troche to dissolve completely. Do not chew or swallow. Inform patient that for troche it may take 30 minutes for it to completely dissolve Remove dentures prior to using the oral suspension. Instruct patient to: Apply dressings properly Avoid wearing tight fitting undergarments if using ointment in the vaginal or groin area. Teach patient to Clean affected area daily Apply medication with a glove Wash hands properly and keep nails clean Change socks daily if rash is on feet

5 Monitor for alcohol use. (Increases the risk of side effects such as nausea vomiting and an increase in blood pressure with concurrent use.) Monitor for effectiveness of medication. (As evidenced by a decrease/elimination of fungus.) Instruct patient to avoid alcohol during drug therapy. Instruct patient to: Report spread of affected area Use medication as ordered. May need to use for several weeks Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

6 NURSING PROCESS FOCUS: Patients Receiving Metronidazole (Flagyl) ASSESSMENT Prior to administration: Obtain complete health history including allergies, drug history, and possible drug interactions. Obtain results from serologic studies, stool POTENTIAL NURSING DIAGNOSES Risk for Injury, related to dizziness secondary to side effect of drug Risk for Fluid Volume Imbalance related to nausea and vomiting secondary to side effect of drug samples or cultures of the suspected area of infection to determine the need for therapy. Obtain baseline vital signs, especially pulse and blood pressure. Obtain complete blood count. PLANNING: PATIENT GOALS AND EXPECTED OUTCOMES The patient will: Report decreased signs and symptoms amebic or other infection Demonstrate an understanding of the drug s action by accurately describing drug side effects and precautions Immediately report effects such as seizures, numbness in limbs, nausea, vomiting, hives, or itching IMPLEMENTATION Interventions and (Rationales) Monitor complete blood count periodically. (The drug may cause leukopenia.) Patient Education/Discharge Planning Instruct patient to notify the healthcare provider of fever or other signs of infection. Encourage treatment of sexual partner. (Asymptomatic trichomoniasis in the male is a Instruct patient that simultaneous treatment of a sexual partner is necessary. frequent source of reinfection.)

7 Monitor use of alcohol. (Metronidazole interferes with the metabolism of alcohol.) Instruct patient to: Abstain from alcohol including any OTC medication that contains alcohol (liquid cough and cold products) Report side effects such as cramping, vomiting, flushing, and headache which may result with alcohol use Monitor CNS toxicity. (High doses may cause seizures and peripheral Instruct patient to immediately report seizures, numbness of limbs, nausea, and vomiting. neuropathy possibly related to the medication s distribution into the CSF.) Monitor for allergic reactions. Instruct patient to immediately report hives and itching, rash, flushing, fever, and/or joint pain. Monitor for gastrointestinal distress. (This is the most common adverse effect.) Instruct patient to: Take medication with food to decrease gastrointestinal distress Recognize that medication may cause a metallic taste in the mouth EVALUATION OF OUTCOME CRITERIA Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

8 Nursing Process Focus: Patients Receiving Zidovudine (Retrovir) Assessment Potential Nursing Diagnoses Prior to administration Infection, Risk for related to decreased Obtain complete health history including CD4 count allergies, drug history and possible drug Injury, Risk for (dizziness) related to interactions. adverse effects of drug therapy Assess for presence or history of viral Pain, Risk for (Headache) related to infection adverse effects of drug therapy Assess complete blood count, CD4 Tissue perfusion, Risk for Ineffective count, liver and kidney function related to bone marrow depression Obtain history of sensitivity to secondary to adverse effects of drug Zidovudine therapy Planning: Patient Goals and Expected Outcomes The patient will: Remain free of side effects, including headache, insomnia, confusion, petechiae, nausea, vomiting, rash, fever and muscle pain. Demonstrate understanding of all lifestyle modifications necessary for successful completion of drug therapy Maintain adequate tissue perfusion Implementation Interventions and (Rationales) Observe for signs and symptoms of infection or bleeding. (Patient may develop granulocytopenia or thrombocytopenia.) Monitor vital signs (especially temperature). Monitor use of acetaminophen. (Concurrent use of acetaminophen may increase chance of bone marrow depression.) Patient Education/Discharge Planning Advise patient: That medication may decrease the level of HIV infection in the blood but will not prevent transmitting the disease To use barrier protection during sexual activity Instruct patient not to use acetaminophen while on drug therapy and warn that acetaminophen is often used with cold product preparations Monitor weight. (Weight gain may indicate positive effect of drug therapy and absence of GI distress.) Monitor intake and output (may cause renal dysfunction) Monitor complete blood count and CD4 counts weekly (to evaluate effectiveness of therapy). Advise patient to: Take medication 1 hour before meals. Report GI distress to the health care provider Instruct patient to report changes in urinary output to the health care provider. Advise patient to keep all laboratory appointments.

9 Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

10 Nursing Process Focus: Patients Receiving Acyclovir (Zovirax) Assessment Potential Nursing Diagnoses Prior to administration Infection, Risk for related to ineffective Obtain complete health history including response to drug therapy allergies, drug history and possible drug Nutrition, Risk for Imbalanced: less than interactions body requirements related to nausea, Assess for presence/history viral vomiting and diarrhea secondary to infections adverse effects of drug therapy Assess renal function, complete blood Injury, Risk for (seizures) related to count, viral culture, and vital signs adverse effects of drug therapy Assess for herpes simplex infection Knowledge Deficient, related to drug therapy and side effects Planning: Patient Goals and Expected Outcomes The patient will: Demonstrate understanding of intended effects of drug therapy and the lifestyle modifications necessary to achieve intended drug effect. Maintain weight within expected levels Remain free of physical injury Remain free of side effects including headache, confusion, seizures, flank pain, hematuria, rash and petechiae. Interventions and (Rationales) Monitor complete blood count periodically. (Drug may cause thrombocytopenic purpura or hemolytic uremic syndrome.) Monitor vital signs (especially temperature). Monitor renal status. (Acute renal failure may result if administered with other nephrotoxic drugs.) Implementation Patient Education/Discharge Planning Advise patient to: Report occurrence of unusual bleeding and bruising to the health care provider Increase fluid intake while on drug therapy to prevent dehydration Refrain from sexual activity until no symptoms of herpes infection remains Inform patient that: Recurrences of herpes simplex infection may be precipitated by stress, trauma or other physical illness Drug therapy is most effective when begun soon after the start of symptoms Instruct patient: To report all medications taken to the health care provider To report changes in urinary output

11 Monitor intake and output. (Medication may cause anorexia and stomatitis.) Advise patient: To report symptoms of ulcerations of the mouth to the health care provider To report inability to tolerate meals Observe for evidence of GI distress. Advise patient that medication may be taken with food to decrease gastrointestinal distress. Observe IV site closely and stop infusion at first sign of infiltration. (Drug causes severe inflammation at the sit of infiltration.) Periodically monitor BUN, serum creatinine and urinalysis. (Renal dysfunction may occur.) Evaluation of Outcome Criteria Instruct patient to immediately report burning, pain at the IV site to the health car provider. Instruct patient to report changes in urinary output to the health care provider. Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).