NORTH NUR 127 - Pharmacotherapy Superficial Fungal (2 pages)

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Pharmacotherapy Superficial Fungal



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Pharmacotherapy Superficial Fungal

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2
School:
North Seattle College
Course:
Nur 127 - Medical/Surgical Nursing
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ADAMMC35 0131756656 2 28 07 12 43 AM Page 522 Team B ve401 PEQY046 phada2 ch35 MediaLink World Health Organization 522 Unit 5 The Immune System Abstain from sexual intercourse until treatment for vaginal infection has been completed For clients with vaginal candidiasis use the correct method for administering vaginal suppositories creams and ointments Perform oral hygiene before using oral lozenges or swish and swallow formulations PROTOZOAL INFECTIONS Protozoa are single celled animals Although only a few of the more than 20 000 species cause disease in humans they have a significant health impact in Africa South America and Asia Travelers to these continents may acquire these infections overseas and bring them back to NURSING PROCESS FOCUS Clients Receiving Pharmacotherapy for Superficial Fungal Infections Assessment Potential Nursing Diagnoses Prior to administration Obtain a complete health history including allergies drug history and possible drug interactions Obtain a culture and sensitivity of suspected area of infection to determine need for therapy Obtain baseline liver function tests Injury Risk for rash related to side effect of drug Knowledge Deficient related to lack of experience with drug therapy Skin Integrity Impaired Planning Client Goals and Expected Outcomes The client will Report a reduction in symptoms related to the diagnosed infection and have negative results for laboratory and diagnostic tests for the presenting infection Demonstrates an understanding of the drug s action by accurately describing drug side effects and precautions Immediately report hepatoxicity GI distress rash or decreased urine output Demonstrate correct technique for application of medication Implementation Interventions and Rationales Monitor for possible side effects or hypersensitivity Symptoms of hypersensitivity may require immediate interventions Client Education Discharge Planning Instruct client to report Burning stinging dryness itching erythema urticaria angioedema and local irritation to superficial drugs Symptoms of hepatic toxicity jaundice dark urine light colored stools and pruritus Nausea vomiting and diarrhea Signs and symptoms of hypoglycemia or hyperglycemia Encourage compliance with instructions when taking oral antifungals Medication effectiveness increases Instruct client to Cleanse mouth by rinsing before inserting lozenge or solution Swish the oral suspension to coat all mucous membranes and then swallow medication Spit out medication instead of swallowing if GI irritation occurs Allow troche to dissolve completely rather than chewing or swallowing it may take 30 minutes for it to completely dissolve Avoid food or drink for 30 minutes following administration Remove dentures prior to using the oral suspension Take ketoconazole with water fruit juice coffee or tea to enhance dissolution and absorption Monitor topical application and avoid occlusive dressings Dressings increase moisture in the infected areas and encourage development of additional yeast infections Instruct client to Cleanse the affected area with soap and water before applying medication Avoid using the drug near open wounds and active lesions Insert vaginal suppositories creams and tablets high into the vagina and remain recumbent for 1 to 15 minutes after insertion Avoid wearing tight fitting undergarments if using ointment in the vaginal or groin area Monitor for contact dermatitis with topical formulations This side effect is related to the preservatives found in many of the formulations Instruct client to report any redness or skin rash ADAMMC35 0131756656 2 17 07 2 26 PM Page 523 107 PEQY046 phada2 ch35 Chapter 35 Drugs for Fungal Protozoal and Helminthic Infections 523 NURSING PROCESS FOCUS Clients Receiving Pharmacotherapy for Superficial Fungal Infections Continued Implementation Interventions and Rationales Client Education Discharge Planning Encourage infection control practices This prevents the spread of infections Instruct client to Clean affected area daily Apply medication with a glove Wash hands properly before and after application Wear clean dry socks and change daily or more frequently if needed if infection is on the feet Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that client goals and expected outcomes have been met see Planning The client reports a reduction in symptoms and has improved laboratory results The client demonstrates an understanding of the drug s action by accurately describing drug side effects and precautions The client Verbalizes states effects that should be immediately reported The client demonstrates correct application of lotion creams lozenges and other topical drugs See Table 35 3 as well as the oral and topical systemic drugs in Table 35 2 for a list of drugs to which these nursing actions apply the United States and Canada These parasites often thrive in conditions where sanitation and personal hygiene are poor and population density is high In addition protozoal infections often occur in clients who are immunocompromised such as those in the advanced stages of AIDS or who are receiving antineoplastic drugs Agents for malarial infections are listed in Table 35 5 TABLE 35 5 Selected Drugs for Malaria Drug Route and Adult Dose max dose where indicated Adverse Effects atovaquone and proguanil Malarone PO 1 tablet day starting 1 2 days before travel and continuing until 7 days after return Nausea vomiting abdominal pain diarrhea headache myalgia Neutropenia hypotension PO 600 mg initial dose then 300 mg wk chloroquine hydrochloride Aralen hydroxychloroquine sulfate Plaquenil see page 748 for the Prototype Drug box mefloquine Lariam PO 620 mg initial dose then 310 mg wk Nausea vomiting and diarrhea visual changes including blurred vision photophobia and difficulty focusing Hemolytic anemia in clients with G6PD deficiency irreversible retinal damage PO Prevention begin 250 mg once a week for 4 wk then 250 mg every other week Treatment 1 250 mg as a single dose Vomiting nausea diarrhea myalgia dizziness anorexia abdominal pain AV block bradycardia tachycardia psychosis primaquine phosphate PO 15 mg day for 2 wk Vomiting nausea diarrhea myalgia headache anorexia abdominal pain Hemolytic anemia in clients with G6PD deficiency pyrimethamine Daraprim PO 25 mg once a week for 10 wk Vomiting nausea diarrhea myalgia abdominal pain Megaloblastic anemia leukopenia thrombocytopenia quinine Quinamm PO 260 650 mg tid for 3


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