522 Unit 5 The Immune SystemAssessment Potential Nursing DiagnosesPrior to administration:■Obtain a complete health history including allergies, drug history, and possi-ble drug interactions.■Obtain a culture and sensitivity of suspected area of infection to determineneed 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, ImpairedNURSING PROCESS FOCUS Clients Receiving Pharmacotherapy for Superficial Fungal InfectionsPlanning: Client Goals and Expected OutcomesThe 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.ImplementationInterventions and (Rationales)■Monitor for possible side effects or hypersensitivity. (Symptoms ofhypersensitivity may require immediate interventions.)■Encourage compliance with instructions when taking oral antifungals.(Medication effectiveness increases.)■Monitor topical application and avoid occlusive dressings. (Dressings increasemoisture in the infected areas and encourage development of additional yeastinfections.)■Monitor for contact dermatitis with topical formulations. (This side effect isrelated to the preservatives found in many of the formulations.)Client Education/Discharge PlanningInstruct client to report:■Burning, stinging, dryness, itching, erythema, urticaria, angioedema, andlocal irritation to superficial drugs.■Symptoms of hepatic toxicity—jaundice, dark urine, light-colored stools, andpruritus.■Nausea, vomiting, and diarrhea.■Signs and symptoms of hypoglycemia or hyperglycemia.Instruct client to:■Cleanse mouth by rinsing before inserting lozenge or solution.■Swish the oral suspension to coat all mucous membranes, and then swallowmedication.■Spit out medication instead of swallowing if GI irritation occurs.■Allow troche to dissolve completely, rather than chewing or swallowing; itmay 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 dissolutionand absorption.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 andremain recumbent for 1 to 15 minutes after insertion.■Avoid wearing tight-fitting undergarments if using ointment in the vaginal or groin area.■Instruct client to report any redness or skin rash.●Abstain from sexual intercourse until treatment forvaginal infection has been completed.●For clients with vaginal candidiasis, use the correctmethod for administering vaginal suppositories, creams,and ointments.●Perform oral hygiene before using oral lozenges orswish-and-swallow formulations.PROTOZOAL INFECTIONSProtozoa are single-celled animals. Although only a fewof the more than 20,000 species cause disease in humans,they have a significant health impact in Africa, SouthAmerica, and Asia. Travelers to these continents may ac-quire these infections overseas and bring them back toWorld Health OrganizationMediaLinkADAMMC35_0131756656 2/28/07 12:43 AM Page 522 Team B ve401:PEQY046:phada2:ch35:Chapter 35 Drugs for Fungal, Protozoal, and Helminthic Infections 523Interventions and (Rationales) Client Education/Discharge PlanningNURSING PROCESS FOCUS Clients Receiving Pharmacotherapy for Superficial Fungal Infections (Continued)Implementation■Encourage infection-control practices. (This prevents the spread of infections.)Evaluation of Outcome CriteriaSee 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.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.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, ifinfection is on the feet.TABLE 35.5 Selected Drugs for Malariaatovaquone and proguanil (Malarone)chloroquine hydrochloride (Aralen)hydroxychloroquine sulfate (Plaquenil) (see page 748 for the Prototype Drug box )mefloquine (Lariam)primaquine phosphatepyrimethamine (Daraprim)quinine (Quinamm)PO; 1 tablet/day starting 1–2 days before travel, and continuing until 7 days after returnPO; 600 mg initial dose, then 300 mg/wkPO; 620 mg initial dose, then 310 mg/wkPO; Prevention: begin 250 mg once a week for 4 wk, then 250 mg everyother weekTreatment: 1,250 mg as a single dosePO; 15 mg/day for 2 wkPO; 25 mg once a week for 10 wkPO; 260–650 mg tid for 3 dayNausea, vomiting, abdominal pain, diarrhea,headache, myalgiaNeutropenia, hypotensionNausea, vomiting and diarrhea; visual changes, includingblurred vision, photophobia and difficulty focusingHemolytic anemia in clients with G6PD deficiency;irreversible retinal damageVomiting, nausea, diarrhea, myalgia, dizziness,anorexia, abdominal painAV block, bradycardia, tachycardia, psychosisVomiting, nausea, diarrhea, myalgia, headache,anorexia, abdominal painHemolytic anemia in clients with G6PD deficiencyVomiting, nausea, diarrhea, myalgia, abdominal painMegaloblastic anemia, leukopenia, thrombocytopeniaVomiting, nausea, diarrheaCinchonism (tinnitus, ototoxicity, vertigo, fever,visual impairment), hypothermia, coma,cardiovascular collapse, agranulocytosisRoute and Adult Dose (max dose where indicated)Adverse EffectsDrugItalics indicate common adverse effects; underlining indicates serious