PROTOTYPE DRUG: Amphotericin B (Fungizone)



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

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |■ Risk for Injury, related to adverse effects of drug |

|■ Obtain complete health history including allergies, drug |■ Risk for Infection, related to drug-induced leukopenia |

|history, and possible drug interactions. |■ 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 |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|■ Monitor vital signs, especially pulse and blood pressure, |■ Advise patient to report dizziness, shortness of breath, heart |

|frequently during and after infusion. |palpitations, or faintness immediately. |

|(Cardiovascular collapse may result when drug is infused too | |

|rapidly, which is caused by the drug binding to human cytoplasmic| |

|sterols.) | |

|■ Monitor kidney function, including intake and output, |Instruct patient to: |

|urinalysis, and periodic blood work. |■ Keep all laboratory appointments for blood work (CBC, |

|(Amphotericin B is nephrotoxic. This medication is excreted in |electrolytes every 2 weeks; BUN, creatinine weekly) |

|the urine and causes significant electrolyte loss from the |■ Keep an accurate record of intake and output |

|kidneys.) |■ 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. |■ Advise patients with any form of cardiac disease to report any |

|(Patients with cardiac disease are at high risk.) |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 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 |■ Advise patient to report any pain at the IV site. |

|of extravasation. (Medication is irritating to | |

|the vein. Use a central line if possible.) | |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Nystatin (Mycostatin)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Injury, Risk for (rash) related to adverse effects of medication |

|Obtain complete health history including allergies, drug history and |Altered Nutrition: Less than body requirements, Risk for, related to |

|possible drug interactions. |nausea and vomiting secondary to drug therapy |

|Obtain a culture and sensitivity test of suspected area of infection to|Knowledge, Deficient related to drug therapy and side effects |

|determine need for therapy | |

|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. |Instruct patient to report any burning, stinging, dryness, itching, and |

| |local irritation to their health care provider. |

|Monitor for proper use of the different formulations of this |Advise patient to: |

|medication. |“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. |

|Observe for proper application of dressings. (Occlusive dressings |Instruct patient to: |

|increase the moisture in these areas and encourage development of |Apply dressings properly |

|additional yeast infections.) |Avoid wearing tight fitting undergarments if using ointment in the |

| |vaginal or groin area. |

|Strictly follow standard precautions when applying medication to |Teach patient to |

|affected areas (to decrease spread of infection). |Clean affected area daily |

| |Apply medication with a glove |

| |Wash hands properly and keep nails clean |

| |Change socks daily if rash is on feet |

|Monitor for alcohol use. (Increases the risk of side effects such as |Instruct patient to avoid alcohol during drug therapy. |

|nausea vomiting and an increase in blood pressure with concurrent use.)| |

|Monitor for effectiveness of medication. (As evidenced by a |Instruct patient to: |

|decrease/elimination of fungus.) |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”). |

NURSING PROCESS FOCUS:

Patients Receiving Metronidazole (Flagyl)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |■ Risk for Injury, related to dizziness secondary to side effect |

|■ Obtain complete health history including allergies, drug |of drug |

|history, and possible drug interactions. |■ Risk for Fluid Volume Imbalance related to nausea and vomiting |

|■ Obtain results from serologic studies, stool samples or |secondary to side effect of drug |

|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) |Patient Education/Discharge Planning |

|■ Monitor complete blood count periodically. (The drug may cause |■ Instruct patient to notify the healthcare provider of fever or |

|leukopenia.) |other signs of infection. |

|■ Encourage treatment of sexual partner. (Asymptomatic |■ Instruct patient that simultaneous treatment of a sexual |

|trichomoniasis in the male is a frequent source of reinfection.) |partner is necessary. |

|■ Monitor use of alcohol. |Instruct patient to: |

|(Metronidazole interferes with the metabolism of alcohol.) |■ 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. |■ Instruct patient to immediately report seizures, numbness of |

|(High doses may cause seizures and peripheral neuropathy possibly|limbs, nausea, and vomiting. |

|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. |Instruct patient to: |

|(This is the most common adverse effect.) |■ 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”). |

Nursing Process Focus:

Patients Receiving Zidovudine (Retrovir)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration |Infection, Risk for related to decreased CD4 count |

|Obtain complete health history including allergies, drug history and |Injury, Risk for (dizziness) related to adverse effects of drug therapy|

|possible drug interactions. |Pain, Risk for (Headache) related to adverse effects of drug therapy |

|Assess for presence or history of viral infection |Tissue perfusion, Risk for Ineffective related to bone marrow |

|Assess complete blood count, CD4 count, liver and kidney function |depression secondary to adverse effects of drug therapy |

|Obtain history of sensitivity to Zidovudine | |

|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) |Patient Education/Discharge Planning |

|Observe for signs and symptoms of infection or bleeding. (Patient may|Advise patient: |

|develop granulocytopenia or thrombocytopenia.) |That medication may decrease the level of HIV infection in the blood |

|Monitor vital signs (especially temperature). |but will not prevent transmitting the disease |

| |To use barrier protection during sexual activity |

|Monitor use of acetaminophen. (Concurrent use of acetaminophen may |Instruct patient not to use acetaminophen while on drug therapy and |

|increase chance of bone marrow depression.) |warn that acetaminophen is often used with cold product preparations |

|Monitor weight. (Weight gain may indicate positive effect of drug |Advise patient to: |

|therapy and absence of GI distress.) |Take medication 1 hour before meals. |

| |Report GI distress to the health care provider |

|Monitor intake and output (may cause renal dysfunction) |Instruct patient to report changes in urinary output to the health care|

| |provider. |

|Monitor complete blood count and CD4 counts weekly (to evaluate |Advise patient to keep all laboratory appointments. |

|effectiveness of therapy). | |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

Nursing Process Focus:

Patients Receiving Acyclovir (Zovirax)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration |Infection, Risk for related to ineffective response to drug therapy |

|Obtain complete health history including allergies, drug history and |Nutrition, Risk for Imbalanced: less than body requirements related to |

|possible drug interactions |nausea, vomiting and diarrhea secondary to adverse effects of drug |

|Assess for presence/history viral infections |therapy |

|Assess renal function, complete blood count, viral culture, and vital|Injury, Risk for (seizures) related to adverse effects of drug therapy |

|signs |Knowledge Deficient, related to drug therapy and side effects |

|Assess for herpes simplex infection | |

|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. |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Monitor complete blood count periodically. (Drug may cause |Advise patient to: |

|thrombocytopenic purpura or hemolytic uremic syndrome.) |Report occurrence of unusual bleeding and bruising to the health care |

|Monitor vital signs (especially temperature). |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 |

|Monitor renal status. (Acute renal failure may result if administered|Instruct patient: |

|with other nephrotoxic drugs.) |To report all medications taken to the health care provider |

| |To report changes in urinary output |

|Monitor intake and output. (Medication may cause anorexia and |Advise patient: |

|stomatitis.) |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 |Instruct patient to immediately report burning, pain at the IV site to |

|infiltration. (Drug causes severe inflammation at the sit of |the health car provider. |

|infiltration.) | |

|Periodically monitor BUN, serum creatinine and urinalysis. (Renal |Instruct patient to report changes in urinary output to the health care|

|dysfunction may occur.) |provider. |

|Evaluation of Outcome Criteria |

|Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). |

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