Download Antiretroviral Agents

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Chapter 36
Drugs for Viral Infections
541
NURSING PROCESS FOCUS Clients Receiving Antiretroviral Agents
Assessment
Potential Nursing Diagnoses
Prior to administration:
Obtain a complete health history including allergies, drug history,
and possible drug interactions.
Obtain a complete physical examination.
Assess for the presence or history of HIV infection.
Obtain the following laboratory studies:
HIV RNA assay/CD4 count
complete blood count (CBC)
liver function
renal function
blood glucose
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Infection, Risk for , related to compromised immune system
Decisional Conflict, related to therapeutic regimen
Fear, related to HIV diagnosis
Injury, Risk for, related to side effects of drugs
Knowledge, Deficient, related to disease process, transmission, and drug
therapy
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Planning: Client Goals and Expected Outcomes
The client will:
Exhibit a decrease in viral load and an increase in CD4 counts.
Demonstrate knowledge of the disease process, transmission, and treatment.
Demonstrate an understanding of the drug’s action by accurately describing drug side effects and precautions.
Complete the full course of therapy and comply with follow-up care.
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Implementation
Interventions and (Rationales)
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Monitor for symptoms of hypersensitivity reactions. (Zalcitabine may cause
anaphylactic reaction.)
Monitor vital signs, especially temperature, and for symptoms of infection.
Monitor white blood cell (WBC) count. (Antiretroviral drugs such as delavirdine may cause neutropenia.)
Client Education/Discharge Planning
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Instruct client to discontinue the medication and inform the healthcare
provider if symptoms of hypersensitivity reaction develop such as wheezing;
shortness of breath; swelling of face, tongue, or hands; itching or rash.
Instruct client:
To report symptoms of infections such as fever, chills, sore throat, and
cough.
About methods of minimizing exposure to infection such as frequent hand
washing; avoiding crowds and people with colds, flu, and other infections;
limiting exposure to children and animals; increasing fluid intake; emptying
the bladder frequently; and coughing and deep breathing several times per
day.
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Monitor client for signs of stomatitis. (Immunosuppression may result in
the proliferation of oral bacteria.)
Monitor blood pressure. (Antiviral agents such as abacavir may cause a
significant decrease in blood pressure.)
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Advise client to be alert for mouth ulcers and to report their appearance.
Instruct client to:
Rise slowly from a lying or sitting position to minimize effects of postural hypotension.
Report changes in blood pressure and symptoms of dizziness and light-headedness.
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Monitor HIV RNA assay, CD4 counts, liver function, kidney function, CBC,
blood glucose, and serum amylase and triglyceride levels. (These will
determine effectiveness and toxicity of drug.)
Instruct client:
About the purpose of required laboratory tests and scheduled follow-ups with
the healthcare provider.
To monitor weight and presence of swelling.
To keep all appointments for laboratory tests.
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(Continued )
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Unit 5
The Immune System
NURSING PROCESS FOCUS Clients Receiving Antiretroviral Agents (Continued)
Implementation
Interventions and (Rationales)
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Client Education/Discharge Planning
Determine potential drug–drug and drug–food interactions. (Antiretroviral
medications have multiple drug–drug interactions and must be taken as
prescribed.)
Instruct client:
When to take the specific medication in relationship to food intake.
About foods or beverages to avoid when taking medication; some antiretrovirals should not be taken with acidic fruit juice.
To take medication exactly as directed and not to skip any doses.
To consult with the healthcare provider before taking any OTC medications or
herbal supplements.
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Monitor for symptoms of pancreatitis including severe abdominal pain,
nausea, vomiting, and abdominal distention. (Antiretroviral agents such as
didanosine may cause pancreatitis.)
Monitor skin for rash; withhold medication and notify physician at first sign
of rash. (Several antiretroviral drugs may cause Stevens–Johnson
syndrome, which may be fatal.)
Establish a therapeutic environment to ensure adequate rest, nutrition,
hydration, and relaxation. (Support of the immune system is essential in
HIV clients to minimize opportunistic infections.)
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Instruct client to report the following immediately: fever, severe abdominal
pain, nausea/vomiting, and abdominal distention.
Advise client to check skin frequently and notify the healthcare provider at the
first sign of any rash.
Teach client to incorporate the following health-enhancing activities:
Adequate rest and sleep.
Proper nutrition that provides essential vitamins and nutrients.
Intake of 6 to 8 glasses of water per day.
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Monitor blood glucose levels. (Antiretroviral drugs may cause hyperglycemia, especially in clients with type 1 diabetes.)
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Monitor for neurological side effects such as numbness and tingling of the
extremities. (Many NRTI agents cause peripheral neuropathy.)
Instruct client to report excessive thirst, hunger, dizziness, and urination to
the healthcare provider.
Instruct diabetic client to monitor blood glucose levels regularly.
Instruct client to:
Report numbness and tingling of extremities.
Use caution when in contact with heat and cold owing to possible peripheral
neuropathy.
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Determine the effect of the prescribed antiretroviral agents on oral contraceptives. (Many agents reduce the effectiveness of oral contraceptives.)
Provide resources for medical and emotional support. (Treatment requires
a multidisciplinary approach.)
Assess client’s knowledge level regarding use and effect of medication. (This
discussion provides an opportunity to provide an additional education.)
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Instruct client to practice reliable contraception while taking antiretroviral
medications.
Advise client about community resources and support groups.
Advise client:
That medication may decrease the level of HIV infection in the blood but will
not prevent transmission of the disease.
To use barrier protection during sexual activity.
To avoid sharing needles.
Not to donate blood.
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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’s laboratory values demonstrate a decrease in viral load and an increase in CD4 counts.
The client verbalizes an understanding of the disease process, transmission, and treatment modalities.
The client demonstrates an understanding of the drug’s action by accurately describing drug side effects and precautions.
The client verbalizes the importance of taking medication as ordered and returning for follow-up care.
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See Table 36.1 for a list of drugs to which these nursing actions apply.