McKenna's Pharmacology for Nursing, 2e

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P A R T 2  Chemotherapeutic agents

continue the drug regimen to help decrease the develop­ ment of resistant strains of the virus. Common adverse effects include headache, diz- ziness and an increase risk for the development of rhabdomyolysis and myopathy. There is a risk of decreased serum levels of raltegravir if it is combined with rifampicin; monitor the person and adjust the dose if this combination must be used. People should avoid the use of St Johns wort, which can interfere with the drug’s effectiveness.

concentration needed for the drug to be effective.

■ ■ Monitor nutritional status if GI effects are severe, and take appropriate action to maintain nutrition, including small, frequent meals and balanced nutrition to provide protein and other nutrients. ■ ■ Stop drug if severe rash occurs, especially if accompanied by blisters, fever and other signs, to avert potentially serious reactions. ■ ■ Provide safety precautions (e.g. the use of side rails, appropriate lighting, orientation, assistance) if CNS effects occur, to protect person from injury. ■ ■ Teach the person about the drugs prescribed to enhance knowledge about drug therapy and to promote compliance. Include as a teaching point the fact that these drugs do not cure the disease, so appropriate precautions should still be taken to prevent transmission. ■ ■ Provide the following teaching: –– Have regular medical care. –– Set up a regular schedule for taking all of your drugs at the correct time during the day. –– Have periodic blood tests, which are necessary to monitor the effectiveness and toxicity of the drug. –– Realise that GI upset, nausea and vomiting may occur but that efforts must be taken to maintain adequate nutrition. –– Avoid driving and hazardous tasks if dizziness or drowsiness occurs. –– Report extreme fatigue, severe headache, difficulty breathing or severe rash to a healthcare provider. See the Critical thinking scenario for a case study and focused follow-up for the antiviral agents used for HIV and AIDS. Evaluation ■ ■ Monitor person’s response to the drug (alleviation or reduction of signs and symptoms of AIDS or ARC and maintenance of T cell levels). ■ ■ Monitor for adverse effects (level of orientation and affect, GI upset, renal and hepatic function, skin, levels of blood components). ■ ■ Evaluate the effectiveness of the teaching plan (person can name the drug, dosage, possible adverse effects to watch for and specific measures to help avoid adverse effects). ■ ■ Monitor the effectiveness of comfort and safety measures and compliance with the regimen.

Care considerations for people receiving agents for HIV and AIDS

Assessment: history and examination

■ ■ Assess for contraindications and cautions to the use of these drugs : any history of allergy to antiviral agents to avoid hypersensitivity reactions ; renal or hepatic dysfunction that might interfere with the metabolism and excretion of the drug ; and pregnancy or breastfeeding because of possible adverse effects on the fetus or infant. ■ ■ Perform a physical assessment to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy. ■ ■ Assess level of orientation and reflexes to evaluate any CNS effects of the drug. ■ ■ Examine the skin (colour, temperature and lesions) to monitor for adverse effects of the drug. ■ ■ Check temperature to monitor for infections. ■ ■ Evaluate hepatic and renal function tests to determine baseline function of the kidneys and liver. Check results of a full blood count (FBC) with differential to monitor bone marrow activity and T cell number to determine the severity of the disease and indicate the effectiveness of the drugs. Implementation with rationale ■ ■ Monitor renal and hepatic function before and periodically during therapy to detect changes requiring dose adjustments or additional treatment as needed. ■ ■ Ensure that the person takes the complete course of the drug regimen and takes all drugs included in a particular combination to improve the effectiveness of the drug and decrease the risk of emergence of resistant viral strains. ■ ■ Administer the drug throughout the 24-hour period, if indicated, to provide the critical