McKenna's Pharmacology for Nursing, 2e

175

C H A P T E R 1 2  Antiprotozoal agents

■■ Other protozoal infections include amoebiasis, leishmaniasis, trypanosomiasis, trichomoniasis, giardiasis and Pneumocystis carinii . KEY POINTS

■■ People receiving antiprotozoal agents should be monitored regularly to detect any serious adverse effects, including loss of vision, liver toxicity and so on.

CRITICAL THINKING SCENARIO Coping with amoebiasis

THE SITUATION J.C., a 20-year-old male university student, reported to the university health centre complaining of severe diarrhoea, abdominal pain and, most recently, blood in his stool. He had a mild fever and appeared to be dehydrated and very tired. The young man, who denied he had travelled outside the country, reported eating most of his meals at the local café, where he worked in the kitchen each night making pizza. A stool sample for ova and parasites (O&P) was obtained, and a diagnosis of amoebiasis was made. Metronidazole was prescribed. A public health referral was sent to find the source of the infection, which was the kitchen of the café where J.C. worked. The kitchen was shut down until all the food, utensils and environment passed state health inspection. Although a potential epidemic was averted (only three other cases of amoebiasis were reported), the action of the public health officials added new stress to this student’s life because he was unemployed for several months. CRITICAL THINKING What are the important care implications for J.C.? Think about the usual nutritional state of a university student who eats most of his meals in a pizza place. What are the implications for recovery when a person is malnourished and then has a disease that causes severe diarrhoea, dehydration and potential malnourishment? Consider how difficult it will be for J.C. to be a full-time student while trying to cope with the signs and symptoms of his disease, as well as the adverse effects associated with his drug therapy and the need to maintain adequate nutrition to allow some healing and recovery. What potential problems could the added stress of being out of work have for J.C.? Consider the physiological impact of stress, as well as the psychological problems of trying to cope with one more stressor. DISCUSSION J.C. needed a great deal of reassurance and an explanation of his disease. He learned that oral hygiene and small, frequent meals would help alleviate some of his discomfort

until the metronidazole could control the amoebiasis and that good hygiene and strict hand washing when the disease is active would help to prevent transmission. He was advised to watch for the occurrence of specific adverse drug effects, such as a possible severe reaction to alcohol (he was advised to avoid alcoholic beverages while taking this drug); gastrointestinal upset and a strange metallic taste (the importance of good nutrition to promote healing of the gastrointestinal tract was stressed); dizziness or light-headedness; and superinfections. J.C. was scheduled for a follow-up examination for stool O&P and nutritional status. Metronidazole was continued until the stool sample came back negative. He needed and received a great deal of support and encouragement because he was far from home and the disease and the drug effects were sometimes difficult to cope with. The effects of stress—decreasing blood flow to the gastrointestinal tract, for example—can make it more difficult for people such as J.C. to recover from this disease. Support and encouragement can be major factors in their eventual recovery. J.C. was given a telephone number to call if he needed information or support and a complete set of written instructions regarding the disease and the drug therapy. CARE GUIDE FOR J.C.: METRONIDAZOLE Assessment: History and examination Allergies to metronidazole, renal or liver dysfunction Concurrent use of barbiturates, oral anticoagulants, alcohol Local: culture of stool for accurate diagnosis of infection CNS: orientation, affect, vision, reflexes

Skin: colour, lesions, texture GI: abdominal, liver evaluation Haematological: FBC, liver function tests Implementation Culture infection before beginning therapy.

Provide comfort and safety measures: oral hygiene, safety precautions, treatment of superinfections, maintenance of nutrition. Provide small, frequent meals and monitor nutritional status. Provide support and reassurance for dealing with drug effects and discomfort.