McKenna's Pharmacology for Nursing, 2e

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P A R T 2  Chemotherapeutic agents

CRITICAL THINKING SCENARIO Anthelmintics

THE SITUATION V.Y., a 33-year-old man from Sudan, underwent a complete physical examination in preparation for a training job in custodial work at a local hospital. He was a refugee who had come to Australia 6 months ago as part of a sponsored resettlement program. In the course of the examination, it was found that he had a history of chronic diarrhoea, hepatomegaly, pulmonary rales and splenomegaly. Further tests indicated that he had chronic schistosomiasis. Because of V.Y.’s limited use of the English language, he was hospitalised so that his disease, which was unfamiliar to most of the associated healthcare providers, could be monitored. He was treated with praziquantel. CRITICAL THINKING What are the important care implications for V.Y.? Think about the serious limitations that are placed on medical care, particularly teaching, when the person and the healthcare workers do not speak the same language. What innovative techniques could be used to teach this person about the disease, the drugs and the hygiene measures that are important for him to follow? Are the other people or workers in the hospital exposed to any health risks? What sort of educational program should be developed to teach them about this disease and to allay any fears or anxieties they may have? What special interventions are needed to explain the drug therapy and any adverse effects or warning signs that V.Y. should be watching for? DISCUSSION A language barrier can be a real handicap in the healthcare system. In many cases, pictures can assist communication. For example, the need for nutritious food is conveyed by using appropriate pictures of foods that should be eaten. Frequent reinforcement is necessary because the person has no way of letting you know that they really understand the message that you are trying to convey. The person is prepared for discharge through careful teaching that may involve pictures, calendars and clocks so that they are given every opportunity to comply with their medical regimen. In addition, the staff should contact the local health department to determine whether the local sewer system can properly handle contaminated wastes. In this case, the staff learned from the local health department that the snail’s intermediate host does not live in this country, so the hazards posed by this waste are small, and normal disposal of the wastes should be appropriate.

V.Y. should also be observed for signs of adverse effects, although praziquantel is a relatively mild drug. Drug fever, abdominal pain or dizziness may occur. If dizziness occurs, safety precautions, such as assistance with ambulation, use of side rails and adequate lighting, need to be taken without alarming the person. CARE GUIDE FOR V.Y.: ANTHELMINTIC AGENTS Assessment: History and examination Allergies to this drug, renal or liver dysfunction Drug history: use of albendazole Local: culture of infection CNS: orientation, affect Skin: colour, lesions, texture GI: abdominal and liver evaluation, including hepatic function tests GU: renal function tests Implementation Culture for ova and parasites before beginning therapy. Provide comfort and safety measures: small, frequent meals; safety precautions; hygiene measures; maintenance of nutrition. Monitor nutritional status as needed. Provide support and reassurance to deal with drug effects, discomfort and diagnosis. Provide teaching regarding drug name, dosage regimen, adverse effects and precautions to report, and hygiene measures to observe. Evaluation Evaluate drug effects: resolution of helminth infection. Monitor for adverse effects: GI alterations, CNS changes, dizziness and confusion, renal and hepatic function. Monitor for drug–drug interactions: concurrent use of albendazole. Evaluate effectiveness of teaching program. Evaluate effectiveness of comfort and safety measures. TEACHING FOR V.Y. • This drug is called an anthelmintic. It works to destroy certain helminths, or worms, that have invaded your body. • It is important that you take the full course of the drug— three doses the first day, then retesting to repeat this course if needed to ensure that all of the worms, in all phases of their life cycle, have disappeared from your body. • You may take this drug with meals or with a light snack to help decrease any stomach upset that you may