McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 3  Anthelmintic agents

Individual and family teaching

of the correct cause and use of the appropriate drug . ■ ■ Administer the complete course of the drug to obtain the full beneficial effects . Ensure that chewable tablets are chewed. Give the drug with food if necessary, but avoid giving the drug with high-fat meals, which might interfere with drug effectiveness. ■ ■ Monitor hepatic and renal function before and periodically during treatment to allow for early identification and prompt intervention if signs of failure due to albendazole administration occur . ■ ■ Provide comfort and safety measures if CNS effects occur (e.g. side rails and assistance with ambulation in the presence of dizziness and weakness) to protect the person from injury . Provide oral hygiene and ready access to bathroom facilities as needed to cope with GI effects . ■ ■ Provide small, frequent, nutritious meals if GI upset is severe to ensure adequate nutrition . Monitor nutritional status and arrange a dietary consultation as needed. Taking the drug with food may also decrease GI upset. ■ ■ Instruct the person about the appropriate dosage regimen and other measures to enhance knowledge about drug therapy and to promote compliance . –– Take safety precautions, including changing position slowly and avoiding driving and hazardous tasks, if CNS effects occur. –– Take the drug with meals and try small, frequent meals if GI upset is a problem. –– Identify the importance of strict hand washing and hygiene measures, including daily laundering of underwear and bed linens, daily disinfection of toilet facilities and periodic disinfection of bathroom floors (see Box 13.3). –– Report fever, severe diarrhoea or aggravation of condition, which could indicate a resistant strain or non-effective therapy, to a healthcare provider. Evaluation ■ ■ Monitor response to the drug (resolution of helminth infestation and improvement in signs and symptoms). ■ ■ Monitor for adverse effects (changes in orientation and affect, nutritional state, skin colour and evidence of lesions, hepatic and renal function and reports of abdominal discomfort and pain). ■ ■ 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. ■ ■ Provide the following teaching:

BOX 13.3

Managing pinworm infections Infestation with worms can be a frightening and traumatic experience for most people. Seeing the worm can be an especially difficult experience. Some worm infestations are not that uncommon in Australia and New Zealand, especially infestation with pinworms. Pinworms can spread very rapidly among children in schools, summer camps and other institutions. Once the infestation starts, careful hygiene measures and drug therapy are required to eradicate the disease. After the diagnosis has been made and appropriate drug therapy started, proper hygiene measures are essential. Some suggested hygiene measures that might help to control the infection include the following: • Keep the child’s nails cut short and hands well scrubbed because reinfection results from the worm’s eggs being carried back to the mouth after becoming lodged under the fingernails when the child scratches the pruritic perianal area. • Give the child a shower in the morning to wash away any ova deposited in the anal area during the night. • Change and launder undergarments, bed linen and pyjamas every day. • Disinfect toilet seats daily and the floors of bathrooms and bedrooms periodically. • Encourage the child to wash hands vigorously after using the toilet. • It is important to reassure individuals and families that these types of infections do not necessarily reflect negatively on their hygiene or lifestyle. It takes a coordinated effort among health personnel, families and individuals to control a pinworm infestation.

KEY POINTS

■■ Anthelmintic drugs affect metabolic processes that are either different in worms than in human hosts or are not found in humans. These agents all cause death of the worm by interfering with normal functioning. ■■ Proper hygiene and sanitation processes are an important part in preventing the spread of helminths, including good hand hygiene, and preparation and storage of food.

CHAPTER SUMMARY

■■ Helminths are worms that cause disease by invading the human body. Helminths that affect humans include nematodes (round-shaped worms) such as pinworms, hookworms, threadworms, whipworms and roundworms; and platyhelminths (flatworms), which include tapeworms and flukes. ■■ Pinworms are the most frequent cause of helminth infection in Australia and New Zealand, and