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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.
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
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.
