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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
