Question

This is a respiratory case study

Patient Profile:

Gladys Young is a 68 year old female that resides in an Independent Living facility with her husband. She presents to her primary care physicians office with complaints of fever, chills, nausea and vomiting. She also states that she has had some mild hemoptysis occasionally with her persistent coughing. She has recently completed treatment with Chemotherapy for Breast cancer and is concerned that she may have an infection. You are the nurse caring for her.

You complete the following assessment:

Subjective Data:

She is able to complete a sentence in its entirety, but she is persistently coughing during the history. She is a former smoker, she smoked ½ pack of cigarettes per day for 30 years and quit when she was diagnosed with breast cancer 6 months ago. She denies shortness of breath or chest tightness. She has not yet gotten her influenza vaccine, but did receive the Pneumovax vaccine last year. She has had problems with persistent coughing at night which has prevented her from getting a good night’s sleep for the past two weeks. She also states that she has been waking up soaked in sweat in the morning.

Objective Data:

 Temp – 38.6 C; HR – 132 beats/min; RR—28; BP – 168/87; O2 sat – 90% on Room Air

 Auscultation: Lungs with faint crackles at bases bilaterally. No wheezing present.

 Patient is flushed and warm to touch.

The patient diagnosis is Tuberculosis. Please answer the following question.

1) What pharmacologic interventions do you expect will be ordered for this patient? What routes of administration will be best indicated for this patient? (Include mechanism of action, indication for use and desired outcomes)

2) What are the nursing implications for the above listed pharmacologic treatments (teaching pearls, things to anticipate, adverse reactions)?

Answer 1

1) Mrs. Gladys diagnosed with tuberculosis, pharmacological intervention include first line drugs for tuberculosis which include isoniazid, rifampin, pyrazinamide . streptomycin and ethambutol.

the best route of administration is oral administration of first loine drug.

Mechanism of action: streptomycin and rifampicin interfere with protein synthesis by inhibiting the transcription of messenger RNA and the translation of messenger RNA to produce bacterial protein.

Isoniazid is apro drug that inhibits the formation of the mycobacterial cell wall.

pyrazinamide does not directly block the action of its target, but indirectly triggers its destruction.

indication: effective treatment for tuberculosis.

outcome : effective treatment for tuberculosis

nursing intervention include

promoting airway clearence, preventing spreading of tuberculosis infection, promoting activity and adequate nutrition , monitor adverse effects like orange colored urine, redness and itching in the skin, nausea, diarrhoea, loss of appetite are very common.