Nursing Process Focus: Patients Receiving LINDANE (Kwell)

Transcription

1 Nursing Process Focus: Patients Receiving LINDANE (Kwell) ASSESSMENT Prior to administration: Obtain complete health history including allergies, drug history, and possible drug interactions. Assess vital signs. Assess skin for presence of lice and/or mite POTENTIAL NURSING DIAGNOSES Deficient Knowledge, related to no previous contact with lice or mites or treatment Treatment Regimen Noncompliance, related to knowledge deficit, embarrassment Risk for Impaired Skin Integrity, related to lesions and itching infestation, skin lesions, raw or inflamed skin, and open cuts. Obtain history of seizure disorders. Obtain patient s age. Assess pregnancy and lactation status. Obtain social history of close contacts, including household members and sexual partners. PLANNING: PATIENT GOALS AND EXPECTED OUTCOMES Patient and significant others will be free of lice or mites and experience no reinfestation. Patient will express an understanding of how lice and mites are spread, proper administration of lindane, necessary household hygiene, and the need to notify household members, sexual partners, other close contacts such as classmates of infestation. Skin will be intact and free of secondary infection and/or irritation. IMPLEMENTATION Interventions and (Rationales) Monitor for presence of lice or mites. (This determines the effectiveness of drug therapy.) Patient Teaching/Discharge Planning Instruct patient and caregiver to: Examine for nits on hair shafts; lice on skin or clothes; inner thigh areas; seams of clothes that come in contact with axilla, neckline, or beltline

2 Examine for mites between the fingers, on the extremities, axillary and gluteal folds, around the trunk, and in the pubic area Apply lindane properly. (Proper application is critical to elimination of infestation.) Instruct patient and caregiver: To wear gloves during application, especially if applying lindane to more than one person, or if pregnant That all skin lotions, creams, and oil-based hair products should be removed completely by scrubbing the whole body well with soap and water, and drying the skin prior to application To apply lindane to clean and dry affected body area as directed, using no more than 2 oz per application That eyelashes can be treated with the application of petroleum jelly twice a day for 8 days followed by combing to remove nits To use fine-tooth comb to comb affected hair following lindane application to the hair and scalp to treat all household members and sexual contacts simultaneously To recheck affected hair or skin daily for 1 week after treatment Inform patient and caregivers about proper care of clothing and equipment. (Contaminated articles can cause reinfestation.) Instruct patient and caregiver to: Wash all bedding and clothing in hot water, and to dry-clean all nonwashable items which came in close contact with patient

3 Clean combs and brushes with lindane shampoo and rinse thoroughly EVALUATION OF OUTCOME CRITERIA Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

4 Nursing Process Focus: Patients Receiving BENZOCAINE (Solarcaine) Potential Nursing Diagnoses Comfort, impaired, related to presence of sunburn, burns, toothache, ear infections, etc. Knowledge, deficient, related to lack of proper education regarding health practices necessary to prevent sunburn, burns, etc. and lack of previous contact with benzocaine Noncompliance, overuserelated to reluctance to contact health care provider if symptoms continue past recommended maximum usage time Planning: Patient Goals and Expected Outcomes Assessment Prior to administration: Obtain complete health history including allergies, drug history and possible drug interactions. Assess for presence/history of sunburn, minor burns, serious burns, mild pruritus Patient will: Experience improvement in symptoms without complications Demonstrate proper use of benzocaine Demonstrate necessity to contact health care provider if symptoms do not improve, or worsen, by the time maximum recommended usage is reached Demonstrate knowledge of measures to take to prevent sunburn, burns, etc. from occurring in future Implementation Interventions and (Rationales) Monitor for secondary infection. (Drug should not be used if infection is present in area of sunburn or insect bites.) Monitor status of burns. (Drug should not be used if serious burns are present.) Monitor for perforated tympanic membrane or discharge from ear(s). Patient Education/Discharge Planning Teach patient to: Examine affected areas prior to each application of benzocaine Discontinue use of benzocaine if redness, swelling, pain appears or worsens Advise patient that : Benzocaine cannot be used on burns deeper than one skin layer or if skin is broken and/or weeping If pain is not present, it can be an indicator of the seriousness of burn, since nerve endings may have been damaged Advise patient and caregiver: to use caution whenever applying to the external ear to prevent its getting into the inner ear not to use without health care provider approval if patient has pain in ear, decreased hearing, discharge

5 Monitor for proper use. (Since benzocaine is OTC medication, patient may not understand proper use or precautions.) Instruct patient: To use only on intact skin, to avoid eyes, areas of local sepsis That benzocaine is to be used no more than 7 days To discontinue benzocaine if symptoms of hypersensitivity occur (redness, pain, rash, heat) and to contact health care provider if pain lasts longer than 48 hours To do not chew gum or eat until anesthetic effects of benzocaine used for toothache relief have worn off In infant proper use of benzocaine for relief of teething Monitor for worsening of condition. Instruct patient to discontinue use of benzocaine and contact health care provider if increased pain, pruritus, heat, or other symptoms occur. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

6 Nursing Process Focus: Patients Receiving ISOTRETINOIN (Accutane) ASSESSMENT Prior to administration: Obtain complete health history including allergies, drug history, and possible drug interactions. Obtain pregnancy and lactation status. Assess for history of psychiatric disorders. Assess vital signs to obtain baseline information. POTENTIAL NURSING DIAGNOSES Disturbed Body Image, related to presence of acne and possible worsening of symptoms after treatment begins Decisional Conflict, related to desire for pregnancy, and necessity of preventing pregnancy during therapy with isotretinoin Noncompliance, related to length of treatment time, failure to use effective contraception Impaired Skin Integrity, related to inflammation, redness, scaling, secondary to treatment PLANNING: PATIENT GOALS AND EXPECTED OUTCOMES The patient will: Experience decreased acne, without side effects or adverse reactions Demonstrate acceptance of body image Demonstrate an understanding of the drug s action by accurately describing drug side effects and precautions IMPLEMENTATION Interventions and (Rationales) Monitor lab studies during treatment, including blood glucose. Patient Education/Discharge Planning Instruct patient on importance of lab studies prior to therapy and periodically during therapy and doing home blood glucose monitoring if diabetic. Discuss potential adverse reactions to drug therapy. (Understanding of drug effects is important for compliance.) Instruct patient to Use two forms of reliable birth control for 1 month before beginning treatment, during

7 treatment, and for 1 month following completion of treatment Not donate blood during treatment and for a minimum of 4 weeks after completion of treatment; isotretinoin in donated blood could cause fetal damage if given to a pregnant woman Talk with pediatrician about alternative methods of feeding if breastfeeding Avoid use of vitamin A products Monitor for cardiovascular problems. (Use isotretinoin with caution in patients with heart Discuss with patient importance of complete disclosure regarding medical history and medications. block, especially if patient is also taking a betablocker.) Monitor emotional health. (Patient may become depressed secondary to acne itself, length of treatment, possibility of worsening symptoms at beginning of treatment, changed body image, or drug itself.) Instruct patient: Regarding signs and symptoms of depression and to report To report signs of depression or any feelings of suicide ideation immediately and discontinue isotretinoin Monitor CBC, blood lipid levels, glucose levels, liver function tests, eye exam, GI status, urinalysis. Monitor for vision changes. (Corneal opacities and/or cataracts may develop as result of isotretinoin use. Dryness of eyes during treatment is common. Night vision may be diminished during treatment.) Teach patient importance of a complete workup prior to starting isotretinoin therapy and periodically during course of treatment. Instruct patient: To report any decreased vision and discontinue use of isotretinoin To avoid driving at night if possible Use of artificial tears to relieve dry eyes

8 That use of contact lenses may need to be discontinued during therapy Monitor alcohol use. (Alcohol use with isotretinoin leads to increased triglyceride levels.) Advise patient to: Eliminate or greatly reduce alcohol use, including alcohol-containing preparations such as mouthwashes or OTC medications Read labels for alcohol content Monitor skin problems. (This will determine the effectiveness of drug therapy.) Advise patient: That acne may worsen during beginning of treatment To monitor skin for improvement in 4 to 8 weeks; if no improvement is noted, patient should contact primary healthcare provider Monitor for side effects: headache (especially if accompanied by nausea and vomiting), fatigue, Instruct patient regarding possible side effects and to report immediately if any occur depression, lethargy, severe diarrhea, rectal bleeding, abdominal pain, dry mouth, hematuria, proteinuria, liver dysfunction (jaundice, pruritus, dark urine. Report immediately EVALUATION OF OUTCOME CRITERIA Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).