Wanda McKay is 36 years old and homeless, although she sleeps in a shelter nightly and has been going to a day programfor the past5 weeks, where she showers, receives hermail, gets some counseling, and has hermeals. She is being treated daily for tuberculosis with directly observed therapy (DOT) and has been receiving this treatment for the last 6 months. She had a tubal ligation 5 years ago with no complications and is not currently sexually active. She was last tested for HIV and hepatitis C 2 months ago and was negative. She has been vaccinated for hepatitis B. She drinks, but does notuse drugs, and hasnot been prescribed any psychiatric medications. When she was admitted into the day treatment program, her hospital records were sentindicating that she is sputumculture negative, so she is not a risk to others in closequarters.
When hernurse comes to the day programto administer her meds today, she notices that the sclera of her eyeshave a yellow tintto them. She is broughtinto the mobile center and examined by the nurse practitioner.Data obtained fromthe nursing assessment includethe following:
•The patient complains of abdominal pain, nausea.
•The patient is tender to palpation of liver.
•Lung soundsclear
•Chest x-ray clear
•Vital signs: temperature, 100.2°F; pulse, 88;respirations, 20; blood pressure, 130/80
The patient’s current medications include:isoniazid, 300 mg q day;rifampin, 600mg q day; and ethambutol, 800mg q day.
Case StudyQuestions
1. Provide therationale for whyMs. McKay is prescribedthis combination ofdrugs. (5 pts)
2. Whatcontraindications or precautions would eliminate the use ofthese drugsfor Ms.
McKay?(5 pts)
3. What patient variables are most important to consider forMs. McKay when assessing her drug therapy?(10 pts)
4. Whataspects of core drug knowledge(pharmacotherapeutics, pharmacokinetics, and pharmacodynamics)are especially relevantto consider because they may interact with the patient variables?(5 pts)
5. Which of the findings fromthe nursing assessmentdemonstrate the effectiveness of drug therapy?(5 pts)
6. Which of the findings fromthe nursing assessmentdemonstrate possible adverse effects from the drug therapy?(5 pts)
7. Whatnursingactions are indicated to maximize therapeutic effects?(5 pts)
8. Whatnursingactions are indicated to minimize adverse effects?(5 pts)
9. What teaching is required forMs. McKay regardingherdrug therapy?Include list of any additional data needed to determine appropriate teaching.(5 pts)
