K.B a 36-year-old woman who works as a social worker and has sole custody of her
ID: 126416 • Letter: K
Question
K.B a 36-year-old woman who works as a social worker and has sole custody of her two children is prescribed rifampin and isoniazid after being diagnosed with active TB.
Why is therapy for active infection always initiated with at least two drugs?
What monitoring is necessary while taking rifampin and isoniazid? Explain. How long does the treatment usually last?
Explain the assessment and nursing interventions for a patient who is starting antitubercular medications. Include rationale.
What is included in patient teaching with antituberculars? Be specific.
What will be necessary to determine the effectiveness of drug therapy?
Two months into therapy, K.B returns to the clinic complaining of tingling in her feet. K.B and asks the nurse why this is happening. The nurse reviews her recent laboratory results and notices an elevation in liver enzymes.
How do you respond to K.B's question? What do you think is going on with the patient? Explain your answer.
Explanation / Answer
a) Rifampin and isoniazid is the first line drug treatment for TB. In order to test the response of patient with these first line two drugs the therapy is initiated with only two drugs.
b) Monitoring of infection that is bacterial growth need do be done during this two drugs intake. If the response is better within 1 month these basic drug will be given for continous six months.
c) Rifamycin: instruct your patient about change in urine colour, drug interaction need to be monitored along with hepatitis. It decreases effect of oral contraceptives
Isoniazid: Drug interaction need to be monitored. It can inhibit drug metabolism of phenytoin, primidone, warfarin and carbamazepine. Instruction need to be given for to take drug in empty stomach and to avoid antacids. monitoring for hepatitis and neurotoxicity is required.
d) patient should be prior inform about the drug side effects like mood swings, change in urine colour, weight loss, weakness, drowsiness, appetite loss etc. and patient should be monitored for other complication as mentioned above
e) Patient Physical examination reports, blood test, chest Xray, Continous drug intake, sufficient duration of treatment with adequate dosing depending on the type of infection, selection of an effective drug regimen combination based on drug susceptibility test. These factors are neccessary for deciding effectiveness of drug therapy.
f) It is liver disease as a result of combination antituberculars medicine mainly isoniazid. It could be drug induce hepatitis in liver. I will respond K.B's to go for screening and to start treatment under physician.
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