The public health nurse is providing follow-up care to a client with TB who does not regularly take his medication. Which nursing action would be most appropriate for this client?
A. Ask the client’s spouse to supervise the daily administration of the medications.
B. Visit the clinic weekly to ask him whether he is taking his medications regularly.
C. Notify the physician of the client’s non-compliance and request a different prescription.
D. Remind the client that TB can be fatal if not taken properly.
Correct Answer: A. Ask the client’s spouse to supervise the daily administration of the medications.
Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a responsible person, who may be a family member or a health care provider, observes the client taking the medication. Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or cannot follow the prescribed treatment.
Option B: Stress the importance of uninterrupted drug therapy. Evaluate a patient’s potential for cooperation. Contagious periods may last only 2–3 days after initiation of therapy, but in presence of cavitation or moderately advanced disease, risk of spread of infection may continue up to 3 months. Compliance with multidrug regimens for prolonged periods is difficult, so directly observed therapy (DOT) should be considered.
Option C: Review the importance of follow-up and periodic reculturing of sputum for the duration of therapy. These second-line drugs may be required when infection is resistant to or intolerant of primary drugs or may be used concurrently with primary antitubercular drugs.
Option D: MDR-TB requires a minimum of 18–24 mo therapy with at least three drugs in the regimen known to be effective against the specific infective organism and which patient has not previously taken. Treatment is often extended to 24 mo in patients with severe symptoms of HIV infection.
No comments:
Post a Comment