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 close quarters.
When her nurse comes to the day program to administer her meds today, she notices that the sclera of her eye shave a yellow tint to them. She is brought into the mobile center and examined by the nurse practitioner.Data obtained from the nursing assessment include the following:
•The patient complains of abdominal pain, nausea.
•The patient is tender to palpation of liver.
•Lung sounds clear
•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 Study Questions
1. Provide the rationale for why Ms. McKay is prescribed this combination of drugs. (5 pts)
2. What contraindications or precautions would eliminate the use of these drugs for Ms.
3. What patient variables are most important to consider forMs. McKay when assessing her drug therapy?(10 pts)
4. What aspects of core drug knowledge(pharmacotherapeutics, pharmacokinetics, and pharmacodynamics)are especially relevant to consider because they may interact with the patient variables?(5 pts)
5. Which of the findings from the nursing assessment demonstrate the effectiveness of drug therapy?(5 pts)
6. Which of the findings from the nursing assessment demonstrate possible adverse effects from the drug therapy?(5 pts)
7. What nursing actions are indicated to maximize therapeutic effects?(5 pts)
8. What nursing actions are indicated to minimize adverse effects?(5 pts)
9. What teaching is required for Ms. McKay regarding her drug therapy?Include list of any additional data needed to determine appropriate teaching.(5 pts)
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