Chapter 36
-Also known as Candidiasis -Most common opportunistic fungal infection -May affect nearly any organ -Yeast -Unicellular fungi
Candida albicans
-May increase values of the following: serum creatinine, alkaline phosphatase, BUN, AST and ALT. -May decrease values for serum potassium, calcium, and magnesium.
Lab tests for Amphotericin
-Values for AST, ALT, and alkaline phosphatase may be increased. -Monitor blood sugar levels in diabetics
Lab tests for Diflucan
A client has been prescribed a topical antifungal medication for treatment of ringworm. What teaching should the nurse provide? (Select all that apply.)
-Apply a thin layer of the medication. -After applying the medication, let the area air-dry.
The client receives amphotericin B (Fungizone) for histoplasmosis. What does the best assessment by the nurse include? (Select all that apply.)
-Blood urea nitrogen -Serum creatinine
-Imidazoles -Triazoles
Chemical classes of azole drugs
Treatment for malaria involves
Multi-drug therapy
The client has scalp ringworm and is being treated with econazole (Spectazole). What are the best discharge instructions by the nurse
"Do not share any towels with family members."
The nurse does medication education for the client with histoplasmosis who receives ketoconazole (Nizoral). The nurse evaluates that learning has occurred when the client makes which statement?
"I could develop nausea, vomiting, and abdominal pain with this medication."
The client is being treated for pinworms with mebendazole (Vermox). The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement?
"I should chew this tablet."
The nursing instructor teaches the student nurses about fungal infections. The nursing instructor evaluates that learning has occurred when the student nurses make which statements?
-"Newer medications can be used for superficial as well as systemic infections." -"Superficial infections are considered more benign than systemic infections." -"Systemic infections require oral medications that have serious adverse effects."
The client receives oral nystatin (Mycostatin) suspension for an oral candidiasis infection. She tells the nurse she cannot continue to "swish and swallow" because her nausea is too great. What is the best response by the nurse?
"It is all right to swish the medication and then spit it out."
The client has a fungal infection of the toenails and receives oral terbinafine (Lamisil). The client asks the nurse how a pill will heal his nail infection. What is the best response by the nurse?
"The medication accumulates in your nail beds and is there for many months."
The client receives terbinafine (Lamisil) as treatment for a fungal infection of the toenails. What is an important assessment question for the nurse to ask?
"What analgesic do you take for headaches?"
The client has had malaria for many years. He asks the nurse why medications might not cure his illness when there are several drugs available. What is the best response by the nurse
"When cysts occur late in the disease, the parasite is too resistant for medications to be effective."
A mother calls the emergency department and says, "My 5-year-old just took four chloroquine (Aralen) that my husband was prescribed because he is going to Africa." What should the nurse advise? (Select all that apply.)
-Bring your child to the emergency department immediately. -Call 911 and watch your child for seizure activity until they arrive.
A client receives metronidazole (Flagyl) for treatment of a vaginal yeast infection. What should the nurse include in medication education for this client? (Select all that apply.)
-Do not drink alcohol with this medication. -Do not become pregnant while taking this medication. -You may experience a metallic taste while on this medication.
A client is receiving amphotericin B. The nurse will reinforce teaching by telling the client that he should report which symptoms? (Select all that apply.)
-Feeling hot -Hearing loss -Dizziness
An infant is prescribed fluconazole (Diflucan) for treatment of infant oral candidiasis or thrush. Which information should the nurse provide to the infant's caregiver in regard to this medication? (Select all that apply.)
-Give the infant a small amount of water prior to administering the medication. -Use a dosage syringe to place medication in several parts of the infant's mouth. -The breastfeeding mother may also require treatment.
Metronidazole (Flagyl) is being used to treat a client's Giardia lambila infection, a protozoal infection of the intestines. Which of the following are appropriate to teach this client? (Select all that apply.)
-Metronidazole may leave a metallic taste in the mouth. -The urine may turn dark amber brown while on the medication. -Taking the metronidazole with food reduces GI upset. -Current sexual partners do not require treatment for this infection.
-Nausea, vomiting, and diarrhea are reported at high doses. -Stevens-Johnson syndrome has been reported in patients with immunosuppression. -Patients with hepatic impairment should be monitored carefully for hepatotoxicity. -Most of the drug is excreted by the kidneys and should be used cautiously in patients with pre-existing kidney disease.
Adverse effects of Diflucan
Superficial fungal infections differ from systemic fungal infections in that superficial fungal infections
Affect hair and skin
A 32 year old female client is started on metronidazole (Flagyl) for treatment of a trichomonas vaginal infection. What must the client eliminate from her diet for the duration she is on this medication?
Alcohol
The nurse is preparing to administer a topical, oral antifungal medication to an adult client. The nurse will administer the medication
Alone, and will allow the client to swish and swallow the medication.
Which client is at the greatest risk of acquiring a serious fungal infection?
A client who is immunosuppressed
-Class: Antifungal -Adverse effects: Fever, chills, vomiting, and headache at the beginning of therapy. Phlebitis during IV therapy, nephrotoxicity, and electrolyte imbalances (hypokalemia). Cardiac arrest, hypotension, and dysrhythmias are possible. Can cause ototoxicity. -Nurses should asses for hearing loss, vertigo, unsteady gait, or tinnitus.
Amphotericin B (Fungizone)
-Also known as Aspergillosis -Opportunistic -Most commonly affects the lungs but can spread to other organs.
Aspergillus fumigatus
-Largest and most versatile group of antifungals. -Have a broad spectrum and are used to treat nearly any systemic, cutaneous, or superficial fungal infection.
Azole drugs
-One of the 2 most common antifungals. -Acts by interfering with the synthesis of ergosterol. -Rapidly and completely absorbed when given orally. -Particularly effective against Candida albicans. -Able to penetrate most body membranes to reach infections in the CNS, bone, eye, urinary tract, and respiratory tract. -Approved for the prophylaxis of fungal infections in patients with AIDS, those undergoing bone marrow transplants, or those receiving antineoplastic drugs. -Do not mixed IV formulation with other drugs. -Duration: 2-4 days
Diflucan
The client receives nystatin (Nilstat) for a fungal infection in the mouth. The nurse plans to do medication education prior to discharge. What will the best plan by the nurse include?
Dissolve the oral tablet in your mouth and then swallow it.
A client with type 2 diabetes treated with oral antidiabetic medication is receiving oral fluconazole (Diflucan) for treatment of chronic tinea cruris (jock itch). The nurse instructs the client to monitor blood glucose levels more frequently because of what potential drug effect?
Fluconazole (Diflucan) interacts with certain antidiabetic drugs, causing hypoglycemia.
Dialysis can be used to lower the serum drug level.
How is overdose of Diflucan treated?
-Use with warfarin may cause increased risk for bleeding. -Hypoglycemia may result if administered concurrently with certain oral hypoglycemics. -Levels may be decreased with concurrent rifampin or cimetidine use. -The effects of fentanyl, alfentanil, or methadone my be prolonged with concurrent administration.
Interactions with Diflucan
The mechanism of action of systemic antifungal agents is to
Interfere with the synthesis of ergosterol in the fungal cell membrane.
A client was prescribed chloroquine (Aralen) prior to a trip to an area where malaria is known to be endemic. The nurse will instruct the client to remain on the drug for up to 6 weeks after returning and the client asks why this is necessary. What is the nurse's best response?
It continues to kill any remaining malarial parasites that may have been acquired during the trip that are in your red blood cells.
A client with a severe systemic fungal infection is to be given amphotericin B (Fungizone). Before starting the amphotericin infusion, the nurse premedicates the client with acetaminophen (Tylenol), diphenhydramine (Benadryl), and prednisone (Deltasone). What is the purpose of premedicating the client prior to the amphotericin?
It decreases the risk of hypersensitivity reactions to the amphotericin.
-Caused by 4 species of the protozoan Plasmodium. -2nd most fatal infectious disease in the world. -Beings with a bite from an infected female Anopheles mosquito. -Multiplies in the liver and transforms into progeny called merozoites.
Malaria
The drug that most likely will be used for treatment of Trichomonas vaginalis is
Metronidazole (Flagyl)
A client has been been diagnosed with a fungal nail infection. The health care provider has prescribed griseofulvin (Fulvicin). The nurse will include which of the following in her teaching to the client?
Notify the provider if symptoms of infection worsen.
The nurse plans to provide health promotion to a group of business travelers who are going to travel to Africa. What will the best teaching plan by the nurse include?
Plan to take antimalarial drugs prophylactically.
-Contraindicated with chronic alcoholism. -Toxic to liver -Assess for nausea, vomiting, abdominal pain, and diarrhea. -May affect glycemic control in diabetic patients. -Monitor blood sugar -Monitor for alcohol use (raises risk of nausea, vomiting, and increased BP).
Role of Nurse: Azole therapy
-Use cautiously with renal impairment, severe bone marrow suppression, and pregnancy.
Role of Nurse: Systemic Antifungal therapy
-Stomach pain -Nausea (upset stomach) -Unusual tiredness -Dark-colored urine -Light or clay-colored stools -Jaundice (yellow skin and eyes) -Loss of appetite. -Fever
S&S of Hepatotoxicity
The nurse works in infection control at a large hospital. Which client does the nurse recognize as being at greatest risk for acquiring a fungal infection?
The client with malignant melanoma who is receiving chemotherapy
The client is noncompliant with taking medications to prevent malaria prior to an overseas business trip. What will the best assessment by the nurse reveal?
The side effects of vomiting and diarrhea were too uncomfortable.
The female client has a fungal infection and will receive nystatin (Mycostatin). What assessment data is critical for the nurse to collect prior to administering this medication?
The type of birth control the client is using
Chloroquine (Aralen)
Waht drug is still used to treat Malaria 60 years later?
