ISPN Review Nursing Considerations for Patients Receiving Sulfonamides
磺胺类药物治疗患者的护理考虑
Assessment: History and Examination 评估:病史与检查
• Assess for possible contraindications or cautions: known allergy to any sulfonamide, sulfonylureas, or thiazide diuretic because cross-sensitivity often results (obtain specific information about the nature and occurrence of allergic reactions); history of renal disease that could interfere with excretion of the drug and lead to increased toxicity; and current pregnancy or lactation status.
Perform a physical assessment to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy.
进行体格评估,建立评估药物效果和药物疗法相关不良效应发生率所需的基线资料。
• Examine skin and mucous membranes for any rash or lesions to provide a baseline for possible adverse effects.
检查皮肤、粘膜有无任何皮疹或破损,为可能出现的不良效应提供基线数据。
• Obtain specimens for culture and sensitivity tests at the site of infection to ensure that this is the appropriate drug for this patient.
获取感染部位细菌培养和敏感性试验标本,保证药物适用患者。
• Note respiratory status to provide a baseline for the occurrence of hypersensitivity reactions.
注意呼吸状况,为超敏反应提供基线数据。
• Conduct assessment of orientation, affect, and reflexes to monitor for adverse drug effects and examination of the abdomen to monitor for adverse effects.
实施定向力、情感和反射评估,监测有无药物不良效应;检查腹部,监测有无不良效应。
• Monitor renal function test findings, including BUN and creatinine clearance, to evaluate the status of renal functioning and to determine any needed alteration in dosage. Also perform a complete blood count (CBC) to establish a baseline to monitor for adverse effects.
Nursing diagnoses related to drug therapy might include the following:
• Acute Pain related to GI, CNS, or skin effects of the drug
• Disturbed Sensory Perception related to CNS effects
• Imbalanced Nutrition: Less Than Body Requirements related to multiple GI effects of the drug
• Deficient Knowledge regarding drug therapy
Test 1. When providing patient teaching for oral sulfonamide therapy, the nurse should instruct the patient to take the sulfonamide in what way?
A. At mealtime, when food is available
B. With soy or nonmilk products
C. Between meals with a full cup of water
D. On awakening before breakfast
2. The nurse identifies which statements about Stevens-Johnson syndrome as true? (Select all that apply.)
A. Patients with Stevens-Johnson syndrome have a mortality rate of about 25%.
B. Toxemia is associated with Stevens-Johnson syndrome.
C. Short-acting sulfonamides do not induce Stevens-Johnson syndrome.
D. Patients with Stevens-Johnson syndrome usually are hypothermic.
E. Lesions of the mucous membranes are a characteristic of Stevens- Johnson syndrome.
本期ISPN Review答案: 1. C. Between meals with a full cup of water
Oral sulfonamides should be taken on an empty stomach and with a full glass of water. To minimize the risk of renal damage, adults should maintain a daily urine output of 1200 mL. Sulfonamides should not be taken with soy or nonmilk products or food or before breakfast without liquids.
2. A. Patients with Stevens-Johnson syndrome have a mortality rate of about 25%; B. Toxemia is associated with Stevens-Johnson syndrome; E. Lesions of the mucous membranes are a characteristic of Stevens- Johnson syndrome.
Short-acting sulfonamides do induce Stevens-Johnson syndrome on rare occasions, and patients with Stevens-Johnson syndrome usually are hyperthermic. The other three statements are true.