NURS 133 Rh Immune Globin and Tenofovir

jasmine's version from 2016-06-07 23:55

Section 1

Question Answer
Rh (D: presence or absence of D antigen on RBCs; Du positive: weak D positive) immune globulin Used to prevent the immunological condition known as Rh disease (or hemolytic disease of newborn); IM, IV: Administered to Rh negative patients who have been exposed to Rh positive blood by pregnancy or delivery of a Rh positive infant, abortion of a Rh positive fetus, fetal maternal hemorrhage due to amniocentesis, other obstetrical manipulative procedure, or intra-abdominal trauma while carrying a Rh positive fetus, transfusion of Rh positive blood or blood products to a Rh negative patient; IV: Management of immune thrombocytopenic purpura (ITP or Moschcowitz syndrome) (rare disorder of the blood coagulation system, causing extensive microscopic clots to form in the small vessels throughout the body)
Rh immune globulin actions Prevent production of anti Rh antibodies in Rh negative patients who were exposed to Rh positive blood; Increase platelet counts in patients with ITP
Rh immune globulin therapeutic uses Prevention of antibody response and hemolytic disease of the newborn (erythroblastosis fetalis) in future pregnancies of women who have conceived a Rh positive fetus; Prevention of Rh sensitization following transfusion accident; Decreased bleeding in patients with ITP
Elimination/Excretion of Rh immune globulin Unknown
Adverse/Side Effects of Rh immune globulin Disseminated intravascular coagulation, intravascular hemolysis, anemia
Contraindications of Rh immune globulin Prior hypersensitivity reaction to human immune globulin; Rh or Du positive patients
Use Rh immune globulin cautiously in ITP patients with pre-existing anemia (decrease dose if Hgb less than 10 g/dL); May also cause disseminated intravascular coagulation in ITP patients
Drug/Food interactions of Rh immune globulin May decrease antibody response ot some live virus vaccines (measles, mumps, rubella)
Medication administration of Rh immune globulin IM; IV
Nursing interventions of Rh immune globulin IV: Assess vital signs periodically during therapy in patients receiving IV Rh immune globulin; ITP: Monitor patient for signs and symptoms of intravascular hemolysis (IVH) (back pain, shaking chills, fever, hemoglobinuria), anemia, and renal insufficiency. If transfusions are required, use Rh negative packed red blood cells to prevent exacerbation of IVH; Lab test considerations: Pregnancy: Type and cross-match of mother and newborn’s cord blood must be performed to determine need for medication; mother must be Rh negative and Du negative; Infant must be Rh positive; If there is doubt regarding infant’s blood type or if father is Rh positive, medication should be given; An infant born to a woman treated with Rh immune globulin antepartum may have a weakly posive direct Coombs’ test result on cord or infant blood; ITP: Monitor platelet counts, RBC counts, hemoglobin, and reticulocyte levels to determine effectiveness of therapy
Implementation of Rh immune globulin Do not give to infant, ro Rh positive individual, or to Rh negative individual previously sensitized to the Rh antigen; **Rh immune globulin intravenous may be given IM, however Rh immune globulin (microdose and standard dose) is for IM use only and cannot be given IV; When using prefilled syringe, allow solution to reach room temperature before administration; IM: Administer into the deltoid muscle-dose should be given within 3 hours, yet may be given up to 72 hours after delivery, miscarriage, abortion, or transfusion; IV: Administer over 3-5 minutes
Client education of Rh immune globulin Pregnancy: Explain to patient that the purpose of this medication is to protect future Rh positive infants; ITP: Explain purpose of medication to patient
Evaluation/Desired outcomes of Rh immune globulin Prevention of erythroblastosis fetalis in future Rh positive infants; Prevention of Rh sensitization following incompatible transfusion; Decreased bleeding episodes in patients with ITP
Potential nursing diagnoses of Rh immune globulin Deficient knowledge, related to medication regimen (patient/family teaching)

Section 2

Question Answer
Tenofovir Anti-retrovirals; Nucleoside reverse transcriptase inhibitors; Pregnancy category B; HIV infection (with other anti-retrovirals); Chronic hepatitis B
Tenofovir actions Active drug (tenofovir) is phosphorylated intracellularly; tenofovir diphosphate inhibits HIV reverse transcriptase resulting in disruption of DNA synthesis
Tenofovir therapeutic uses Slowed progression of HIV infection and decreased occurrence of sequelae (condition that is the consequence of a previous disease or injury); Increased CD4 cell count and decreased viral load; Decreased progression/sequelae of chronic hepatitis B infection
Elimination/Excretion of Tenofovir 70-80 percent excreted unchanged in urine by glomerular filtration and active tubular secretion
Adverse/Side Effects of Tenofovir Depression, headache; Hepatomegaly, diarrhea, nausea; Lactic acidosis; Rash
Contraindications of Tenofovir Hypersensitivity; Concurrent use of anti-retroviral combination products containing tenofovir; Concurrent or recent use of NSAIDs (increased risk of acute renal failure); Lactation: HIV-infected women should not breast feed
Use Tenofovir cautiously in Co-infection with HIV and chronic hepatitis B; Obesity, women, prolonged nucleoside exposure (may be risk factors for lactic acidosis/hepatomegaly); Renal impairment (Increased dosing interval if CCr less than 50 mL/min); History of pathologic bone fractures or at risk for osteopenia; OB: Has been used sagely; Pedi: Children less than 2 years old (safety not established)
Drug/Food interactions of Tenofovir May increase didanosine levels; Decrease didanosine dose; Blood levels may be increase by cidofovir, acyclovir, ganciclovir, or valganciclovir; Risk of renal toxicity increase by other nephrotoxic agents; Combination therapy with atazanavir may lead to decrease virologic response and possible resistance to atazanavir (small amounts of ritonavir may be added to boost blood levels); may also increase tenofovir levels; Lopinavir/ritonavir may increase levels; Concurrent use with adefovir for chronic hepatitis B infection should be avoided; Concurrent use with NSAIDs may increase risk of acute renal failure
Medication administration of Tenofovir PO
Nursing interventions of Tenofovir Monitor for change in severity of HIV symptoms and for symptoms of opportunistic infection before and during therapy; Monitor bone mineral density in patients who have a history of pathologic bone fracture or are at risk for osteoporosis or bone loss; Lab test considerations: Monitor viral load and CD4 count before and routinely during therapy to determine response; Monitor liver function tests and hepatitis B virus levels throughout and following therapy; If therapy is discontinued, may cause severe exacerbation of hepatitis B; May cause increase AST, ALT, alkaline phosphatase, creatine kinase, amylase, and triglyceride concentrations; Lactic acidosis may occur with hepatic toxicity causing hepatic steatosis; may be fatal, especially in women; Calculate creatinine clearance prior to and periodically during therapy and when clinically indicated; Monitor serum phosphate periodically during therapy inpatients at risk for renal impairment; May cause hypophosphatemia in patients with renal impairment; May cause hyperglycemia and glucosuria
Client education of Tenofovir Instruct patient on the importance of taking tenofovir as directed, even if feeling better; Discontinuing therapy may lead to severe exacerbations; Caution patients not to share or trade this medication with others; Inform patient that tenofovir may cause hyperglycemia; Advise patient to notify health care professional if increased thirst or hunger, unexplained weight loss, increased urination, fatigue, or dry, itchy skin occurs; Instruct patient to notify health care professional before taking any new medications; Caution patient to avoid crowds and persons with known infections; Inform patient that tenofovir does not cure AIDS, and does not reduce risk of transmission of HIV to others through sexual contact or blood contamination; Caution patient to use a condom and avoid sharing needles or donating blood to prevent spreading HIV to others; Advise patient that changes in body fat distribution (increased fat in upper back and neck, breast, and trunk, and loss of fat from legs, arms, and face) may occur, yet may not be related to drug therapy; Advise female patients to notify health care professional if pregnancy is planned or suspected; Breast feeding should be avoided; Pregnancy registry is available for patient taking anti-retroviral medications; Emphasize importance of regular exams to monitor for side effects
Evaluation/Desired outcomes of Tenofovir Decreased incidence of opportunistic infection and slowed progression of HIV infection; Slowed progression of chronic hepatitis B infection
Potential nursing diagnoses of Tenofovir Risk for infection (indications, side effects); Risk for injury (side effects)