Chapter 28

Peptides, Antimalarials,and Anthelmintics,

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 Malaria
 Malaria
 Protozoan disease
 Incubation period 10-35 days
 Etiology
 Protozoan parasites, P. malariae, P. ovale, P. vivax, and
P. falciparum
 Phases
 Tissue phase
• Invasion of body tissue, no symptoms
 Erythrocytic phase
• Invasion of RBCs
• Symptoms: fever, chills, sweating, flu-like symptoms

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Malaria Transmission

3
 Antimalarial Drugs
 Treatment regimen
 Combinations used for drug-resistant malaria
 Prophylactic measures
 Prevent malaria; prevent relapse
 Malaria eradication methods
 Prophalaxis
 Treatment for acute attack
 Prevention of relapse

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 Antimalarial Drugs (Cont.)
 Side effects/adverse reactions
 Visual disturbances, dizziness
 GI distress: anorexia, nausea, vomiting, diarrhea,
abdominal cramps
 Seizures, confusion, headache, psychosis
 Eighth cranial nerve damage, ototoxicity
 Renal impairment, hepatomegaly
 Hemolytic anemia
 Cardiovascular effects

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 Nursing Process: Antimalarials
 Assessment
 Assess whether the patient has traveled out of the country
to a malaria-endemic area.
 Obtain a patient history of malaria and whether antimalarial
drugs were taken.
 Nursing diagnoses
 Infection, Risk for
 Planning
 The patient will take antimalarial drugs at the times and
dosages prescribed.
 The patient will utilize preventive measures when in the
outside environment.

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Nursing Process: Antimalarials (Cont.)
 Nursing interventions
 Monitor renal and liver function by checking urine
output and liver enzymes.
 Monitor the patient for impaired consciousness,
headache, or seizures.
 Monitor patients returning from malaria-endemic
areas for malarial symptoms.
 Evaluation

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 Helminths
 Helminths (parasitic worms)
 Four groups of helminths
 Cestodes (tapeworms)
 Trematodes (flukes)
 Intestinal nematodes (roundworms)
 Tissue-invading nematodes (tissue roundworms)

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 Helminths (Cont.)
 Transmission
 Entry from infected soil to humans via:
• Contaminated food
• Bites of carrier insects
• Direct penetration of skin
 Sites affected
• Intestine, lymphatic system
• Blood vessels, liver

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 Anthelmintic Drugs
 Action
 Destroy parasitic worms
 Usually given 1 to 3 days
 Side effects/adverse reactions
 Dizziness, drowsiness
 Headache, weakness
 Lymph node swelling
 Ocular opacity, tachycardia
 GI distress
 Elevated hepatic enzymes

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 Nursing Process: Antihelminics
 Assessment
 Assess the patient for complaints of anal itching and
abdominal discomfort.
 Assess whether the patient has traveled to other
countries.
 Obtain a history of foods the patient has eaten and
how the food was prepared.
 Nursing diagnoses
 Activity Intolerance, Risk for

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Nursing Process: Antihelminics (Cont.)
 Planning
 The patient will demonstrate handwashing before
eating.
 The patient will explain how to prepare foods properly
to avoid recurrence.
 Nursing interventions
 Monitor the patient for adverse effects.
 Explain to the patient the importance of handwashing
before meals and after use of the toilet.
 Evaluation

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 Peptides
 Action
 Interferes with the bacterial cell wall causing cell
death.
 Classification
 Antiviral
 Antimicrobial
 Antifungal
 Antiparasitic

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 Peptides (Cont.)
 Peptides
 Colistimethate
• Treats Pseudomonas aeruginosa, CRE, Klebsiella, Shigella
 Polymyxins
• Treats Pseudomonas aeruginosa, Escherichia coli,
Klebsiella, Shigella
 Bacitracin
• Treats most gram-positive and some gram-negative bacteria
 Metronidazole
• Treats Trichomonas vaginalis, amebiasis, giardiasis,
Helicobacter pylori, Clostridium difficile

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 Peptides (Cont.)
 Side effects/adverse reactions
 Hypersensitivity, anaphylaxis
 Dizziness, headache, slurred speech
 GI distress
 Pruritus, rash, fever
 Peripheral neuropathy
 Seizures
 Ototoxicity, nephrotoxicity
 Respiratory distress
 Superinfection
 Clostridium difficile associated diarrhea

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 Practice Question #1
Which is the most appropriate nursing intervention
for a patient who is taking mefloquine and
hydroxychloroquine?

A. Collect a stool specimen.

B. Assess the patient’s hearing.
C. Advise the patient to take showers, not baths.
D. Encourage female patients to have a Pap test every 6
months.

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 Practice Question #2
Travelers visiting malaria-infested countries are
instructed to

A. avoid mosquitoes in these countries.

B. receive immunizations before travel.
C. visit these countries only while in good health.
D. take prophylactic antibiotics before traveling.

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 Practice Question #3
Which information will the nurse include when
teaching a patient about anthelmintic therapy?

A. Take the medication 1 hour before meals.

B. Take a bath at least once a day.
C. Change your sheets every other day.
D. Be aware that drowsiness may occur.

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 Practice Question #4
The nurse is aware that most patients receiving
metronidazole are being treated for infections of
the

A. urinary tract.
B. gastrointestinal system.
C. integumentary system.
D. reproductive system.

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