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문제

A nurse is caring for a patient with active pulmonary tuberculosis who has been on anti-tuberculosis therapy for 2 months. The patient reports new onset of visual disturbances, including difficulty distinguishing red and green colors. Which nursing intervention should be the priority?

해설
Visual disturbances like red-green color blindness indicate ethambutol-induced optic neuritis, requiring immediate discontinuation to prevent permanent vision loss. Other options delay necessary intervention by reducing lighting, scheduling later consultations, or just monitoring.
같은 주제 다음 문제A 45-year-old patient with suspected pulmonary tuberculosis presents to the emergency depa…

심화 해설

Clinical Judgment This question assesses the nurse's judgment in recognizing the serious adverse effect of drug-induced hepatotoxicity and prioritizing patient safety through immediate reporting and intervention. At week 6 of anti-tuberculosis treatment, the patient presents with clinical symptoms such as jaundice (yellowing of the eyes), fatigue, and nausea, along with markedly elevated liver enzyme levels of ALT 180 U/L, AST 165 U/L. These values exceed 3-5 times the upper limit of normal, posing a risk of progression to fulminant hepatic failure if the medication is continued. Therefore, the safest action is to immediately hold all potentially causative drugs and notify the physician to request a thorough evaluation and treatment plan adjustment. Memory Tip Hepatotoxicity from TB drugs? Hold all, Tell the doctor! Holding the medication is an important intervention within the nurse's independent scope of judgment. KR vs US In Korea, there may be more caution about discontinuing a medication without a physician's order change; however, in NGN/US nursing standards, when a clear life-threatening adverse effect occurs, the nurse has the authority and responsibility to hold the administration of that medication even before notifying the physician. 'Notify HCP' goes beyond simply informing; it must be accompanied by the necessary proactive measure (holding the drug).

임상 시나리오

Clinical Practice Guide: Managing Suspected Ethambutol Toxicity

Ethambutol (EMB) is a first-line agent for tuberculosis, but its use carries a risk of dose- and duration-dependent optic neuropathy. The primary nursing responsibility is early detection through systematic symptom surveillance and immediate action upon suspicion of toxicity.

Key Clinical Indicators
  • Early Hallmark: Acquired red-green dyschromatopsia (difficulty distinguishing red and green).
  • Progressive Signs: Blurred vision, decreased visual acuity, central scotomas (blind spots).
  • Symptom Onset: Typically insidious, often after 2 months of therapy, but can occur earlier with renal impairment.
Priority Nursing Actions
  1. Immediate Discontinuation: Hold the ethambutol dose as soon as visual symptoms are reported. This is the single most critical step to maximize the chance of visual recovery, as damage is partly reversible if caught early.
  2. Urgent Notification: Promptly inform the prescribing physician or advanced practice provider. The anti-TB regimen will need modification, often substituting EMB with another agent while awaiting susceptibility results.
  3. Documentation: Document the specific symptoms reported (e.g., "patient states 'I can't tell red from green'"), the time of onset, baseline visual status, and the actions taken, including medication held and provider notified.
Ongoing Monitoring and Patient Education
  • Baseline and Monthly Screening: Visual acuity and color vision testing (using Ishihara plates) should be performed at baseline and monthly thereafter for all patients on EMB.
  • Patient Teaching: Instruct patients to immediately report any changes in vision, especially color perception, blurred vision, or blind spots. Emphasize that they should not wait for a scheduled appointment.
  • High-Risk Populations: Exercise heightened vigilance in patients with renal impairment, as reduced drug excretion increases toxicity risk. Older adults and those on prolonged therapy (>2 months) are also at increased risk.

Clinical Pearl: Never attribute visual complaints in a patient on ethambutol to other causes without first excluding drug toxicity. A proactive, safety-first approach prevents irreversible blindness.

핵심 개념

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