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
Management of patients with active pulmonary tuberculosis: 1) Placement in a Negative Pressure Room. 2) Healthcare workers must wear an N95 Respirator. 3) If the patient leaves the isolation room (e.g., for radiography), they must wear a well-fitting surgical mask. This is a key component of source control. 4) Infectivity can generally be discontinued after 2-3 weeks of effective treatment and when 3 consecutive sputum smear tests are negative.
Caution:
A common pitfall in SATA (Select All That Apply) questions is placing 'patient education' or 'medication adherence monitoring' at the same priority level as infection control measures. While treatment completion is crucial from a public health perspective, the immediate safety priority in an acute care ward setting is always preventing transmission. Be careful with questions asking for the "MOST important" intervention.
학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요.