Before administering a newly prescribed dose of terbinafine HCL to a client with a fungal toenail infection, which assessment finding is most important for the nurse to address?
A.
Reported history of alcoholism.
B.
Toenails appear thick and yellow.
C.
White blood cells count of 8,500/mm3 or 85 x 109 /L (SI).
D.
Employed as a construction worker.
The Correct answer and Explanation is:
The most important assessment finding for the nurse to address before administering a newly prescribed dose of terbinafine HCL to a client with a fungal toenail infection is:
A. Reported history of alcoholism.
Explanation:
Terbinafine HCL is an antifungal medication used to treat various fungal infections, including onychomycosis (fungal toenail infection). Before starting treatment, it is crucial for the nurse to assess the client’s medical history thoroughly, including any history of chronic conditions or substance use. Among the options provided, a history of alcoholism is particularly significant due to its potential impact on the metabolism and safety of terbinafine.
1. Terbinafine Metabolism and Liver Function:
Terbinafine is primarily metabolized by the liver. Chronic alcohol use can compromise liver function, leading to impaired drug metabolism. This can increase the risk of drug toxicity and liver damage. Alcoholism can exacerbate the risk of adverse effects from terbinafine, as the liver’s ability to process and eliminate the drug may be diminished. This makes it essential to assess liver function before initiating therapy.
2. Risk of Hepatotoxicity:
Terbinafine has been associated with hepatotoxicity (liver toxicity). Signs of liver dysfunction, such as elevated liver enzymes, jaundice, or abdominal pain, should be monitored closely. In individuals with a history of alcoholism, the risk of hepatotoxicity is heightened due to potential pre-existing liver damage or compromised liver function. The nurse must ensure that the liver is functioning adequately to handle the medication safely.
3. Other Assessment Findings:
- Toenails appearing thick and yellow (B) are typical symptoms of a fungal infection but do not directly impact the decision to start terbinafine. While they confirm the need for treatment, they do not present an immediate contraindication or concern like a compromised liver would.
- White blood cell count of 8,500/mm³ (C) is within normal limits and does not indicate any immediate issue related to the medication.
- Employment as a construction worker (D), while relevant to other health considerations, does not have a direct impact on the safe administration of terbinafine compared to a history of alcoholism.
Therefore, addressing the reported history of alcoholism is the most crucial assessment finding as it directly affects the medication’s safety and efficacy.