Presentation on Rntcp Guidelines

7/25/2019 Presentation on Rntcp Guidelines

1/35

PRESENTATION ONSAFE NURSING DRUG

ADMINISTRATIONBASED ON RNTCP

GUIDELINES RELATEDTO PEDAITRICTUBERCULOSIS

Presented by:

Ligy Mary Th!as

Ms" n#rsing

$a!ia %a!dard


2/35

PEDIATRIC TUBERCULOSIS

The tuberculosis in childrenupto 14 years.The RNTCP Revised National

Tuberculosis Control Programme


3/35

OBJECTIVESTo decrease mortality and morbidity by:Ensuring cureinimi!ing relapses

Preventing development o" drug resistanceTo decrease in"ections and brea# the chain o"

transmission o" in"ectionTo minimi!e the side e""ects due to anti$

tubercular drugs.


4/35

PRINCIPLES

%ppropriate combination o" at least4 anti tubercular drugs to avoiddrug resistance

Prescription o" correct dosageTo be ta#en regularly and "or the

prescribed duration to prevent therelapse a"ter combination


5/35

COMPONENTS

&omicilliary treatment%s e""ective as hospitali!ed treatmentNo e'tra ris# as a source o" in"ection

o" others

)hort course chemotherapyTreatment regimens "or *$+ months,iven either daily or intermittent


6/35

CONTD.

-ntermittent regimen%s e""ective as daily regimen

&irect observation o" treatmentEnsures adherence


7/35

CONTD.

The "irst to being given at the inpatientlevel in the hospitals.The short course chemotherapy is given in

to phases:

Intensi&e 'hase: here in /$0 drugs are giveninitially /$0 months2 hen the bacillary load ishigh and emergence o" drug resistance mutantscan be reduced.

Cntin#atin 'hase: this is ith "eer drugs "or alonger time o" 4$3 months and ensure eliminationo" bacteria hich are responsible "or relapses.


8/35

CASE DEFINITIONS

Ne( Case: % patient ho has had no previous%TT or "or less than 4 ee#s.

Re)a'se: Patient declared curedcompletedtherapy in past and has evidence o" recurrence.

Treat!ent a*ter De*a#)t: % patient ho has

ta#en treatment "or at least 4 ee#s and comesa"ter interruption o" treatment "or / monthsand has active disease.


9/35

CONTD.

P#)!nary TB re"ers to disease involving lungparenchyma.

E+tra P#)!nary TB re"ers to disease involving

sites other than lung parenchyma. -" bothpulmonary and e'tra pulmonary sites area""ected5 it ill be considered as Pulmonary "orregistration purposes. E'tra Pulmonary T6involving several sites should be de"ined bymost severe site.


10/35

CONTD

Fai)#re t res'nd: % case o" pediatricT6 ho "ails to have bacteriologicalconversion to negative status or "ails to

respond clinically or deteriorates a"ter1/ ee#s o" compliant intensive phaseshall be deemed to have "ailed responseprovided alternative diagnoses reasons

"or non$response have been ruled out.


11/35


12/35

ANTI-TUBERCULAR DRUGS

The anti$tubercular drugs havethree main actions:

6actericidal activity)terili!ing activityThe ability to prevent resistance.


13/35


14/35

CONTD

The essential drugs used are:-sonia!id72sRi"ampicin R2Pyra!inamide 82)treptomycin )2Ethambutol E2

-sonia!id19mg#g2 "or * months inchildren "or chemoprophyla'is ho arein contact ith active tuberculosis eventhough e give 6C, vaccination


15/35

CONTD

-sonia!id5 Ri"ampicin5 pyra!inamideand streptomycin are the mostpoer"ul bactericidal drugs.

Ri"ampicin is the most potentsterili!ing drug

Ethambutol is used in associationith more poer"ul drugs to preventthe development o" resistantTubercular bacilli


16/35

DAILY V/S INTERMITTENT

REGIMEN

The intermittent therapy ill remain themainstay o" treating paediatric patients.

7oever5 children ith severe

disseminated disease5 Neuro$tuberculosisand seriously ill hospitalised childrenhaving high li#elihood o" vomiting andintolerance to oral drugs an initial dailysupervised therapy during their stay inthe hospital is needed.


17/35

CONTD

%"ter discharge they ill be ta#enon thrice ee#ly &T regimenithsuitable modi"ication to thriceee#ly dosages2.


18/35

DOSAGES

The "olloing are the daily doses mg per #g o"body eight per day2R$i"ampicin 19$1/ mg#g ma' *99 mgday25

-$sonia!id 19 mg#g ma' 099 mgday25P$yra!inamide P8%2 09$03mg#g ma' /999

mgday2E$thambutol /9$/3mg#g ma' 1399 mgday25)treptomycin 13 mg#g ma' 1gmday2.


19/35

CATEGORIZATION

There ill be si' eight bands and threegeneric patient ise bo'es ill be used incombination to treat patients in the si' eight

bands.The neer eight bands*$+ #g;$1/ #g10$1* #g51


20/35

CONTD

The categori!ation o"patients are the same as in

adults$-ntensi"ication phase$/monthsContinuation phase$ * months


21/35

INSTRUCTIONS -mportant points to be remembered in drug

administration:

The nurse needs to be #noledgeable about thepharmaco#inetic o" drugs is based on ho a drugacts a"ter entering the body by absorption5distribution5 metabolism and e'cretion o" adrugs.

The nurse needs to be aare about the e""ectso" drugs on the body: therapeutic e""ects5 sidee""ects5 adverse e""ects5 to'ic e""ects5 allergicreaction.


22/35

CONTD

The anti$tubercular drugs are used inmulti$combinations alays to avoidresistance.

These drugs need to ta#e regularly.The drugs have to be ta#en in accordance

ith the phase o" treatment hetherintensive or continuation


23/35

CONTD

The anti$tubercular drugs havebactericidal e""ect even a"ter ithdraalas re"erred to as lag period needs to be

remembered.The antitubercular drugs have common

side e""ects hich the nurse has toin"orm the parents about li#e the

=aundice hen ta#ing isonia!id5 Ri"ampicinand pyra!inamide hile ethambutol hasimpaired vision as the side e""ect.


24/35

CONTD

Chec# the physician>s order be"ore administeringthe drugs.

Read the medication label care"ully as manyproducts come in similar rappers5 colors andshapes.

?ollo the 19 rights o" drug administration hileadministering the drug.


25/35

CONTD

The drugs can be crushed and administered tothe patients hen the child has di""iculty insalloing the drugs.

The child ho is able to sallo the drug5 thenurse has to place the drug under the tongue.

The nurse needs to chart the administration o"drug in the treatment card ith date5 time anddose.

onitor the a"ter a""ects o" the drugs andreport i" nay abnormal "indings to the physician.

The drug Ri"ampicin needs to be ta#en 1 hourbe"ore meal or / hours a"ter meals


26/35


27/35


28/35


29/35


30/35


31/35


32/35


33/35


34/35

DRUG ADMINISTRATION

-t includes the observance o" the 19patients rights right patient5 right drug5right dose5 right route5 right time5 right

documentation5 right history5 right tore"use5 right evaluation5 right educationand in"ormation hich needs to bee'plained to the parents.


35/35

NURSING RESPONSIBILITES

%dherenceNutrition

Counseling@i"estylePrecautions)ide e""ects

Presentation on Rntcp Guidelines

Documents

Transcript of Presentation on Rntcp Guidelines