An older adult patient is prescribed systemic antifungal therapy for 1 month. Which precautions are important for the nurse to teach this patient? (Select all that apply.)
a. "Avoid drinking coffee or any other beverages or food that contain caffeine."
b. "Check your pulse daily and report any new irregularities to your prescriber."
c. "Examine all bowel movements and any vomit for the presence of pus and report it to your prescriber."
d. "Look at the whites of your eyes daily and if a yellow color appears, report it to your prescriber."
e. "If your daily urine output drops below a liter less than your daily fluid intake, notify your prescriber immediately."
f. "If you should develop abdominal bloating and diarrhea, go to the nearest emer-gency department as soon as possible."
B, D, E
Most of the antifungal drugs can affect cardiac rhythm. Patients should check their pulse daily for a full minute, and if new irregularities are present or the rate is slow, the prescriber should be notified. The risk for drug-induced liver toxicity is higher among older adults; often the first symptom of reduced liver function is yellowing of the sclera and skin. Older adults are also more likely to have some degree of renal insufficiency and can develop kidney problems more quickly while taking an antifungal drug; normal daily urine output should be very close to the volume of fluid taken in each day. There is no recommendation to avoid caffeine with any antifungal drug. GI infection is not a specific risk associated with antifungal therapy. Abdominal bloating and diarrhea are not especially associated with antifungal therapy and are not indications of the need to seek immediate medical attention.
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