A client diagnosed with active tuberculosis is receiving a daily pharmacological regimen that includes oral isoniazid, rifampin, pyrazinamide, and ethambutol. Prior to administering the scheduled morning doses, the practical nurse (PN) reviews the client's current data. The client states, "My urine has been a bright orange-red color for the last two days." The morning laboratory results show an aspartate aminotransferase (AST) of 152 U/L and an alanine aminotransferase (ALT) of 168 U/L. Based on these clinical findings, which action is most appropriate for the practical nurse to take?
- AReassure the client that the orange-red urine is an expected effect of rifampin and administer the scheduled medications.
- Withhold the scheduled tuberculosis medications and promptly report the laboratory results to the registered nurse (RN).Answer
- CAdminister the isoniazid and ethambutol, but withhold the rifampin due to the abnormal urine appearance.
- DInstruct the client to increase oral fluid intake to flush the kidneys, then proceed with administering the medication regimen.
Answer
The most appropriate action is to withhold the scheduled tuberculosis medications and promptly report the laboratory results to the registered nurse (RN).
Isoniazid, rifampin, and pyrazinamide are highly hepatotoxic medications. The significant elevation of liver enzymes (AST and ALT > 3 times the upper limit of normal) indicates drug-induced liver injury. The practical nurse must recognize this critical laboratory finding, safely withhold the medications, and immediately escalate the information to the RN or healthcare provider. While the orange-red urine is a known, harmless side effect of rifampin, the elevated transaminases require immediate clinical intervention.
Step-by-Step Solution
Key Concept
Monitoring for severe adverse effects of antitubercular medications and applying the practical nursing scope of practice for critical laboratory values.