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PRESENTATION ON

SAFE NURSING DRUG


ADMINISTRATION
BASED ON RNTCP
GUIDELINES RELATED
TO PEDAITRIC
TUBERCULOSIS
Presented by:
Ligy Mary Thomas
Msc nursing
Jamia Hamdard

PEDIATRIC TUBERCULOSIS

The

tuberculosis in children
upto 14 years.
The RNTCP Revised National
Tuberculosis Control Programme

OBJECTIVES
To

decrease mortality and morbidity by:

Ensuring

cure
Minimizing relapses
Preventing development of drug resistance

To

decrease infections and break the chain of


transmission of infection
To minimize the side effects due to antitubercular drugs.

PRINCIPLES
Appropriate

combination of at least
4 anti tubercular drugs to avoid
drug resistance
Prescription of correct dosage
To be taken regularly and for the
prescribed duration to prevent the
relapse after combination

COMPONENTS
Domicilliary

treatment

As

effective as hospitalized treatment


No extra risk as a source of infection
of others

Short

course chemotherapy

Treatment

regimens for 6-8 months


Given either daily or intermittent

CONTD.
Intermittent

As

regimen

effective as daily regimen

Direct

observation of treatment

Ensures

adherence

CONTD.
The

first two being given at the inpatient


level in the hospitals.
The short course chemotherapy is given in
two phases:
Intensive

phase: where in 2-3 drugs are given


initially (2-3 months) when the bacillary load is
high and emergence of drug resistance mutants
can be reduced.
Continuation phase: this is with fewer drugs for a
longer time of 4-5 months and ensure elimination
of bacteria which are responsible for relapses.

CASE DEFINITIONS
New

Case: A patient who has had no previous


ATT or for less than 4 weeks.

Relapse:

Patient declared cured/completed


therapy in past and has evidence of recurrence.

Treatment

after Default: A patient who has


taken treatment for at least 4 weeks and comes
after interruption of treatment for 2 months
and has active disease.

CONTD.
Pulmonary

TB refers to disease involving lung


parenchyma.
Extra Pulmonary TB refers to disease involving
sites other than lung parenchyma. If both
pulmonary and extra pulmonary sites are
affected, it will be considered as Pulmonary for
registration purposes. Extra Pulmonary TB
involving several sites should be defined by
most severe site.

CONTD
Failure

to respond: A case of pediatric


TB who fails to have bacteriological
conversion to negative status or fails to
respond clinically / or deteriorates after
12 weeks of compliant intensive phase
shall be deemed to have failed response
provided alternative diagnoses/ reasons
for non-response have been ruled out.

ANTI-TUBERCULAR DRUGS
The

anti-tubercular drugs have


three main actions:
Bactericidal

activity
Sterilizing activity
The ability to prevent resistance.

CONTD
The

essential drugs used are:

Isoniazid(H)s
Rifampicin

(R)
Pyrazinamide (Z)
Streptomycin (S)
Ethambutol (E)
Isoniazid(10mg/kg) for 6 months in
children for chemoprophylaxis who are
in contact with active tuberculosis even
though we give BCG vaccination

CONTD
Isoniazid,

Rifampicin, pyrazinamide
and streptomycin are the most
powerful bactericidal drugs.
Rifampicin
is the most potent
sterilizing drug
Ethambutol is used in association
with more powerful drugs to prevent
the
development
of
resistant
Tubercular bacilli

DAILY V/S INTERMITTENT


REGIMEN
The

intermittent therapy will remain the


mainstay of treating paediatric patients.
However,
children
with
severe
disseminated disease, Neuro-tuberculosis
and seriously ill hospitalised children
having high likelihood of vomiting and
intolerance to oral drugs an initial daily
supervised therapy during their stay in
the hospital is needed.

CONTD
After

discharge they will be taken


on thrice weekly DOT regimen(with
suitable modification to thrice
weekly dosages).

DOSAGES
The

following are the daily doses (mg per kg of


body weight per day)
R-ifampicin

10-12 mg/kg (max 600 mg/day),


I-soniazid 10 mg/kg (max 300 mg/day),
P-yrazinamide
(PZA) 30-35mg/kg (max 2000
mg/day)
E-thambutol 20-25mg/kg (max 1500 mg/day),
Streptomycin 15 mg/kg (max 1gm/day).

CATEGORIZATION
There

will be six weight bands and three


generic patient wise boxes will be used in
combination to treat patients in the six weight
bands.
The newer weight bands
6-8

kg
9-12 kg
13-16 kg,
17-20 kg
21-24 kg
25-30 kg.

CONTD
The

categorization
of
patients are the same as in
adultsIntensification

phase-2months
Continuation phase- 6 months

INSTRUCTIONS

Important points to be remembered in drug


administration:

The nurse needs to be knowledgeable about the


pharmacokinetic of drugs is based on how a drug
acts after entering the body by absorption,
distribution, metabolism and excretion of a
drugs.
The nurse needs to be aware about the effects
of drugs on the body: therapeutic effects, side
effects, adverse effects, toxic effects, allergic
reaction.

CONTD
The

anti-tubercular drugs are used in


multi-combinations
always
to
avoid
resistance.
These drugs need to take regularly.
The drugs have to be taken in accordance
with the phase of treatment whether
intensive or continuation

CONTD
The

anti-tubercular
drugs
have
bactericidal effect even after withdrawal
as referred to as lag period needs to be
remembered.
The antitubercular drugs have common
side effects which the nurse has to
inform the parents about like the
jaundice when taking isoniazid, Rifampicin
and pyrazinamide while ethambutol has
impaired vision as the side effect.

CONTD
Check the physicians order before administering
the drugs.
Read the medication label carefully as many
products come in similar wrappers, colors and
shapes.
Follow the 10 rights of drug administration while
administering the drug.

CONTD
The drugs can be crushed and administered to
the patients when the child has difficulty in
swallowing the drugs.
The child who is able to swallow the drug, the
nurse has to place the drug under the tongue.
The nurse needs to chart the administration of
drug in the treatment card with date, time and
dose.
Monitor the after affects of the drugs and
report if nay abnormal findings to the physician.
The drug Rifampicin needs to be taken 1 hour
before meal or 2 hours after meals

DRUG ADMINISTRATION
It

includes the observance of the 10


patients rights right patient, right drug,
right dose, right route, right time, right
documentation, right history, right to
refuse, right evaluation, right education
and information which needs to be
explained to the parents.

NURSING RESPONSIBILITES
Adherence
Nutrition

Counseling
Lifestyle

Precautions
Side

effects