Pharmacological and Parenteral Therapies Q 106
A client with AIDS is taking Zovirax (acyclovir). Which nursing intervention is most critical during the administration of acyclovir?
A. Limit the client’s activity
B. Encourage a high-carbohydrate diet
C. Utilize an incentive spirometer to improve respiratory function
D. Encourage fluids
Correct Answer: D. Encourage fluids
Clients taking Acyclovir should be encouraged to drink plenty of fluids because renal impairment can occur. Acute kidney injury (AKI) is the most significant side effect of parenteral acyclovir administration. The incidence of AKI is comparable to other nephrotoxic medications such as aminoglycosides. Patients with CKD are at higher risk. Dose adjustment of acyclovir for ideal body weight and baseline renal function is imperative.
Option A: Limiting activity is not necessary. Patients should be monitored for adverse effects such as malaise, inflammation or phlebitis at infusion site, nausea, vomiting, rash (including Steven-Johnson syndrome), transaminitis, nausea, vomiting, diarrhea, headache, abdominal pain, aggression/confusion, agitation, alopecia, anaphylaxis, anemia, angioedema, anorexia, ataxia, coma, disseminated intravascular coagulation (DIC), dizziness and fatigue.
Option B: Eating a high-carbohydrate diet is unnecessary. When taken orally, acyclovir may be taken with or without food 2 to 5 times a day for 5 to 10 days as well as up to 12 months to prevent outbreaks of genital herpes. For limited mucocutaneous lesions, acyclovir administration can be via the oral route. In cases in which there is disseminated, visceral, or CNS involvement, the acyclovir administration should be intravenous.
Option C: Use of an incentive spirometer is not specific to clients taking Acyclovir. A study regarding the pharmacokinetics of acyclovir demonstrated that a patient’s glomerular filtration and tubular secretion contribute to its renal excretion. Appropriate cautions are necessary when administering intravenous acyclovir to such higher-risk patients.