Fungal Skin Infections: Nursing Management and Monitoring

00:00 Now let's walk through some key clinical takeaways for treating fungal skin infection.

00:07 Accurate diagnosis through clinical examination, microscopy, and culture is essential before initiating antifungal therapy.

00:15 You want to make sure that the treatment is matched to the pathogen, so the antifungals will be selected based on the specific fungal organism and the infection site.

00:25 Think about the patient's factors.

00:27 Assess for comorbidities, other drug interactions, and special populations like patients who are pregnant, pediatric patients, or renal hepatic impairment.

00:38 Monitor the drug for efficacy and toxicity.

00:41 We want to make sure it's doing what we want it to do in the treatment plan, but it's not putting the patient at risk.

00:46 So follow the appropriate monitoring parameters and adjust the therapy as needed.

00:51 Monitor duration to make sure the patient completes the full treatment course so we can prevent recurrence and resistance.

00:58 Now I know we touched on monitoring for efficacy and toxicity, but I want to dig deeper into that.

01:05 So it's important that all of us follow appropriate monitoring parameters and we want to be part of the team that's adjusting the therapy as needed.

01:12 So let's start with a framework of four broad categories.

01:16 First you're going to monitor for hepatotoxicity.

01:20 Second, you're going to monitor for cardiac effects, particularly with itraconazole.

01:25 Third, you want to watch for severe skin reactions or anaphylaxis.

01:30 And fourth, the drug interaction effects.

01:34 So let's take a look at that.

01:36 What are we looking for in signs of hepatotoxicity or liver dysfunction? Well think about their skin and their eyes.

01:43 That may be a sign of jaundice if you see them turning yellow.

01:46 The patient might complain of right upper quadrant abdominal pain.

01:50 The patient may have some unexplained nausea or vomiting.

01:54 They may feel extra tired.

01:56 Their urine may be darker and their stool may be lighter.

02:00 These are all signs that the liver is struggling.

02:03 And if the patient is on an oral antifungal, this is reason for alarm.

02:08 Now we'll come to the cardiac effects.

02:10 Remember that's that second category, but we're specifically talking about itraconazole.

02:14 So this could cause signs of heart failure.

02:16 You know, the typical ones, shortness of breath, edema, and unusual fatigue.

02:21 But remember that is specific to this oral antifungal.

02:24 They can also have symptoms of arrhythmia.

02:27 Now if they're not on a monitor, they may describe it to you like, I feel like I'm having palpitations or I'm kind of dizzy and I almost even fainted.

02:34 Those are signs that the patient may be having some cardiac arrhythmias.

02:38 Now with severe skin reactions, and we'll talk about allergic reactions, with the skin reactions, you want to think about Stevens-Johnson syndrome.

02:46 That's also called toxic epidermal necrolysis.

02:50 This can be caused by these oral antifungals.

02:53 Also watch for widespread rashes, blistering or peeling of the skin.

02:57 Look at their mouth and their eyes to see if there's mucosal involvement.

03:01 And especially if there's a fever accompanying skin changes, the client needs to know they need to reach out and contact their healthcare provider.

03:09 Now in regards to severe allergic reactions, these can be life-threatening.

03:12 So the patient may experience anaphylaxis.

03:15 They might have angioedema, the swelling of their face, their lips or their tongue.

03:19 That may lead to difficulty breathing and at least they're going to have severe itching.

03:24 So at best, if the patient has any of these symptoms, to keep them the safest, you want them to seek immediate medical attention.

03:32 Now finally, they launch for signs of significant drug interactions.

03:37 Now the symptoms are going to depend on the other medication that it's interacting with.

03:41 Kind of a basic guideline would be with statins, you're going to watch for muscle pain and weakness.

03:47 With benzodiazepines, you're going to look for excessive sedation.

03:50 And with calcium channel blockers, you're looking for hypotension.

03:54 Now that's just a quick review. We went in detail earlier in the series.

03:58 There's some emerging trends in antifungal therapy that all members of the healthcare team need to keep in mind.

04:04 We do have a rising global incidence of fungal infections, but we also have a rising antifungal resistance.

04:10 Now the good news is we've got some novel antifungal agents and they're in development.

04:14 Those are going to target new molecular pathways.

04:17 So that's great news.

04:19 But keep in mind, you may need to use combination therapy if it's a very difficult to treat infection.

04:25 So this underscores the importance of antifungal stewardship and clear programs to accomplish this.

04:32 Remember, we've got some advances in some rapid diagnostic techniques, so stay tuned for those.

04:37 That will improve the time to appropriate treatment, which hopefully will make that more effective.

04:43 If you want to provide clinical excellence in antifungal management, keep these points in mind.

04:49 Make sure the diagnosis is accurate through appropriate testing.

04:53 Make sure the therapy has been selected based on the pathogen, the site, and the patient factors.

04:59 Make sure you've considered special populations and drug interactions, you're monitoring for efficacy and safety, and that you're staying current with the evolving guidelines and emerging resistance patterns.

05:10 Remember, your expertise as a member of the healthcare team makes the difference between treatment success and failure.