Question

Which information would the nurse include when developing a teaching plan for a client receiving methotrexate for psoriasis? a. Creatinine clearance and other tests of renal function are required weekly for the first month of therapy b. Periodic EKGs will be done from the start of therapy until 6 months after its completion c. Pulmonary function tests and arterial blood gases need to be checked before the start of therapy d. Liver function tests, lipid levels, and blood counts need to be monitored during therapy

Short answer

Option d is the correct information: Liver function tests, lipid levels, and blood counts need to be monitored during therapy.

Step-by-step solution

Understand the Question

Identify the correct information that should be included in a teaching plan for a client receiving methotrexate for psoriasis.

Analyze Each Option

Review and analyze each of the given options (a, b, c, d) to determine their relevance and correctness for a teaching plan for methotrexate.

Option A Analysis

Evaluate option a: 'Creatinine clearance and other tests of renal function are required weekly for the first month of therapy'. Creatinine clearance and renal function tests are indeed important but not typically required on a weekly basis specifically for methotrexate in psoriasis treatment.

Option B Analysis

Evaluate option b: 'Periodic EKGs will be done from the start of therapy until 6 months after its completion'. Methotrexate does not necessitate periodic EKGs as part of its monitoring plan.

Option C Analysis

Evaluate option c: 'Pulmonary function tests and arterial blood gases need to be checked before the start of therapy'. This might be relevant for medications affecting respiratory function, but methotrexate primarily affects liver function, blood counts, and potentially lipid levels.

Option D Analysis

Evaluate option d: 'Liver function tests, lipid levels, and blood counts need to be monitored during therapy'. This is correct since methotrexate can affect liver function and blood counts and monitoring these values is essential.

Choose the Correct Option

Based on the analysis, select the option that provides accurate information for developing a teaching plan for a client receiving methotrexate for psoriasis.

Key concepts

Liver function tests

When a patient is undergoing methotrexate treatment for psoriasis, liver function tests are vital. Methotrexate can cause liver damage, so frequent monitoring helps ensure that the liver is functioning properly.
Liver function tests assess enzymes and proteins in the blood that indicate how well the liver is working. Key indicators often measured include:

• Alanine aminotransferase (ALT)
• Aspartate aminotransferase (AST)
• Alkaline phosphatase (ALP)
• Bilirubin

Regular monitoring can identify liver issues early. If abnormalities are detected, doctors may adjust the medication dosage or discontinue methotrexate to prevent further damage.
It's crucial for patients to attend all scheduled blood tests and report any symptoms related to liver problems immediately.

Blood counts

Blood counts are another essential aspect to monitor during methotrexate therapy. Methotrexate can suppress bone marrow, leading to decreased production of blood cells. Regular blood tests check several components:

• White blood cells (WBC): Important for fighting infections
• Red blood cells (RBC): Carry oxygen throughout the body
• Platelets: Help with blood clotting

An abnormal blood count might manifest as:

• Infections or fever (low WBC)
• Fatigue or weakness (low RBC)
• Easy bruising or bleeding (low platelets)

Frequent blood tests allow early detection of issues, enabling timely intervention, such as dosage modifications or additional treatments, to keep blood cell levels stable.

Lipid levels monitoring

Lipid levels monitoring may be less commonly discussed but is still relevant during methotrexate therapy. Methotrexate can potentially influence lipid metabolism, leading to changes in cholesterol and triglyceride levels. This monitoring typically involves testing for:

• Total cholesterol
• Low-density lipoprotein (LDL) cholesterol: Known as 'bad' cholesterol
• High-density lipoprotein (HDL) cholesterol: Known as 'good' cholesterol
• Triglycerides

Abnormal lipid levels can increase the risk of cardiovascular diseases. Therefore, regular lipid level checks help manage these risks and allow doctors to advise on lifestyle changes or medications if needed, ensuring overall cardiovascular health during methotrexate treatment.