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. What would you like to do?
What do antivirals do?
KILL VIRUSES by inhibiting their ability to replicate, so the body’s immune system can destroy the virus
What are some viruses antivirals work against?
- Influenza A (flu)
- RSV- resp. syncytial virus
what viruses does Acyclovir work against
- HSV 1 and 2
what does CRIXIVAN do?
- Treatment for advanced HIV *
- Taken in combo with other antivirals
- Increases CD4 count
What does RIBAVIRIN do
- Used to treat severe LRI caused by RSV
- MAY cause fetal toxicity!
- Inhilation nasally or orally
what does RIBAVIRIN do?
Inhilation nasally or orally
What do AZT, RETROVIR, ZERIT do?
- For HIV treatment
- May cause bone marrow suppression, if so, HIV clients would need a different medication
- COMBIVIR is a combo drug
What to assess when on these meds?
- ALL labs
- Bone marrow suppression
- Allergic reactions
- Is the drug working- decreased HSV, increased CD 4 counts, etc
- Some can cause dizziness- SAFETY education
what do pt's taking immuno-supression drugs need to do?
What do you have to wear when treating / assessing pts on antiviral drugs?
GLOVES!!! Especially with topical’s and infected clients
what is MYCOBACTERIUM TUBERCULOSIS
the bacteria that causes TB!
The bacteria becomes dormant or walled off by fibrous or calcified tissue
TB is a slow growing organism
There has been a resurgence of the disease
Is TB aerobic or anaerobic
It is an aerobic bacillus that requires a lot of O2 to grow
What areas are affected by TB
- Highly oxygenated areas:
- Growing ends of the bones
- Genitourinary tract
what is TB transmitted from
How is TB transmitted?
- Conveyed in DROPLETS
- Expelled by infected people or animals by sneezing, coughing
- Inhaled by the host
Does TB affect all people that inhale it?
who does TB affect?
Those immuno-supressed by CA, chemo, HIV/AIDS are common hosts that are affected and this can be deadly
what are the antitubercular drugs
what is a Primary antitubercular drugs
properties of INH- (ISONIAZIDE)
- Can be used for the prophylaxis of or the sole agent for the treatment of active TB
- Metabolized via the liver
Can cause blood sugars to increase
properties of ETHAMBUTOL-
Used for the treatment of active TB *
Used in combo drugs with rifampin, streptomycin, INH
Not used in children under 13
Can cause optic neuritis- loss of vision
properties of RIFAMPIN
- Works against mycobacterium, Meningococcus and leprosy
Can turn urine, feces, saliva, skin, sputum, sweat, tears- orangish-brown! *
Oral contraceptives are ineffective when on Rifampin
properties of STREPTOMYCIN
Used only in combination because it can cause toxicity
Review this medication in your information about antibiotics!!
Nursing Assessment TB
- a medical history
- LFT’s (liver function test) due to hepatic toxicity risks- especially in ETOH’ers and the elderly
- Neuro assessment- can cause peripheral neuropathies on INH – check for numbness and tingling- lets discuss a neurovascular assmt.
- Take all meds as ordered and all meds thoroughly
How do you prevent the spread of TB?
Careful hand washing, covering the mouth with cough/sneeze, may require isolation from the pub
What labs do yo asses for antitubercular drugs
CBC, HGB, HCT- INH can cause hematolgic disorders
BUN, Cr, UA, possibly a 24 hour collection?
Sputum Cultures throughout treatment course
What education should you give pts taking antitubercular drugs?
Medication administration- no skipping and no doubling up
Side effects of medications
Labs for follow ups
Disease transmissionIsolation precautions
MEDIC ALERT TAGS for meds
Do you need to report TB to CDC ?
yeast/mold. Some are in the normal flora of the skin, mouth, intestines, vagina
single-celled fungi that bud and can be useful organisms
What is infection caused by fungus called?
HOW is the host infected by fungus?
- Inhaled- fungal “spores” are airborne
- Implanted -under skin
- Ingested- orally
Who is in the population infected by fungus?
Long term antibiotic clients
- Those who are imunosupressed- they are more susceptible to developing fungal infections.
- -Transplant patients that are on immunosuppressive therapy
- -CA r/t to chemo therapy
What is Vag candidiasis?
yeast infection: pregnant women, women with DM, women on antibiotics, women on oral contraceptives
What can taking Corticosteroids cause?
can result in colonization of candida albicans- THRUSH-
in what population is Thrush common in ?
common in newborns and and the immunocompromised
Have the ability to kill or inhibit the growth of fungi
What do you use to treat Systemic fungal infections with?
What do you use to treat CRYPTOCOCCAL MENINGITIS with?
Fluconozole or “Diflucan”- it penetrates the CSF
what can you use to treat oropharyngeal and esophageal candida
amphotericin B and Diflucan
However… there are a lot of side effects!
What can you use topical NYSTATIN AND MYCOSTATIN for?
diaper rash and vaginal candidiasis
What forms can NYSTATIN AND MYCOSTATIN come in?
Oral and topical- ointment, powder, spray, vaginally
side effects of Ampho-B
can easily cause hepatotoxicity, neurotoxicity, renal toxicity,
Resp difficulties, cardiac dysrythmias, fever, chills, malaise and hypotension
side effects of Diflucan
- cause N/V/D
- increased AST
Nursing Assessment for antifungal
- Assess all lab values- AST/ALT, kdney function, WBC’s and RBC’s
May have cardiovascular effects- cardiac enzymes, P, Bp, EKG
Weight gain in Ampho-B clients should not exceed >2 lbs per week- if so… call Dr.
what population group need to be cautious when taking antifungal?
Great caution in the pregnant or lactating woman
Caution in lupus clients
What are some things you have to education the pt about when taking antifungal?
If using the medication for a vaginal infection- abstain from sexual intercourse
Partner may need to be treated as well
Medication administration- no skipping and no doubling up
Continue medication even if menstruating
Side effects of medications
Labs for follow ups
Isolation precautionsHand washing
able to kill organisms and are used on non-living objects to destroy any organisms
ONLY inhibit growth of microorganisms, but do NOT necessarily kill them and applied only to living tissue
where can antiseptics be used?
Mucous membranes and skin
What do antiseptics come in?
In soaps, such as pre-surgical scrubs when the skin will be incised
What forms do antiseptics come in?
Topicals, ointments, mouthwashes, douches
What are some effects of antiseptics
Some can cause skin irritation if in contact with skin such as dryness, burns
What do Antiseptic Agents do?
Kills microorganisms- bacteria, fungi and viruses
What are some Antiseptic Agents?
- Isopropyl alcohol (rubbing alcohol)- antiseptic
- Aldehyde (Cidex) - mostly disinfectant-
Hibiclens- surgical scrub antiseptic
Chlorine compounds (Dakin’s sol)-
What does Aldehyde (Cidex) do?
causes burns to skin easily, sterilizes equip
What does Chlorine compounds (Dakin’s sol)- do?
only partially active against fungi- athletes foot
What does Iodine do?
kills all forms of microorganisms and SPORES
What does Hydrogen peroxide do?
can be used to irrigate wounds,
used first for some surgeries,
but can also cause skin irritation
how do you apply Creams and ointments antifungals?
use a sterile q-tip or sterile gauze
Pt education for antifunals
Patient education, have the client verbalize and return demonstrate, give written instructions
Teach and USE good hand washing
FOLLOW Dr. orders carefully!
Document all teaching done!
drawing the serum blood levels after the drug is administered as it distributes rapidly and reaches its peak in therapeutic range
highest safe level of medication
When are labs for peaks drawn?
about one hour after the infusion finished.
•This is the lowest drug level that is needed to reach therapeutic range.
What should you do if trough is less than normal?
- the patient is at risk for adverse effects.
- Therefore, the doctor should expand the time interval before ordering the next dose or decrease drug dose.
When is a trough drawn?
usually one hour prior to start infusion
Microorganisms are both internal and external
They can be harmful to humans or they can live without interference and even be he
How are we able to fight infection?
•We are able to fight of infections caused by microorganisms that invade the body because of the existence of host defenses
How can people get an infection?
If the microorganisms invade the body that is not at it’s optimum health level- infection occurs
prior rheumatic fever!
Streptococcus is present in the body and don’t cause any harm, BUT… under certain circumstances they can cause “endocarditis” in the client with damaged heart valves due to
when should you assess for antibiotics
before, during and after therapy
What is Emperic therapy?
The antibiotic selection is based on the type of microorganism and which med will work the best-
What should be done before Empiric therapy?
the organism should be cultured and identified
what can be done if microorganism is ID'd in emperic therapy?
- the lab can then run a “susceptibility”
- - which shows which antibiotic works the best
When can Antibiotics be given PROPHYLACTICLLY?
times where the likelihood of microorganism invasion is high as in before a procedure (surgery)
What is THERAPEUTIC RESPONSE in antibiotic use?
when there is a decrease in s/s of infection
What is SUB-THERAPEUTIC RESPONSE in antibiotic use?
THE ANTIBIOTICS ARE INEFFECTIVE
what is TOXIC levels in antibiotic use
when the serum antibiotic levels are too high
when antibiotics completely destroy the normal bacterial flora- this permits other bacteria and fungi to take over and cause an infection
example: vaginal yeast infection
Interactions with antibiotics
- interactions- as in milk or cheese and tetracycline (causes decreased levels of tetra), or antacids and quinolone antibiotics (decreases the absorption of the antibiotic).
HOST FACTORS with antibiotics
factors that pertain to the infected client that can interfere with antibiotic therapy such as, age, allergies, liver and kidney function, pregnancy, site of infection
Miscellaneous antibiotics- in a class of their own!
One of the first groups of antibiotics
Sulfonamides DO NOT destroy bacteria, but inhibit their growth
Where do sulfas achieve very high concentration?
in the kidneys, through which they are eliminated
What are sulfas primarily used for?
- Used primarily for UTI’s caused by
- : Enterobacter, E.Coli, Klebsiella, Proteus Mirabilis and
- Vulgaris and Staph aureus
What are sulfas used for?
What are sulfa's a DRUG OF CHOICE for?
Pneumocystis carinii (common in HIV and AIDS clients)
How is the greatest effectiveness achieved with sulfas
if you combine a sulfonamide and a non-sulfonimide
How should you give Sulfas
with plenty of fluids to prevent crystalluria
What are some Side effects and interactions of sulfas
•Usually a delayed reaction
- Stevens-Johnson Syndrome
- Renal and hepatic,
- GI and hematologic complications- may be fatal (there are so much more, but this is an overview
Interactions of Sulfas
: Oral anticoag’s
What is Bactrim used for?
•Used for UTI’s
Pneumo. carinii pneumonia
Used prophylactically for HIV clients
What are Septra & Septra DS
•Sulfamethoxazole and trimethoprim combination
What are Septra & Septra DS used for?
What is Pediazole used for
used on the urinary tract
- Used for otitis media in children
- and available in oral suspension
Used primarily for children
How well is Pediazole tolerated?
Tolerated fairly well unless and allergy
What are Penicillins derived form
Derived form fungus or mold found on bread and fruit
What do penicillins work against?
Kill a wide variety of gram positive and some gram negative bacteria•
how does penicillin work?
PCN works by inhibiting bacterial wall sythesis
PCN’s only inhibit the wall synthesis of bacteria cells, not the other cells in the body
What are somem microorganisms killed by PCN?
What are some side effects of PCN
•Most common side effect- rash, itching, dermatitis and Stevens Johnson Syndrome
•10% are life-threatening and 10% or fatal
•May cause GI upset- N/V/D, Bone marrow suppression, Increased ALT and AST, convulsions
What do you need to asses for with PCN
Check for hypersensitivity
what are some drugs PCN interacts with
NSAIDS- provides more free/active PCN
Oral contraceptives- decreases contraceptive efficiency
Rifampin- may inhibit the killing activity of PCN
Coumadin- may decrease the effect of coumadin
what groups sould Natural PCN, PCN G, PCN V not be used on
•Not used in newborns
When should PCN be taken
Give 1 hour before food and 2 hours after food
What should Oral PCN not be taken with?
sodas or caffiens, fruit or tomato juice- decreases effectiveness
What are Penicillinase resistant penicillins ?
antibiotics, which are not inactivated by the penicillinase enzyme.
These can resist the breakdown of the PCN destroying enzyme commonly produced by staphylococci
what is penicillinase?
enzyme some bacteria produce that destroys the beta-lactam ring of the antibiotic,
Making the penicillin ineffective
what drugs are penicillinase RESISTANT PCN-
what is MRSA?
a staphylococcus aureus RESISTANT to PCN
•Amoxicillin- Best for ears, nose, throat, GU tract, bladder, skin
Also used to fight gonnorhea
Ampicillin- available po and IV
These all work best on gram negative bacteria
What is a gram – bacteria?
When gram staining- Gram Negative bacteria does not retain crystal violet dye
- - E. Coli, Salmonella, Pseudomonas, Ghonnorhea,
- Neisseria Meningitis
What is a gram+ bacteria?
- Gram Positives- do retain the dye and appear blue or purple under the microscope
- - Staphylococcus, Streptococcus, Enterococcus
What is drugs are Extended Spectrum PCN
how is Extended Spectrum PCN given?
All IV except Carbenicillin (po)
What are Cephalosporins?
•Related to PCN ( beta lactams)
Can destroy a broad spectrum of bacteria
What are Cephalosporins effective against?
many gram positives, some gram negatives and some anaerobes
What are cephalosporins not effective agains?
NOT active against fungi or viruses
what are the 4 generations of cephalosporins?
Generation 1 = best for gram positive coverage, with little coverage for gm. neg
Generation 2 & 3 = better for gram negative coverage, but have some gram positive fighting properties
4th generation = greater activity on gram positives than 3rd generation, but also cover gram negatives as well
•“CEFEPIME” (4th generation)
Side effects of cephalosporins?
May cause diarrhea, abdominal cramps, redness, edema, and pruritis
If one is allergic to PCN, may be allergic to cephalasporins (“cross-sensitivity”)•
- ONLY if a client has an anaphylactic reaction to PCN, then they should not be given cephalasporins
- -Consult physician
What are some 1st generation Cephalosporins?
Ancef, Kefzol, Keflex
1st generation Cephalosporins?
Good for gm + coverage
Little coverage for gm
What does giving 3rd generation cephalosprin cause
Who can 1st generation Cephalosporins be given to?
to children as well as adults
how can 1st generation Cephalosporins be administered
what are some Second Generation cephalosprin drugs
Zinacef (does not kill anaerobes)
Second Generation cephalosprin drugs properties
better coverage for gram negative bacteria
•Good for gm + and better gm – coverage than gen.1
Used extensively for prophylaxis before surgery and abdominal and colorectal operations due to the fact that it kills many organisms that reside there
Third Generation cephalosprin drugs properties
HAS better GI absorption than the others*
Better activity against gram negatives
Has a very long half-life and can be given once daily IV/IM
What does giving 3rd generation cephalosprin IM do?
Given IM- causes pain, medication is thick!!
Usually ok to massage after IM
What are some 3rd Generation Cephalosprin drugs
What are Fortaz & Tazadime good for?
for hard to cover Pseudomonas
how are 3rd Generation Cephalosprin eliminated?
How are 3rd Generation Cephalosprin administered?
OK for children- careful use though
what do all 3rd Generation Cephalosprin work well on?
What are some 4th Generation Cephalosprin?
CEFEPIME (Maxipime), Cefron
4th Generation Cephalosprin
What are 4th Generation Cephalosprin good for
- complicated and uncomplicated
- -skin infections,
Also used commonly for pseudomonas
What can most 4th Generation Cephalosprin do?
cross the blood brain barrier so good also for Meningitis
What should Tetracyclines not be given for? Why?
•NOT given with milk or any dairy products, antacids, iron salts or iron preparations due to reduction of oral absorption of the tetracycline
What do Tetracyclines have a strong affinity for?
They have a strong affinity for calcium- so… NOT used on clients under 8, pregnant women, nursing moth
How do Tetracyclines work?
inhibit the protein synthesis in susceptible bacteria-
What are Tetracyclines used for?
- Rickettsia( Rocky Mt. Spotted Fever),
- Mycoplasms (Myco Pneumonia)
- Also useful in Lyme disease
- •USED ALSO FOR A SCLEROSING AGENT for pleural effusion treatment
What do Tetracyclines cause?
cause inflammation that causes fibrosis in the lungs-
What happens when Tetracyclines are instilled into the pleural space of the lungs
causing scar tissue, reducing fluid accumulation
What kind of pts are Tetracyclines useful for?
clients with pleural or pericardial effusions caused by metastatic tumors, thoracentesis, thoracostomy tubes
When the med is instilled into the pleural space of the lungs- causing scar tissue, reducing fluid accumulation
What are some side effects of Tetracyclines?
- Can discolor teeth in fetus and children
- Can retard fetal skeletal development if taken during pregnancy
- Can cause photosensitivity
- Can cause candida –superinfection in the intestinal flora
- •Pseudomembranous colitis*
- Can alter vaginal flora
- Can cause reversible bulging fontanels in neonates
- Can precipitate thrombocytopenia
- Can cause coagulation irregularities and hemolytic anemia
- Can exacerbate systemic lupus
what must you evaluate with Tetracyclines?
- Depending on the dose- can elevate serum levels
- monitor liver function
What are some Tetracycline drugs?
- –DECLOMYCIN- used for SIADH…
- –DOXYCYCLINE- Vibramycin-
Properties of Declomycin
most likely to cause photsensitivity
Wht are properties of Doxycycline (Vibramycin)?
well absorbed from GI tract
highly lipid soluble
- used for Bacillus anthracis (anthrax)
- Chlamydia trachomatis
What can Tetracycline interfere with?
- birth control pills
- antibiotics like penicillin
- some multivitamins
- Warfarin (coumadin)
Properties of Aminoglycocides?
- •Have POOR oral absorption, except for NEOMYCIN-
- These drug require PEAKS and TROUGHS for serum drug levels
There is a narrow therapeutic index
What are Aminoglycocides used for?
- •Used for Serratia (common bug in human waste, also in some hospital acquired infections)
- Used to decontaminate the GI tract when given orally
What can Aminoglycocides cause?
- can cause toxicity
- Generally reserved for more life-threatening infections
What other medications are Aminoglycocides often used with?
Vanco, PCN, Cephalasporins for synergy
What are some side effects of Aminoglycocides
- •Ototoxicity causing hearing loss resulting in s/s such as:
- RINGING IN THE EARS.
- Renal failure causing s/s of:
- Increased BUN and Creatinine,
What should Aminoglycocides not be given with?
- neuromuscular blockers,
- oral anticoagulants
What population should take Aminoglycocides with extreme caution ?
- •The elderly,
- those with renal dysfunction
What can Aminoglycocides do?
can cross the placenta and be harmful to the fetus and can cross into breast milk
What is the peak and trough for GENTAMYCIN/TOBRAMYCIN?
- •peaklevel = 5-12 ug/ml
- •Trough = <2 ug/ml
How can GENTAMYCIN be administered?
- ointment for optic use
- topically as well for burns and skin infections
What are the peaks and troughs for AMIKACIN
- Peak = 20-35 ug/ml
- Trough = <10 ug/ml
What are Quinolones?
- •Broad spectrum antibiotics
- Used very commonly if no history of allergy or adverse reactions** Can cause colonization with MRSA and C-Diff
How do Quinolones work
They KILL bacteria and alter their DNA so they can replicate vs. inhibiting the growth
What are Quinolones used for
Active against gram positive and gram negative bacteria
What can Quinolones cause?
** Can cause colonization with MRSA and C-Diff
What are some side effects of Quinolones?
- blurred vision
- Elevated liver enzymes
- Oral candidiasis
- Pseudomembranous colitis
What are Cipro, Levaquin, Floxin used for?
- KILLS pseudomonas
- •Kills some anaerobics-
- Lower resp. tract infections
- Bone and joint infections
- Infectious diarrhea
What forms do Cipro, Levaquin, Floxin come in?
What was the 1st Macrolide
- •EES (Erythromycin)
- x, Biaxin
what are Macrolide used for?
- • Strep Pyogenes (Group A beta-hemolytic strep)
- Upper and Lower resp infections caused by haemophilus influenzae
- Lyme disease
- Ghonnorea and chlamydia and mycoplasmas
what do Macrolide do?
•They irritate the GI tract, thus causing GI motility- a benefit for those with decreased GI motility
What are some side effects of Macrolide?
- •There are many- most effect the GI tract
- Can cause CP and palpitations
- thrombophlebitis (flush) at the IV site
- Hearing loss
- problems with liver=> tinnitis or leuroigloss
What is an allergic reaction to Macrolide?
flush at IV site and all over
What are some intereactions of Macrolide?
If on theophyline: can decrease the clearance of the theo, increasing the serum levels
They are highly protein bound- so they bind to the albumin in the blood.
If other drugs are highly protein bound, there will be competition = free drug in the circulation = prolonged drug effect (remember?)
Where are Macrolide metabalized?
- Metabolized in the liver
- •NOT in the client with liver disease - can cause jaundice
What are some Macrolide drugs?
Where are Macrolide metabolixd
How should you take EES?
•Take on an empty stomach to increase absorption
What does EES cause?
•Causes GI upset•So take after or with food = less absorption = educate!
What are some properties of Zithromax and Biaxin?
•Have less GI irritation
NOT with food- affects absorptioin-- educate
What can Zithromax and Biaxin be taken for?
- Can be used for both upper and lower resp tract infections
- Can be used for skin infections
What are some properties of Zithromax?
- Zithromax has excellent tissue penetration and long duration of action-
- has a long diration QD dosing
- PRIMAXIN (Imipenem and MERREM)
what is CLINDAMYCIN used for?
Used for chronic BONE infections
what is PRIMAXIN used for?
Used for bone infections and bacterial endocardiitis
What are some side effects of PRIMAXIN
seizures, especially in the elderly and the renally impaired
What is Zyvox used for?
Used to treat VREF- Vancomycin resistant enterococcus faecium or VRE!
OK for the treatment of skin infections and hospital acquired pneumonias- including MRSA as well as CAP
What can Zyvox do?
•Can decrease platelets
What needs to be monitored when taking Zyvox?
•Careful monitoring of platelets
What is Vancomycin used for?
What happens if pt takes Vancomycin often?
What are the peaks and trough s of Vancomycin?
- •PEAK = 18-26 ug/ml
- TROUGH = 5-10 ug/ml
- NARROW therapeutic window
What mixes with Vancomycin?
NOTHING MIXES WITH VANCO!!!
WHat toxicity can Vancomycin cause?
- ototoxicity = watch for ringing in the ears / ear problems
- nephrotoxicity= keep eye on kidney
how long do you infuse IV Vancomycin?
Vanc always for 1hour or more IV
- * Cultures and Sensitivities FIRST!!
- * All labs and serum levels where indicatedMonitor I&O
- (can mess with kidneys)
- WBC’s to assess antibiotic effectiveness
- VS, especially temp
- List of all meds, including OTC’s
- Monitor for allergic reactions, especially with PCN
when givning IM -deep muscle / rotate frequently/ can be given w/ lidicane to ease pain
Some other antibiotic nursing process
- •Assess injection sites for heat, swelling, hematoma
- Assess IV site frequently for s/s of phlebitis
- •ETOH with some cephalasporins can cause “antabuse-like” symptoms**** -
- (get nauseous if takesip of ETOH) ALL abx. for the FULL course to prevent resistance
- Educate medic alert bracelets for allergies
- ALL abx, for 6-8 oz of water for better absorption
Fever of unknown origin
- •Expect to be assessing just about everything
- Full physical assessment
- Check IV sites
- Check injection sites
- Any welling or erythema or edema anywhere?
- Check all drains and tubes
- Check all wounds, pressure ulcers
- What about recent surgeries? Any hardware?
What are some fat soluable vitamins
- VITAMIN A- (Retinol)
- VITAMIN D
- VITAMIN E
- VITAMIN K
What is Vitamin A derived from?
animal fats found in dairy products (butter and milk), eggs, meat, liver and fish liver oils.
What is “Provitamin A” (carotenes) found in?
found in plants- green/yellow veggies and yellow fruits
What is Vitamin A used for
- Vit . A deficiency
- Can be used to help treat acne,
- Night blindness,
- needed for nursing/ pregnant women and infants
What is Vitamin A required for?
- Required for the growth of teeth and bones,
- night vision
- normal vision
What are the highest safe levels of Vitamin A?
OD management = levels >25,000 U/kg
What are some s/s of Vitamin A toxicity?
- In infants = can cause increase in cranial pressure = bulging fontanels
- Skin may start peeling after a few weeks and erythema may occur
What is Vitamin D needed for?
Needed for the proper utilization of calcium and phosphorus in the body
In what foods can Vitamin D be obtained?
- Fish oils, salmon, sardines,
- FORTIFIED milk, bread and cereal,
- animal liver
What is Vitamin D needed for?
- Needed for the normal calcification of the bone
- Vitamin D deficiency
- Given to clients with hypoparathyroidism
What does long term deficiency of Vitamin D cause?
- infantile rickets- bone malformation
What can an OD of Vitamin D cause?
- bone pain
- metallic taste
What can be done for OD of Vitamin D
Lower dietary intake of D and stop the supplements
What are some dietary sources of Vitamin E
- wheat germ
What can Vitamin E fight off?
What is usually the only population Vitamin E deficiency is seen in?
INFANTS , (especially premature infants)
What can Vitmain E defiency cause?
What foods is Vitamin K found in?
What does Vitamin K vital for?
the synthesis of blood coagulation factors that take place in the liver
What can cause Vitamin K defiency?
- low dietary intake
- broad spectrum antibiotics because there is some stored Vit. K in the intestine (and antibiotics can inhibit the flora in the intestine) Vitamin
Where is some Vitamin K stored?
in the intestine
What is Vitamin K used for?
reversal of increased coagulation to aid in clotting of the blood
What is usually the only population that gets Vitamin K toxicity?
What can Vitamin K toxicity cause?
- hemolysis of RBC’s
How is Vitamin K toxicity treated?
replacement of blood products
What are the WATER SOLUBLE VITAMINS
- VITAMIN B1- (THIMINE)
- VITAMIN B 2- (RIBOFLAVIN)
- VITAMIN B3- (NIACIN)
- VITAMIN B 12
- VITAMIN C
What foods is Vitamin B1 found in?
What does Vitamin B1 deficiency cause?
What causes Vitamin B1 defiency?
- poor diet
- liver disease
What depends highly on Vitamin B1 ?
- GI tract
- cardiovascular system
What is another name for Vitamin B1?
What is another name for VITAMIN B 2
What is Riboflavin found in?
- green leafy’s,
What is Riboflavin essential for?
- tissue respiration
- to maintain erythrocyte integrity
What can Riboflavin deficiency cause?
- corneal changes
What are causes of Riboflavin defiency?
- liver disease
What can large doses of Riboflavin cause?
the urine to turn yellow-orange
What is another name for VITAMIN B3?
What foods can Niacin be found in?
What can Niacin deficiency cause?
- various psychotic s/s,
- dryness of the skin,
- oral/vaginal/urethral lesions, Diarrhea and bloody diarrhea
What is Niacin
- water soluable vitamin
- anti-hyperlipidemic agent
What can Niacin do?
lowers cholesterol and triglyceride levels
What is Niacin needed for?
the breakdown of stored glycogen to usable glucose
What can Niacin cause with continual usage?
Who should not take Niacin suupplements?
client with DM
- hepatic dysfunction
What should Niacin be given with?
milk or food to decrease GI upset
What is Vitamin B12 needed for?
- fat and carbo metabolism
- protein synthesis
- for growth,
- cell replication,
What is Vit B12 found in?
animal food origins (liver, kidney, meat, shellfish and dairy)
What can Vit B12 deficiency cause?
- GI lesions,
- neuro symptoms
- megoblastic anemia
What groups tend to get Vit B12 defiency?
- in alcoholics,
- chronic hemorrhage
- poor diet
What are some side effects of Vit B12 defiency?
What is Vit C found in?
- in fruits
What does Vit C defiency cause?
What are some symptoms of scurvy?
- bleeding gums/loss of teeth,
- bone lesions,
- delayed healing of soft tissue and bone)
What is Vit C needed for?
- tissue repair,
- maintenance of bone and teeth and capillaries
What can Vit C do?
- Enhances the absorption of iron
- lessen the severity of the common cold
What can an OD of Vit C cause?
- abdominal cramps
- can cause renal stones
How are Vit C supplements usually taken?
Oral supplement mixed in 6 oz water or juice
What should edu should be given with Vit C supplements?
they may have an increase in urination
What are minerals needed for?
Needed for intra and extra-cellular body fluid electrolytes
What are some minerals?
What is Calcium?
- Most abundant mineral element in the human body = approximately 2% of the total body weight
Where is the highest concentration of Calcium found?
- in the bones
What can Calcium defiency cause?
- muscle cramps
- osteoprosis (esp. in postmenapausal women),
What can toxic levels of Calcium cause?
- ** Cardiac irregularities!!
WHat can hypercalcemia cause in pts on Digoxin
serious cardiac dysrythmias Calcium
What are some problems of Calcium supplements given IM or IV
- can be costic to the skin
- cellulits of the tissue
What can Calcium do?
can “Chelate” (bind) to tetracycline
What are some meds Calium can interact with?
- calcium channel blockers,
- lot of meds
In what pts are Calcium supplements contraindicated for?
- with bone tumors
What should IV calcium clients do after IV infusion?
remain recumbent for at least 15 minutes after IV infusion- helps to decrease risk of cardiac arrest.meal
what should be done when giving Calcium via IV?
- Give very slowly IV
- have crash cart available
WHat should be done if IV calcium extravasates?
- stop infusion immediately.
- The Dr. may order “procaine” to reduce vasospasms and dilute the effects of calcium in surrounding tissue
When should oral Calcium be given
should be given 2-3 hours AFTER a meal
WHat is MAGNESIUM associated with?
with energy metabolism
WHat is MAGNESIUM required for?
- Required for muscle contraction
- nerve physiology- produces and anticonvulsant effect
WHat can cause MAGNESIUM ( Hypomagnesia) defiency?
- long-term IV feedings,
- diabetic ketoacidosis,
What can MAGNESIUM defiency cause?
- mental disturbances,
- cardiovascular disturbances
- neuromuscular impairment
Who can get Hypermagnesia?
clients with renal dysfunction that take large amounts of antacids because they contain magnesium
How common is Phosphorus dietary defiecincy?
RARE because phosphorus is in many foods
What can cause Phosphorus defiency
- acute diarrhea or vomiting,
- hepatic disease,
- long-term use of aluminum or calcium antacids
What is Phosphorus important for?
maintenance of teeth and bones
WHat are some side effects of Phosphorus supplemental treatment
GI disturbance- n/v/d.
What can antacids do to phosphorus
reduce the oral absorption
What needs to be monitored before, during and after vit/min supplement therapy
LABS AND ELECTROLYTES
What do you assess& monitored w/ vit/ min therapy?
- Medical history- renal insufficiency, cardiac disease, GI bleeding, intestinal obstruction
- VS during supplement therapy
- WBC, RBC, H/H, and trace elements
- Get a thorough medication history
- Social history (a lot of these deficiencies are due to alcoholism)
- Baseline EKG’s
What would you like to do?
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