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What causes infections?
- -Bacteria, Viruses, Fungi, Protozoa, Parasitic worms.
What other factors effect the bodies defense against bacteria?
- Organ Fxn
What are the bodies natural barriers (defenses) against infection?
Skin, mucous membrane, gastric acid, immune factors
What 3 general things put people at a greater risk for infections?
- Advanced age
- Pre-existing Dx that suppresses the immune system
- impaired blood supply
Inhibits the growth of bacteria
Kills the bacteria
What are the mechanisms of action for Bacteriostatic & Bactericidal drugs?
- Inhibit cell wall synthesis
- Alter membrane permeability
- Inhibit protein synthesis
- Inhibit synthesis of RNA & DNA
- Interferes w/metabolism
What needs to happen with the bacteria & drug in order for the MEC to occur?
The drug MUST penetrate the bacterial cell wall sufficiently & bind to sites on bacterial cell.
The duration of time a patient spends on an Antibacterial agent is determined by what 3 factors?
- Type of pathogen
- Site of infection
- Immuno-competency of patient
How does a bacteria become resistant to an antibiotic?
- Inherent resistance (naturally resistant to it)
- Acquired resistance
- Inappropriate use of Abx
- Nosocomial Infxns
- Cross-resistance: bacteria resistant to one abx can change & become resistant to other drugs.
How do we handle the challenge of a resistant bacteria?
- DO C&S BEFORE ABX THERAPY STARTS!!
- Abx combinations
What are the s/s of in infection?
- wt loss (long term infxn or sepsis)
- pus formation
What should the nurse assess for before Abc therapy starts?
- site of infxn
- other current & recent meds
- *if going to be IV abx check compatability to other current meds
What should the nurse assess during Abx therapy?
What should the nurse be looking for after Abx therapy is done?
What is Empiric therapy?
- An Abc selected is one that can best kill the microorganism known to most commonly cause the infxn.
- C&S collected but pt started on Empiric Abx immediately & then changed if needed after C&S is done.
With Gram-stain cultures, which bacterial strain turns purple?
IF s/s of infection do not subside, what are the possible causes of this?
- pt not taking right
- course of therapy not long enough
- Wrong dosing (can't reach MEC)
- Bacterial resistance
What are the 3 major adverse rxns to antibacterial therapy?
- Allergic rxn
- Organ toxicity
What would be a mild allergic rxn to an Abx?
- pruritus (skin becomes red & swollen)
What is the severe allergic rxn that can occur from Abx therapy or any med?
Anaphylactic shock: Bronchospasms, laryngeal edema, vascular collapse, cardiac arrest
What is a "Superinfection"?
a secondary infection
Where do secondary infections (superinfections) typically occur?
- Mouth (thrush)
- Respiratory tract
- Vagina (Yeast infxn)
- **occurs after being on Abx for over a week
If a patient has liver disease what does the nurse need to monitor with Abx therapy in this pt?
AST & Bilirubin
If a patient is on Abx therapy but has a known Hx of kidney disease what does the nurse need to monitor?
What were PCN Abx introduced to kill?
What is the action of PCNs?
Bactericidal: Inhibit bacterial cell wall synthesis
What are the common s/e of PCNs?
What are the possible drug interactions the nurse should watch know when giving a PCN?
- Oral contraceptives (broad spectrum PCNs)
What are the nursing interventions with PCNs?
- C&S before drug is given
- Monitor closely w/1st dose given
- Take WITH meals
- Assess for s/e
- NEED: alternate form of BC
What is the action of Cephalosporins?
Bactericidal: Inhibit bacterial cell-wall synthesis
What are Cephalosporins like used to treat?
How many generations of Cephalosporin Abx are there?
1st Generation Cephalosporins are used to treat which gram-strain?
2nd &4th generation Cephalosporins are used to treat which Gram-strain(s)?
BOTH + & -
3rd generation Cephalosporins are used to treat which Gram-strain?
Cephalosporins are contraindicated with what allergy?
What are the s/e of Cephalosporins?
- GI distress: N/V, diarrhea, ^bleedind w/lg doses of chephs
- Nephrotoxicity: pt's w/pre-exisiting kidney dx
What are the nursing interventions for Cephalosporins?
- C&S before therapy
- Take WITH FOOD/or 1hr b4 or 2hr after
- Admin IV over 30-45min
- Monitor for superinfection
- Assess for renal & liver fxn w/pre-exisiting conditions
the Microlide Abx include which 3 major Abx?
- Erythromycin (E-mycin) *not often used
- Azithromycin (Z-pack)
- Clarithromycin (Biaxin)
What is the mechanism of action for the Microlides?
- Broad spectrum
- Bacteriostatic: in low doses
- Bactericidal: in high doses
What are Microlide Abx (Azithromycin) used for?
- Z-pack: Resiratory, sinuses, GI tract, skin, soft tissue, & certian STDs
- E-mycin: Tx's mycoplasmal pneumoniae & legionnaire's Dx
What are the s/e for Erythromycin, Clarithromycin & Azithromycin?
- E-mycin: SEVERE GI distress
- ALL 3: GI distress, N/V, Diarrhea, Abd cramping
- Hepatotoxicity (in high doses w/other hepatotoxic drugs)
- Z-pack: not much GI distress at all
What are the drug interactions for the Microlides: E-mycin, Clarithromycin, & Z-pack?
^ serum levels of WARFARIN, Theophylline, Carbamazepine
Erythromycin levels ^ with use of what other drugs?
*Causes risk of sudden cardiac death**
- Fluconazole (Diflucan)
- Ketoconazole (Nizoral)
- Diltiazem (Cardizem)
The Macrolide Azithromycins (Zpack) levels can be reduced with the use of this other supplement?
What are the nursing interventions for the Macrolides: E-mycin, Clarithromycin, & Zpack?
- Monitor liver enzymes
- **finish FULL Abx course
- Admin antacids 2hrs before/after macrolides
- give Zpack 1hr before/2hrs after meals w/FULL glass of WATER
What is the action of the Macrolide Clindamycin?
- Bacteriostatic & Bactericidal (*dosage*)
- Inhibits bacterial protein synthesis
What are the s/e or a/r for the Macrolide Clindamycin?
- GI distress
- Anaphylactic shock
What are the drug interactions for the Macrolide Clindamycin?
What is the action of the Macrolide Vancomycin?
Bactericidal: Inhibits cell wall synthesis
What is the Macrolide Vancomycin used for?
Serious infections of: Bone, skin, lower resp. tract, MRSA
Vancomycin should be used with caution when given to patients with what other issues?
- Kidney disfunction
- hearing loss
What are the s/e & a/r of the Macrolide Vancomycin?
- Rash, N/V
- Red neck/man syndrome
- Pseudomembranous Colitis: sever abd cramping, fever, pus/mucus in stool, nausea
With the IV administration of Vancomycin, what needs to happen to prevent Red Man Syndrome?
IV FLOW VERY SLOW
What are the nursing interventions for Vancomycin?
- Monitor Peak & Trough levels
- B/P, renal fxn, superinfection, hearing, IV site
- INCREASE fluids to <nephrotoxicity
What is the action of Aminoglycosides?
Bactericidal: Inhibit bacterial protein synthesis
Name a few Aminoglycoside Abx.
- Gentamicin (IM, IV)
- Tobramycin (IM, IV)
- Neomycin (po or IV)
What are the Aminoglycoside Abx used for?
- SERIOUS infections
- Neomycin: used for pre-op bowl antiseptic
What are the s/e or a/r to Aminoglycosides?
- Nephrotoxicity (^^BUN & ^^Creatinine)
- GI distress, HA, paresthesias (tingling), skin rash, fever
What are the common drug interactions with Aminoglycoside Abxs?
- COUMDIN ^bleeding
- other nephrotoxic drug
What are the nursing interventions for Aminoglycoside Abx?
- Monitor renal fxn/nephrotoxicity: BUN & Creatinine
- Monitor for hearing loss
- Warn pt: use sunblock
- PEAK & TROUGH LEVELS
- Use caution: w/razors, bruises & bumps w/coumadin
What is the action of the Tetracycline Abxs?
- Bacteriostatic: Inhibits protein synthesis
- Are broad spectrum Abx
What types of bacteria are Tetracycline Abx used for?
- Helicobacter pylori (GI ulcers)
- Acne (oral or topical)
- Lyme disease
Which Tetracycline Abx can be taken with milk products & food?
What are the s/e of Tetracycline Abx?
- GI distress
- stomatitis (mouth ulcers)
- Discolors permanent teeth (dont give w/pregnancy or kids <8yrs old)
- Blood dyscrasis: Thrombocytopenia (<platelets)
- Hemolytic anemia (breaks blood cells)
- Superinfection (pseudomembranous colitis)
With extra high doses of Tetracycline Abx, what other a/r could happen?
- CNS toxicity
What are the drug interactions the nurse need to educate the client about with Tetracycline Abx?
- Avoid Antacids, milk products & Iron preparations
- <effects of oral BC
- Digoxin absorption is ^ leading to toxicity
- ^effects of coumadin
What are the nursing interventions for the Abx group, Tetracyclines?
- C&S prior to drug
- Admin 1hr b/4 or 2hr aftr meals
- Monitor kidney & liver fxn in high doses
- store out of light & extreme heat
- USE SUNBLOCK
- client to report superinfection
- **AVOID milk,iron,antacids
- client needs good oral hygiene
What is the action of Fluoroquinolone Abx?
Broad spectrum Bactericidal
What types of bacterial infections do the Fluoroquinolones kill?
- (UTI, bone infxn, Joint infxn, Bronchitis, pneumonia, gonorrhea, gastroenteritis
What suffix identifies the Fluoroquinolones?
What suffix identifies the Tetracycline Abx?
What are the s/e of Fluoroquinolone Abx?
- GI distress
- Urticaria (hives)
- Pseudomembranous Colitis
- ^^AST & ALT
What are the drug interactions to watch for with Fluoroquinolones?
- Antacids <absorption rate
- Levofloxacin ^effect of oral hypoglycemics, theophylline & caffeine
- ^effect of coumadin
What are the nursing interventions for the Quinolone Abx group?
- Infuse IV over 60-90min
- To avoid Crystalluria ^^fluid intake to >2000ml/d
- Superinfection ed
- Photosensitivity ed
- Monitor liver labs
What is the action of Sulfonamide Abx?
Bacteriostatic: Inhibit synthesis of folic acid
What do Sulfonamide Abx treat?
- Otitis media
- Respiratory inf
What are the routes Sulfonamide Abx can be given?
What is the prefix that identifies all Sulfonamide Abx?
What other drug is Sulfamethoxazole mixed with to create Bactrim DS (TMP/SMZ)???
synergistic effect w/sulfas
- Trimethoprim: interferes w/folic acid synthesis
- is a Urinary tract anti-infective
What is the action of TMP/SMZ (Bactrim DS)?
Bactericidal: Blocks bacterial protein synthesis
What is TMP/SMZ (Bactrim DS) used to treat?
- Otitis media
- Intestinal infxns
- Lower resp tract infxn
What are the drug interaction issues with TMP/SMZ?
- ^Anticoagulation effects of coumadin
- ^Hypoglycemia effects w/hypoglycemics
What are the s/e or a/r of Sulfonamide Abx?
- DELAYED cutaneous rxn (few days aftr abx done)
- GI distress
- Crystalluria *^fluids
- Renal failure
- Blood dyscrasias w/^doses: anemia, <WBC (risk for infxn), <platlets (low/no clotting)
What are the nursing interventions for a client on TMP/SMZ (Bactrim DS)?
- *give with FULL glass of water 1hr before meals or 2hr after
- ^^Fluid intake
- Monitor for sore throat, bruising, bleeding, CBC
- NO antacids
- AVOID direct sunlight
What are the critical assessments a nurse should do before administering ANY abx?
- know the route: if more than one IVPB check compatibility.
What in general should the nurse teach the Pt on any Abx?
- Take FULL COURSE as ordered
- Use alternate BC
- Wear medical alert bracelet if allergies
- Use sunscreen: sulfa, tetracyclines, quinolones
- report s/e
- Drug interaction education (ie coumdin)
What drugs work well in curing UTIs?
What is the action of the Abx Macrodantin?
What is a common s/e of Macrodantin that the client should be informed of?
May turn urine BROWN
What client teaching should be done with admin of Macrodantin?
- ^Vit C: keeps urine acidic which helps kill bacteria & move them out
When experiencing severe pain from a UTI, what would the dr. prescribe & what is a strange s/e?
Pyridium: Analgesic for burning w/urination
may turn urine reddish/orange
Bethanechol (Urecholine) is a urinary what?
Urinary Stimulant (parasymathomimetic)
Tolterodine (Detrol) is a urinary what?
Urinary Antispasmodic (Anticholinergic effects)
How is TB spread?
Droplets: coughing, sneezing
What are the s/s of TB?
- Cough, sputum
- Fever, night sweats, wt loss
- Positive acid-fast bacilli (AFB)
TB medication can be given on a prophylactic basis for what reasons?
- Family member has TB & will be in close contact.
- HIV+ with TB+ tests (d/t lower immune)
- A -TB person can become +Tb when exposed
TB medications are contraindicated in what clients?
clients with liver disease
With TB single-drug therapy is ineffective, what needs to be done to cure TB?
- Multidrug therapy: <bacterial resistance to drug
- & <Tx duration from 2yrs to 6-9months
Antitubercular Tx regimen is divided into how many phases?
What are the s/e or a/r that are common to all three Antitubercular drugs? (INH: Isoniazid, Rfampin, Streptomycin)
- Blood dyscrasias
- Parasthesias (nerve damage)
- GI distress
- Occular toxicity
The Antitubercular drug Isoniazid (INH) not only has the s/e of the Rifampin & Streptomycin, but also causes what other s/e?
- Peripheral neuropathy
- **basically drives all electrolyte down**
The Antitubercular drug Rifampin also has one extra s/e that may concern the client if not informed ahead that they need to wear old clothes so it won't stain.
Turns body fluids orange: tears, urine, sweat...
The Antitubercular drug Steptomycin has an extra s/e as well. A few of the "mycin" Abx are known to cause what?
When giving an Antitubercular drug, what should the nurse assess for?
- Note Hx of liver problems
- assess for s/e of meds
- Monitor liver enzymesd
- Collect sputum spec in early morning
The Antitubercular drug, INH should be given when?
1hr before or 2hr after meals
What should be included in the client teaching for Antitubercular durgs?
- Follow complete regimen
- Take pyridoxine (vit B6) to prevent peripheral neuropathy
- Report numbness, tingling, burning
- Need frequent eye exams
- Avoid antacids & alcohol
What is another name for fungal infections?
What are the general types of Mycosis (fungal infxns)?
- Superficial: wring worm, candidia
- affects skin, hair, nails, mucus membrane
To Tx superficial fungal infections, what routes work?
Systemic fungal infections are treated via what routes?
- Oral or IV
- for: Lung, CNS, or severe fungal infxns
What is the Antifungal, Amphotericin B used for?
SEVERE fungal infections
The Antifungal, Amphotericin B should be infused over how many hours via IV?
What are the s/e of the Antifungal, Amphotericin B?
- Flushing, fever, chills, N/V
- GI distress, pseudomembranous colitis
- Nephrotoxicity, electrolyte imbalances
What is used in conjunction with the Antifungal, Amphotericin B to prevent febrile rxns or anaphylaxis?
Antipyretics, antihistamines, corticosteroids
What nursing interventions need to take place when a client is on IV Amphotericin B (antifungal) ?
- VS q30min
- Monitor: urine output, Wt
- BUN & Creatinine (kidneys)
- AST, ALT, Bilirubin (liver)
The Antifungal Nystatin is used for what kinds of fungal infections?
Thrush of the throat or yeasty areas like under breasts
What is the action of the Antifungal Nystatin?
- Fungistatic & Fungalcidal
- ^permeability of fungal cell membrane
The Antifungal Fluconazole (Difulcan) is a powerful med that can be given in one pill for fungal infections such as what?
- Vaginal Candidiasis infections
- Serious systemic fungal infections
What are the s/e of the Antifungal Fluconazole (Diflucan)?
The Antifungal, Difulcan has interaction issues with what other meds?
- oral antidiabetic agents
Miconazole (Monistat) & Clotrimazole (Lotrimin) are Antifungals used for what?
Vaginal Yeast infections
What should the client be taught when taking Monistat or Lotrimin?
- Take full course
- Abstain from sex until Tx is done
- Continue Tx during menses
What is the Antifungal Metronidazole (Flagyl) used to Tx?
- GI - C-diff
- GU - severe UTI
- Resp Infxn
What are the s/e of Metronidazole (Flagyl)? *Antifungal
- GI distress
- metallic taste
When taking Flagyl (antifungal), the client should avoid alcohol d/t what possible reaction?
Disulfiram-type reaction: N/V, facial flushing, sweating, severe HA, slurred speech. (Disulfiram is a drug used to help detour alcoholics from drinking)
Name the viruses controlled by antiviral agents.
- CMV: Cytomegaloviros
- Hepatitis viruses
- Herpes Viruses
- RSV: Respiratory Synctial Virus
Which Antivirals are used to Tx Influenza A?
- Amantidine (Symmetrel)
- Rimantidine (Flumadine)
What are the s/e of the Antiviral drugs Amantidine & Rimantidine?
Insomnia, Ataxia, Dizziness, Orthostatic Hypotension, Depression, Anxiety, Confusion, Weakness, Slurred speech
Which Antivirals are used to Tx BOTH Influenza A & B
- Znamavir (Relenza)
- Oseltamiver (Tamiflu)
What are the nursing considerations with the Antiviral meds Relenza & Tamiflu?
- Tx should begin w/in 2days of flu symptoms
What Antivirals are used to Tx HSV-1 & HSV-2, shingles, & chickenpox?
- Acyclovir (may sting)
What are the s/e of Antivirals such as Acyclovir or Tamiflu?
Dizziness, HA, N/V, Diarrhea, Lethargy, ^^bleeding, Orthostatic hypotension, hematuria, nephrotoxicity
What are the nursing interventions for Antivirals such as Acyclovir or Tamiflu?
- Monitor Labs
- educate r/t spreading infection
- interventions to deal with s/e
- if IV, infuse slowly
What is HIV?
- Human Immunodeficiency Virus
- Member of the "retrovirus family"
With HIV, CD4 T-Cell counts are monitored because what can happen when they are low?
When CD4 #s fall, it ^^risk of secondary infections.
What are the normal CD4 T-Cell counts?
What is "Viral Load"??
Measures how much HIV is in the blood
What is Viral Load used for in HIV clients?
- To eval effect of therapy
- Monitor changes in HIV infxn
- Guides Drs' Tx choices
What are the indications to start a client on an HIV or Antiretorviral Agent?
- Symptomatic HIV clients
- Asymptomatic clients w/CD4 T cells <350
- Clients w/CD4 counts >350 based on comorbidities
What is the ultimate goal with HIV patients?
^^CD4 T-Cells & LOW Viral Load
What are the most common HIV related opportunistic infections/Dx?
- Bacterial: TB, pneumonia
- Protozoal: PCP, toxoplasmosis
- Fungal: Candidiasis
- Viral: Herpes simplex, herpes zoster
- HIV-associated malignancies: Kaposi's sarcoma, lymphoma, squamous cell carcinoma
What is HAART, & what are it's goals?
Highly Active Antiretroiral Therapy
- Suppress viral replication to slow decline of CD4 cells
- Suppress VL to undetectable levels
- <incidence of opportunistic infections
- Minimize adverse effects
- ^quality of life
- improve survival & reduce mortality
- *expect constant med changes
What are the s/e of HIV & Antiretorviral Agents such as AZT?
- NRTIs: Lactic acidosis, peripheral neuropathy, pancreatitis, lipoatrophy, N/V, bone marrow suppression
- NNRTIs: Rash, fatigue, peripheral neuropathy, dizziness, insomnia, N/V
- PI: hyperglycemia, ^bilirubin, HA, N/V
- EI: N/V, rash, hypotension
- CCR5: URI, cough, rash, fever, dizziness
- Integrase inh: N/V, HA, diarrhea, fatigue
What are the nursing interventions for HIV & Antiretroviral Agents?
- Monitor labs: CD4 counts, VL, CBC
- Teaching rd: modes of transmission
- Avoid contact w/others who have communicable Dx
- Teach & assess for s/e
- Health promoting activities
What is a MAJOR concern with HIV & Antiretroviral Agents?
Adherence to the regimen d/t it's lengthy process
Nonadherence to the HIV & Antiretroviral Agent regimen can result in what?
- Viral replication
- ^ VLs
- Development of resistant viral strains
- Deterioration of the immune system
What are the nursing interventions for HIV/AIDS related drugs?
- Assess barriers to adherence:
- Med organizers
- Written schedule
- Financial support
- Assess support systems
- AIDS network
what is PEP?
Postexposure Prophylaxis for health care workers
What is the risk of contracting HIV via percutaneous injury & via mucocutaneous injury? And when should a health care worker seek therapy?
- Percutaneous: 0.3%
- Mucocutaneous: 0.09%
w/in hours of the event & continue for 4wks
Explain prophylactic Tx measures for Malaria when getting ready to enter a country that has Malaria issues.
- used to prevent malaria & prevent a relapse
- Prophylaxis: Take w/food
- Start before exposure, take during & for 6-8wks after leaving the region.
What are the drugs used to Tx Malaria or for Prophylactic purposes & what is their action?
- Chloroquine*Inhibit growth by interfering w/protein synthesis
What is an Anthelmintic used for?
Parasitic worms/Helminths (mintics)
There are different types of Helminths (parasitic worms), & different drugs for each worm. Name some of the worms.
- Cestodes: Tapeworms
- Trematodes: Flukes
- Intestinal Nematodes: Roundworms, Pinworms
- *Tx WHOLE family
- Tissue-invading Nematodes: Pork roundworm