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Four stages in infectious process:
- Stage1 incubation period
- Stage 2 prodromal period
- Stage 3 the illness period
- Stage 4 the convalescent periond
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Stage 1 incubation period
- organism first enters body and last until onset of symptoms
- infection can be transmitted
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Stage 2 prodromal period
- short time from onset of vague symptoms to the onset of specific diseases symptoms
- highly infectious
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Stage 3 the illness period
localized and systemic symptoms appear
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Stage 4 the convalescent period
symptoms begin to subside and continue until the person returns to normal
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Patients at great risk for infection include those with:
- surgical incisions with/without drains
- artificial airways
- urinary catheters
- intravenous (IV) lines
- implanted prosthetic devices
- repeated injections or venipunctures
- immune compromise
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HIA
Healthcare Associated Infection
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HIA transmitted
while receiving healthcare services
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Prevent contact between patient and other
isolation
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Ways to prevent infection and control it
- use medical and surgical asepsis
- standard precautions
- transmission based precautions
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Use in invasive diagnostic and therapeutic procedures (IV catheters, urinary catheters, surgical procedures)
Strict aseptic technique
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Infection prevention and control involve
- monitoring diagnostic reports related to infections
- observing patients for signs of infection
- implementing procedures to contain microorganisms
- properly handling, sterilizing, or disposing of contaminated items
- using approved sanitation methods
- recognizing individuals at high risk for infection and implementing appropriate protection
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Current standards for infectious prevention and control
- Tier 1: standard precautions
- Tier 2: transmission-based precautions
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Tier 1: standard precaution
delineate methods for avoiding direct contact with body secretions except sweat
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Tier2: transmission based precautions
interrupting mode of transmission by identifying specific secretions that might be infective
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Transmission-based precautions
- standard
- airborne
- droplet
- contact
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Standard precautions to be taken with
all patients
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Airborne precautions to be taken with
- measles
- varicella
- TB (special mask)
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Droplet precautions to be taken with
- meningitis
- pneumonia
- diptheria
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Contact precautions to be taken with
- GI
- skin
- wound infection
- RSV
- herpes simples
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Standard precautions
- handwashing and gloving
- do not recap/properly dispose of soiled linen and equipment
- use mouthpiece or bag/mask for mouth-to-mouth
- *for all patients*
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Transmission based precautions
- limit contact with staff and visitors
- signs on doors
- no shared equipment
- clean transport mechanisms
- signs for doors with name of specific type of isolation
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Airborne transmission:
- 1st choice private room
- small droplet, can stay in air long time
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Airborne transmission requirements:
- negative pressure room
- staff/visitors immune and wear N95 mask
- do not touch mask once on
- requires good asepsis and use of gloves
- patient wears mask to leave room
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Airborne transmission examples:
Tb, varicella and measles
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Measles s/s
- onset fatigue
- congestion
- cough
- photophobia
- macular eruption (rash)
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Measles (rubeola)
- rash last 4 to 5 days
- can result in CNS damage
- usually gives permanent immunity
- incubation 8-14 days after exposure
- vaccine usually given in MMR combination of measles, mumps and rubella
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Varicella zoster virus
- small blisters
- can lead to encephalitis and meningitis
- life threatening to unborn fetus
- incubation 7-21 days
- full recovery takes weeks
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Varicella s/s
- temperature
- headache
- anorexia
- blister rash
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Types of Varicella zoster virus
- chicken pox in child
- shingles in adults
- herpes simplex
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Chicken pox in child
lesions in mouth can swell throat
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Shingles in adult
- reactivate with stress or decreased immunity
- pain can stay long after rash is gone
- can reappear more than once
- post-herpetic neuralgia can be severe
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Herpes simplex
- lesions caused by virus=cold sores on mouth or genital herpes
- drainage from lesions can be contagious on contact
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Tuberculosis
- priority for private room
- incubation 4 to 12 wks before may see + test
- can be positive but non-infective
- usually requires long term therapy
- commonly occurs in lungs but can kidney, bone, GI tract
- mammals, birds and fish can infect humans
- *6 month therapy
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Tuberculosis s/s
- cough
- increased and/or bloody sputum
- night sweats
- fever
- weight loss
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Estimated 1/3 of the worlds population is
+ tuberculosis
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Droplet-precaution
- larger particle (3 ft guide)
- do not remain in air as long as airborne
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Droplet precautions
- staff/visitors wear surgical mask to enter room
- private room or same diagnosis
- monitor fluid balance and treat symptoms
- patient wears mask to leave room
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Droplet precaution examples
- scarlet fever
- flu
- strep throat
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Rubella
- usually milder than rubeola
- droplet precaution
- contagious 10 day prior to appearance of rash
- incubation 14-23 days
- can harm fetus during first trimester
- MMR vaccine
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Rubella s/s
- temperature
- fatigue/malaise
- joint pain
- swollen lymph nodes
- starts with red spots on palate of mouth
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Define mumps
inflammation of salivary glands and parathyroid glands
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Mumps
- droplet precaution
- incubation 12-25 days
- virus present 6 days before and up to 9 days after onset of swelling
- boys may have swelling in testicles and need support
- can result in deafness and lead to meningitis
- usually complete recovery with lifelong immunity
- Accute stage needs bed rest, fluids, soft foods, non-acid
- MMR vaccine
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Mumps s/s
- temperature
- headache
- earache
- pain with chewing
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Define meningitis
inflammation of meninges (membrane lining of Brain and Spinal Cord)
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Meningitis
- *most severe
- severe neurological injury
- fatal in 10 to 40 percent of cases
- vaccine recommend for kids and high risk adults
- deafness in children common
- requires several weeks of IVAB for bacterial agent
- viral form treatment is supportive/anti-viral agents
- may come from mosquito bites
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Meningitis s/s
- temperature
- chills
- *headache*
- *stiff neck*
- AMS
- May have rapid onset requiring emergency treatment
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Contact-precaution
blood or body fluids with potential to contain blood
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Contact precautions
- private room or person with same infection
- do not share equipment
- nurse and visitors wear gloves
- *double glove when caring for infected
- *wear mask, face shield, hair and shoe covers
- *remove soiled PPE and wash hands immediately before leaving room
- patient leaves must wear isolation gown and gloves
- wound site covered, waterproof pad if possible
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Contact precaution examples
- clostridium difficile (c-diff)
- shigella
- impetigo
- scabies
- lice
- conjunctivitis
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Herpes
- contact precaution
- airborne virus
- lesion exudate (drainage) is contact
- can migrate to numerous sites
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Common kinds of herpes
- simplex-cold sore
- genital-very contagious-transmitted to baby during birth with serious complications
- zoster-shingles-contagious until completely crusted with no new eruptions, pain may remain, may re-erupt or pain may reappear for years
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Define hepatitis
inflammation of the liver caused by virus, may also me alcohol or drug induced
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Hepatitis
- contact precaution
- easier to transmit than HIV/AIDS
- some types can remain viable on surface for several days
- may not have obvious clinical s/s found on physical exam or lab
- may take months to recover
- *does not respond to antibiotics, use anti-viral drugs
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Hepatitis s/s
- fatigue
- low grade fever
- nausea/vomiting
- flu-like symptoms
- anorexia
- weight loss
- *jaundice
- itchy skin
- brown urine
- liver enlargement
- abnormal liver functions test
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Treatment and teaching hepatitis
- standard and contact precautions depending on s/s exhibiting
- rest
- no strenuous exercise
- don't share utensils
- clean bathroom after each use
- separate linen
- wear gloves at even at home
- don't share personal items
- avoid OTC and herbs
- high calorie/high carbohydrate low fat diet
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Types of hepatitis
- A-fecal/oral route
- B (HBV)-body fluid contact
- C (HCV)-body fluid contact
- D-body fluid contact
- E-fecal/oral route
- G-body fluid contact
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Hepatitis A
- poor hygiene, contaminated food or water
- incubation 2 to 6 weeks
- acute stage 2 to 12 weeks
- recovery up to several months
- immune globulin given early, 90 percent effective, short term
- Avaxim vaccine available-lasts 10 yrs
- usually no long term effects, no carrier state or chronic condition
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Hepatitis B (HBV)
- can live outside body
- 300 million cases worldwide
- vaccine recommended for healthcare workers, high risk and school children
- incubation 8 weeks to 6 months
- can survive up to a week on dried blood
- may be asymptomatic to severe
- lead to hepatitis or cirrhosis or liver cancer
- *no cure-supportive treatment
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Hepatitis C (HCV)
- most common in chronic bloodborne infection in US
- over 30,000 new cases a yr
- may be mild or asymptomatic
- has more chronic carriers
- more of this type leads to cirrhosis and liver cancer
- many don't know how or when exposed
- no post exposure treatment or vaccine currently
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Hepatitis D
- rare, milder effects
- usually only seen in people with hepatitis b
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Hepatitis E
most common in areas with poor water and treatment systems
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Hepatitis G
- remotely related to hepatitis c
- usually milder
- can cause chronic condition
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Antibiotic resistant organism
- isolation signs may state specific name or ARO
- most commonly found in wounds
- can colonize in skin, wounds, GI tract, respiratory and urinary systems
- may clear after time or remain positive
- handwashing with antimicrobial soap
- careful handling of supplies and equipment
- visitors may not wish to wear gloves but must if visiting other patients
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Examples of antibiotic resistant organisms
- MRSA-methicillin resistant staphlococcus aureus
- VRE-vancomycin resistant enterococcus
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HIV-human immunodeficiency virus
- contact precautions
- virus causes aids
- damage immune system-destroys B&T lymphocytes
- may be + for yrs with no s/s of active disease
- may be + and never convert to active AIDS
- if + can be transmitted
- can not live outside a live host
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AIDS-acquired immune deficiency syndrome
- contact precautions
- mother can pass to baby through placenta
- dementia can occur in advanced stages
- standard precautions unless
- can not live outside a live host
- can not get by casual contact
- if responds to treatment can live for many yrs
- may die from secondary infections
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Enteric
- fecal/oral route (found in stool)
- usually severe diarrhea
- may have significant weight lose
- gown, double glove, mask/shield
- keep linen clean, bed disinfected
- clean bathroom after each use
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Examples of enteric
- hemorrhagic E-coli
- salmonella
- norovirus-sever cramping, diarrhea-spreads quickly especially among elderly
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Combination-precaution
uses respiratory (airborne) and contact
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Combination precautions
- use all ppe=face shield, N-95 mask, gown, gloves
- patient wears mask to leave room
- use antiseptic hand wash
- clean area well
- clean bathroom after each use
- do no share equipment, utensils
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Examples of combination precautions
- Varicella with open/draining lesion
- SARS (coronavirus)
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Guidelines for patient care contact
- never touch anything with bare hands
- gloves for contact of body fluids of any sort
- only time gloves not worn is in contact with intact skin or unsoiled articles
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Application of nursing process
- assessment (data collection)
- nursing diagnosis
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Assessment (data collection)
- assess for signs of infection may require transmission-based precautions
- wounds assessed each shift for infection
- monitor temperature
- admission lab studies may indicate infection
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Nursing diagnosis
- things nurses can control
- risk for infection
- r/t surgical wound
- open wound
- weakened condition
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Planning
- expected outcomes include "no healthcare associated infection is evident"
- when using transmission-based precautions that require ppe you must prepare before entry
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Implementation
- patient teaching needed on disease process, modes of transmission, and precautions to prevent spread of infection
- standard precautions used for every patient
- transmission-based precautions implemented based on patients infection status
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Implemenation-hand hygiene
- most important in prevention of infection transmission
- before and after contact with patient, wound care, invasive procedure
- before donning gloves and after removal
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Implemenation-PPE
- disposable gloves
- masks
- gowns
- goggles or face shield
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PPE
- worn appropriately based on transmission mode
- discard after use in appropriate container
- remove most contaminated items first just before you step outside room
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Specimen removal in isolation precautions
- label container before entering room
- collect specimen
- place in leak proof container without contaminating outside
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Linens in isolation precautions
- handle as little as possible
- roll up and place inside hamper inside patients room
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Guidelines for isolation precautions-trash
- disposable soiled equipment placed in plastic bags lining waste receptacle
- biohazard (red) bag may be needed
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Guidelines for isolation precautions-sharps
- never recap needle before disposal
- all sharps in sharps container
- replace sharp containers when 2/3 full
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Guidelines for isolation precaution-other equipment
reusable equipment cleaned if visibly soiled, then sent to central supply to be disinfected
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Guidelines for isolation precautions-natural defenses
- institute measures to enhance patients
- examples:
- natural body defenses
- protect intact skin
- promote a balanced diet
- provide opportunity for sleep
- decrease stress
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Guidelines for isolation precautions-patient placement
patient who need transmission precautions should be placed in private room or another infected patient with same organism
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Guidelines for isolation precautions-transporting patient
- avoid unless absolutely unnecessary
- patient given standard mask to wear outside room
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Infection prevention and control in home
- keep clothes and linen away from others
- teach patient and family proper hand hygiene techniques
- disinfect bathroom 1:10 bleach/water solution
- wash dishes in scalding water and let air dry
- use heavy plastic jug with secure top to hold needles
- use clean gloves for wound care and dressing
- teach family how to remove soiled gloves
- clean patient room frequently
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Protective isolation
- special room with its own ventilation
- no one with active infection allowed in room
- remain aware of your facilities policies and procedures and follow at all times
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Infection prevention and control for the nurse
OSHA regulations protect health care workers from exposure to blood-borne pathogens in workplace
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Three main modes of occupational exposure to blood-borne pathogens
- puncture wounds-contaminated needles or other sharps
- skin contact-allowing blood, body fluids, other potential infectious materials to enter through damaged or broken skin
- mucous membrane contact-allowing infectious materials through mucous membranes of eyes, mouth, nose
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Four rules of surgical asepsis
- know what is sterile
- know what is not sterile
- separate sterile from not sterile
- remedy contamination immediately
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Goal for surgical asepsis
keep an area free from microorganisms
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Surgical scrub
- more lengthy and vigorous hand hygiene
- remove as many microorganisms as possible without damaging skin
- timing based on actual time spent scrubbing not including rinse time
- usually 2 to 4 minutes
- brushless technique with antimicrobial agent may be used
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Opening sterile packages
- perform hand hygiene
- open away from body
- touch only outside wrapper
- do not reach across a sterile field
- always face sterile field
- allow at least 6 inches between body and sterile field
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Evaluation
- Patient recovering without additional infection from other organisms or other body areas
- Assessing if patients has been transmitted to any healthcare worker or patient in hospital or unit
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Gerontologic considerations
- elderly often have poor nutrition
- may have atypical s/s of infection & more severe complications
- many LTC and elderly colonized with antibiotic resistant bacteria
- pneumonia, influenza, UTI, skin infections, TB common in elderly especially in LTC
- may have invasive procedures: pacemakers, catheters, feeding tubes
- need immunizations
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Drugs anti-viral agents
- indications: for viral (non-bacterial) infections
- contraindications/cautions: liver disease, DM, renal disease
many patients on these drugs are immunocompromised
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Common drug for varicella/herpes
- zovirax
- valtrx
- abreva
- acyclovir
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Common drug for Influenza
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Common drug for hepatitis
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Side effect for anti-viral agents
- mouth ulcers
- edema
- rash
- itching
- bone marrow suppression
- hyperglycemia
- blood disorders
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Drug interactions for anti-viral agents
- numerous based on individual dosage
- avoid OTC including topicals
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Food interactions for anti-viral agents
avoid herbs/supplements
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Teaching/nursing considerations for anti-viral agents
- viruses can become resistant to drugs easily
- teach s/s of pancreatitis, fungal or other secondary infections
- monitor liver and kidney function
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