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Explain how normal flora protects the human host.
Protects from pathogens
Identify several human pathogens.
- Gram-positive: staphylococcus aureus, streptococcus pneumonia, Group B streptococcus, clostridium perfringens
- Gram-negative: Neisseria meningitdes, escherichi coli (E. coli), haemophilus infuenae
Explain what clients are most likely to get an "opportunistic" infection
- Those on antibiotics, corticosteroids, chemotherapy or other immuneosuppressives
Why are there so many bacteria that are resistant to the effects of antibiotics?
- Resistance to antibacterials
- ? Natural or inherent resistance
- ? Acquired resistance
- ? Nosocomial infections
- ? Cross-resistance
How can the nurse contribute to the prevention of the spread of micro-organisms in the hospital setting?
Teach pts about the proper use of antibiotics to prevent situations that promote drug resistance to bacteria
Identify the therapeutic effects and the adverse effects (Table 29-2) that may occur when treating the client with antimicrobial therapy.
- Therapeutic Effects
- Kill bacteria and stop bacterial infection
- General adverse reactions
- Allergy or Hypersensitivity
- ? Mild allergic reaction
- Rash, pruritus, hives
- ? Severe allergy: anaphylactic shock
- Bronchospasm, laryngeal edema
- Vascular collapse, cardiac arrest
- ? Treatment
- Secondary infection: normal flora killed
- Sites: mouth, skin, respiratory tract, vagina, intestines
- Usually occurs when treated more than 1 week
- Organ toxicity
Define bacteriostatic and bacteriocidal.
- Bacteriostatic drugs: Inhibit growth of bacteria
- Bactericidal drugs: Kill bacteria
What are the indications for penicillin use? What are the indications for amoxicillin and ampicillin? Contraindications? Therapeutic effects? Side Effects? Adverse Reactions?
- ? Introduced to kill Staphyloccus
- ? Inhibit bacterial cell wall synthesis
- ? Narrow-spectrum
- PENICILLINS (pen-i-sill-ins)
- penicillin G, penicillin V, procaine penicillin G, benzathine penicillin G
- Treatment of a wide variety of infections including: Pneumococcal pneumonia, Streptococcal pharyngitis, Syphilis, Gonorrhea strains. Treatment of enterococcal infections (requires the addition of an aminoglycoside). Prevention of rheumatic fever. Should not be used as a single agent to treat anthrax.
- Bind to bacterial cell wall, resulting in cell death.
- Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Active against: Most gram-positive organisms, including many streptococci
- (Streptococcus pneumoniae, group A beta-hemolytic streptococci), staphylococci (nonpenicillinase-producing strains) and Bacillus anthracis, Some gramnegative organisms, such as Neisseria meningitides and Neisseria gonorrhoeae (only penicillin susceptible strains), Some anaerobic bacteria and spirochetes including Borellia burgdorferi.
- Contraindicated in: Previous hypersensitivity to penicillins (cross-sensitivity may exist with cephalosporins and other beta-lactams); Hypersensitivity to procaine or benzathine (procaine and benzathine preparations only); Some products may contain tartrazine and should be avoided in patients with known hypersensitivity.
- Adverse Reactions/Side Effects
- CNS: SEIZURES. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, epigastric distress, nausea, vomiting. GU: interstitial nephritis. Derm: rash, urticaria. Hemat: eosinophilia, hemolytic anemia, leukopenia. Local: pain at IM site, phlebitis at IV site. Misc: allergic reactions including ANAPHYLAXIS and SERUM SICKNESS, superinfection.
- Treatment of: Skin and skin structure infections, Otitis media, Sinusitis, Respiratory infections, Genitourinary infections. Endocarditis prophylaxis. Postexposure inhalational anthrax prophylaxis. Management of ulcer disease due to Helicobacter pylori. Unlabeled Use:Lyme disease in children _8 yr.
- Binds to bacterial cell wall, causing cell death.
- Therapeutic Effects: Bactericidal action; spectrum is broader than penicillins. Spectrum: Active against: Streptococci, Pneumococci, Enterococci, Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Neisseria meningitidis, N. gonorrhoeae, Shigella, Chlamydia trachomatis, Salmonella, Borrelia burgdorferi, H. pylori.
- Contraindicated in: Hypersensitivity to penicillins (cross-sensitivity exists to cephalosporins and other beta-lactams).
- Adverse Reactions/Side Effects
- CNS: SEIZURES (high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting,qliver enzymes. Derm: rash, urticaria. Hemat: blood dyscrasias. Misc: allergic reactions including ANAPHYLAXIS, SERUM SICKNESS, superinfection.
- Treatment of the following infections: Skin and skin structure infections, Soft-tissue infections, Otitis media, Sinusitis, Respiratory infections, Genitourinary infections, Meningitis, Septicemia. Endocarditis prophylaxis.
- Unlabeled Use: Prevention of infection in certain high-risk patients undergoing cesarean section.
- Binds to bacterial cell wall, resulting in cell death.
- Therapeutic Effects: Bactericidal action; spectrum is broader than penicillin. Spectrum: Active against: Streptococci, nonpenicillinase-producing staphylococci, Listeria, Pneumococci, Enterococci, Haemophilus influenzae, Escherichia coli, Enterobacter, Klebsiella, Proteus mirabilis, Neisseria meningitidis,
- N. gonorrhoeae, Shigella, Salmonella.
- Contraindicated in: Hypersensitivity to penicillins.
- Adverse Reactions/Side Effects
- CNS: SEIZURES (high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting. Derm: rash, urticaria. Hemat: blood dyscrasias. Misc: allergic reactions including ANAPHYLAXIS and SERUM SICKNESS, superinfection.
Why would the prescriber use a beta-lactamase inhibitor?
- ? Not given alone
- Combined with penicillinase-sensitive penicillin
- ? Inhibits bacterial beta-lactamase enzyme
- Amoxicillin-clavulanate (Augmentin)
- ? Given orally
- ? Combination intensifies effect of amoxicillin
When you compare penicillins to cephalosporins, why would cephalosporins be used?
Fungus active against gram-positive AND gram-negative bacteria & resistant to beta-lactamase (an enzyme that acts against the beta-lactam structure of penicillin)
What are the most important nursing actions related to the delivery of penicillins and cephalosporins?
- ? Assess for allergy: have epinephrine available to counter severe reaction
- ? Perform C & S before therapy.
- ? Assess renal and liver function.
- ? Administer IV over 30 min b.i.d.-q.i.d.
- ? Monitor for superinfection.
- ? For safety, keep out of reach of children.
- Do not mix aminoglycosides with a high-dose or extended-spectrum penicillin G, this combo may inactivate aminoglycoside
List several adverse effects of beta-lactams.
What are the indications for cefazolin use? cefaclor? Contraindications? Therapeutic effects? Side Effects? Adverse Reactions?
- Cefazolin: for infections including otitis media, skin bone & respiratory or uti
- Cefaclor: respiratory, urinary, bone, joint, skin infections; otitis media; surgical infection prophylaxis, septicemia gonorrhea, Klebsiella pneumonia, E. coli, strep pneumonia & s. aureus
What are macrolides active against?
Gram-positive bacteria and moderately active against some gram-negative bacteria
What is the first macrolide?
Why are macrolides, lincosamides, glycopeptides and ketolides similar? What are the uses and considerations for each? (Table 30-1)
- They are similar to penicillin but used as penicillin substitutes when someone is allergic to penicillin
- Macrolides: azithromycin & erythromycin; active against gram-positive and moderately active against gram-negative. Contraindication: renal insufficiency
- Lincosamides: against gram-positive like staph aureus; used for serious infections
- Glycopeptides: used against drug resistant s. aureus and in cardiac surgical prophylaxis for people with penicilin allergy; MRSA;
- Ketolides: used in adults to treat mild community-acquired pneumonia usually caused by step pneumonia
What infections would be treated with tetracycline?
Is it likely that a gram negative organism would be resistant to tetracycline?
Yes, continuous use caused resistance
What situation would be a contraindication to the use of tetracycline?
What is Azithromycin? Contraindications? Therapeutic effects? Side Effects? Adverse Reactions?
- Extended macrolide w/long half-life up to 40-68 hrs-only needed once a day for 5 days. Inhibits protein synthsis, bacteriostatic or bacteriocidal
- aka Zithromax
- contraindication: hypersensitivity, bradycardia, hypokalemia, hypomagnesemia,
- Caution: hepatic dysfunction, lactation, renal dysfunction
- Therapeutic: trat gram-positive and some gram-negaive
- For pts allergic to penicillin
- To treat upper respiratory tract infect, gonorrhea, skin infect
- Azasite for bacterial pink eye
- Side effects: blurrd vision, HA, sleepy, dizzy, fatigue, nausea, vomit, diarrhea, tinnitus, abdominal cramps, pruritus, rash
- Adverse Rx: superinfection, vaginitis, urticaria, stomatitis, hearing loss, dehydration, angioedema, seizures
- Life-thratening: hepatotoxicity, anaphylaxis, stevens-johnson syndrome
When are aminoglycosides used?
- Inhibit protein synthesis of gram-negative like E.coli proteus spp, pseudomonas spp
- USED for serious infections
When would aminoglycosides be contraindicated? Side effects? Adverse reactions?
- Contra In: hypersensitivity, severe renal disease, pregnancy, pseudomembranous colitis
- SE: anorexia, nausea, vomit, rash, numbness, visual disturbance, HA, confusion, depression, temors, tinnitus, hearing loss, pruritus, muscle cramps or weakness, photosensitivity, alopecia, arthralgia
- AR: oliguria, urticarial, palpations, superinfection, peripheral neuropathy, laryngeal edema, hypokalemia, hypomagnesemia, hyponatremia
- Life-threatening: ototoxicity, nephrotoxicity, thrombocytopenia, agranulocytosis, neuromuscular blockage, liver damage
What are the therapeutic effects of gentamicin sulfate (Garamycin)?
TE: treat serious infections caused by gram-negative (eg pseudomonas aeruginosa, proteus); to treat pelvic inflammotry disese MRSA (methiciin-resistant staph aureus)
Name one of the body systems that are often invaded by fluroquinolone sensitive organisms.
Discuss the choice of multiple daily dosing versus single daily dosing of an aminoglycoside.
How can the nurse decrease the chances for aminoglycoside toxicity?
- Monitor peak and trough
- Monitor vital sign and urine output
- Assess lab results for renal and live function (BUN, serum creatine, alkaline phosphate, alanine minotranferase, aspartate aminotransferase, bilirubin.
- Get md hx r/t renal or hearing disorders (large doe could cause ototoxicity
List several nursing actions necessary for client safety when client is receiving an aminoglycoside.
- Check for haring loss
- Decreasd body temp
- Peak & trough (blood draw 45-60 mins after drug given for peak and minutes before given for trough)
After giving a fluroquinolone, what observations should the nurse make?
- I&Os (output at least 750ml/d)
- Lab results (BUN, serum creatine)
- Monitor BS for levofloxacin
- Signs of superinfection (stomatitis [mouth sores], fury blck tongue anal or genitl dscharge an itching
Are macrolides effective against both gram positive and gram negative organisms?
Why is erythromycin used less often?
Resistance to it?
If the client has a history of penicillin allergy, can a macrolide be used?
Could a macrolide be used to treat a respiratory infection caused by streptococci?
You are given two orders;
- o Stat Culture and Sensitivity
- o Azithromax (Zithromycin) 500 mg Stat and 250 mg QD for 4D
- Which order do you implement FIRST?
- Culture and sensitivity so the meds dont change C&S results
What are the adverse effects that you might expect after giving Zithromax (azithromycin)?
Adverse Rx: superinfection, vaginitis, urticaria, stomatitis, hearing loss, dehydration, angioedema, seizures
What drugs decrease the effectiveness of Zithromax (azithromycin)?
What client situations would require therapy with a sulfonamide?
- Those allergic to penicillin
- Treat urinary tract & ear infections (90% effective with UTI caused by E.coli)
- Newborn eye prohylaxis
List nursing actions related to the delivery of sulfonamide drugs.
- I&O: Assess renal function Output >600 mL/d, BUN (should e 8-24 mg/L), serum creatine (normal 0.5-1.5 mg/dL)
- Sensitivity to sulfonamides
- Baseline labs
- Give w/full glass water
- Vital sings. Look for decreased temp
- Look for signs of life threatening anemias
- Signs of superinfection
What drug interactions would be problematic in a client ordered to receive Bactrim?
Those on nticagulants
What would be some side effects of being on Bactrim? Adverse reactions?
- Mild to modrate rahses, anorexia, nausea, vomiting diarrhea, stomatitis (mouth sores), crytalluria, photosensitivity
- AR: agranulocytosis. Aplastic anemia, allergic myocarditis