mgccc nursing

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mgccc nursing
2010-10-29 12:30:59
Hurlbert\'s lecture on anti infectives

anti infectives
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  1. normal flora
    everybody has normal flora on skin, in colon, diff areas of body that help body cope w/organisms that are not supposed to be there
  2. sterile areas
    inside lungs, bladder, etc.
  3. colonized areas
    • include skin...things that are on outside of body that shouldnt go into skin.
    • upper respiratory tract, mouth, external genitalia, colon (things that are in colon that can help digest food)ex: cdiff lives there, but is not supposed to be a large population
    • -eat yogert to replace normal flora (ex: when on antibiotic)
  4. when you have a systemic infection
    you may have to do a blood test to determine...may not always have a fever.
  5. factors that increase risk of infection
    • -skin that has been broken
    • -neutropenia & other blood disorders (reverse isolation may be used)
    • -malnutrition (if we dont eat how we should, immune system goes down)
    • -poor personal hygiene (ex: female wiping back to front, person not cleaning cut)
    • -suppression of normal bacterial flora (antibiotics wipe normal flora out)
    • -suppression of immune system (ex: cancer, anemia)
    • -diabetes & other chronic diseases (ex: COPD-potential for fluids to retain in body)
    • -advanced age
  6. nosocomial
    is usually antibiotic resistant type of opportunistic infection
  7. Interventions to decrease risk of infections
    • -wash hands
    • -promote general health and well being (teach hand washing etc.)
    • -treat all body fluids as infections
    • -(children w/exema are high risk for staph inf)
    • -always wear your gloves!
    • -PPD (TB skin test)
    • -
  8. Interventions to decrease risk of infections cont....
    • -standard universal and isolation precautions (treat everyone (be aware of thier body fluids) as if they have HIV to protect yourself)
    • -Hand washing (cdiff is not killed by sanitizer-only soap & water)
    • -flu & pneumonia vaccines
    • -sterile technique
    • -assess fluid and nutrition status (ex: if have UTI drink cranberry juice)
    • -decrease levels of stress
  9. Question:
    A nurse is teaching a mother about the medicine for her child's respiratory problem. The nurse should include which of the floowing in her teaching
    • A. Administer the medicine if the child is afebrile
    • B. The secretions will become thicker and darker to due the tx.(treatment)
    • C. Keppe any remaning antibiotics for the next illness
    • D.Remember to wash your hands frequently to reduce the risk of infection
  10. Drug Selection Criteria-Match the drug to the bug
    • -culture and sensitivity----this should be done before 1st dose of antibiotic
    • (-with an infant...they have done the culture....but you dont have the sensivity (the results) back yet.)
    • -pt tolerance, allergy and contraindications (if benifit outweighs detriment to pt-will be ordered)
    • -specificity to infectious organism (ex: if fungal infection-will give antifungal)
    • -site of infectionl(-depending on site, ex: UTI agents help eliminate bacteria from UT, there are also broad-spectrum antibiotics)
    • -dosage requirements
    • -cost (is pt going to be able to afford the medication?)
    • -culture
  11. Emergence of Resistant organisms:
    Methicillin Resistant Organisms-MRSA
  12. Methicillin Resistant Staphylococcus Aureus-MRSA
    • -most common site is in the skin and urine and respiratory tract
    • -most coommon treatment is vancomycin
    • 80% of staph in hospitals are resistant to methicilin
    • -the organism may be resistant to penicillins, erythromycin, clindamycin, tetracycline, aminoglycosides, and cephalosporins
  13. Emergence of Resistant organisms
    Vancomycin resistant enterococcus-VRE
    • accounts for 12% of nosocomial infections
    • mortality rate of 40%
    • major contributing factor is the frequent use of vancomycin to treat other resistant organisms such as mrsa
  14. Penicllin resistant steptococcus pneumonia
    • -over the past 5 years resistance to penicillin has increased by more than 300%
    • (resistance to claforan (cefotaxime) has increased by more than 1000%)
    • -contributing factors to resistant organisms
    • -overuse and misuse of antibiotics in human and animal medicine
    • -global transmission of resistant bacteria
    • -increasing cost of develping new antibiotics
  15. shigella
    causes dysenterry
  16. CDC has 12 step approah to preventing resistance
    • -vaccinate
    • -get the catheters out (they build up baceria-they must be changed)
    • -target the pathogen (take the culture before hang the antibiotic)
    • -access the expert (dr will consult w/expert on subject)
    • - practice antimicrobial control (WASH HANDS)
    • -use local data
  17. 12 steps continued
    • treat the infection not the contamination
    • treat the infection and not the colonization
    • know when to say "no" to vancomycin
    • stop antimicrobial treatment (ex: dont treat cold w/antibiotic)
    • -isolate the pathogen
    • -break teh chain of infection
  18. nursing care when administering antimicrobials:
    accuracy, adverse effects, drug interctions
  19. accuracy
    • intervals
    • with or without food
    • reconstituting
  20. adverse effects
    • hypersensitivity
    • super-infection
    • toxicity
  21. drug interactions
    • -special consderations
    • -children
    • -elderly
    • -peri-operative
    • -renal impairment
    • -hepatic impairment
    • critical illness
    • -superinfection
    • -catergories of antibacterials
  22. catergories of antibacterials
    • penicillins
    • cephalosporins
    • aminoglycosides
    • fluroquinolones
    • tetracyclines
    • sulfonamides
    • macrolides
    • miscellaneous
  23. penicillin:
    • PCN is the safest and most effective for children
    • -rapidly excreted by the kidneys and produce a high drug concentration in the urine, except for nafciliilin which is excreted by the liver. (so good for UTI's
    • -children are usually prescribed amoxcilin (the pink stuff)
    • contraindications-allergies to penicillin or to its agents (so cant take any "cillin")
    • -be careful when using Erythromycin, AMinoglycosides, or Tetracylines in concoitant with one another (hepatic and renal complications can occur)
    • potential for cross sensitivity with cephalosporins
  24. Adverse effects of penicillin
    • -allergic reaction- rash, serum sickness (etc: glomerulonefphritis of the kidney), anaphylaxis
    • -loss of normal flora-black furry tongue (thrush), vaginal candidas, diarrhea (c-diff)
    • -hematologic-hemolytic anemia or leukopenia
    • -nephropathy-nephritis
    • -electorlyte imbalances (side eff of antibiotic-its not caused by the infection...this imbalance may happen b/c of the diahrrhea or lack of appetite)
  25. Cephalosporins
    (EX: keflex, Ancef, rocephin)
    • -similar to penicillins. Used as a surgical prophylaxis tx for rep. infections, skin, soft tissue, brain, spinal cord, and bloodstream.
    • -most common is Keflex po.
  26. Contraindications for Cephalosporins
    • -allergy to cephalosporin agents
    • -careful of cross sensitivity with penicillins
  27. Adverse effects
    • -pseudomembranous colitis
    • -GI disturbances- nauseau, diahrrhea, vomiting
    • -allergy-rash, anaphlaxis
    • -superinfection
  28. Amnoglycosides
    • -among the most used for psudomonas, proteus, e. coli, enterobacter species
    • -bacteriocidal
    • -examples: neomycin, kanamycin, gentamicin
  29. Adverse effects of aminoclycosides
    • -ototoxicity
    • -nephrotoxicity
    • -tremors
    • -urticaia
    • -pruritus
    • -rash
  30. Fluroquinolones
    • -broad spectrum agent particularly effective against gram neg organisms
    • -disrupts bacterial replication
    • -examples: cipro, tequin, levaquin
  31. Indications for fluroquinolones
    • -soft tissue infections
    • -respiratory infections
    • -gi & gu infections
    • -multidrug resistant tuberculosis