Professional Documents
Culture Documents
Fever
definition: elevated body temperature, sign of inflammation
caused by pyrogens released from macrophages which interfere with the
temperature regulating centers located in the hypothalamus (bodys
thermostat)
role of fever bodys defense mechanism to kill off the bacteria and viruses
o constant fever that rises and falls only a few degrees typhoid
o intermittent fever returns to normal 1-3x/24 hours pyogenic infections
(pus-forming infection)
o remittent fever fluctuates but does not return to normal viral or bacterial
infections
o relapsing fever accompanied by afebrile episodes every few days malaria
o fever of unknown origin (FUO) T higher than 103F recorded daily for
more than 2 weeks with no diagnosis, brought into the hospital to
identify it usually through blood cultures, sometimes cancer
o hypothalmus no longer in contact with pyrogens T reset back to normal
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D.
E.
5.
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F.
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v.
Characteristics
Difference
Incidence
Drug triggers
Cause
Onset
Course
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Discontinue drug!
Discontinue drug!
Transferred to burn center
(some antibiotics may be
Treatment is supportive
completed before sx)
Fluid and lyte replacement
Treatment is supportive
Nutritional support (TPN, enteral)
Fluid replacement
Pain management
Nutritional support
Thermoregulation
Meticulous eye care
Meticulous eye care
Thermoregulation
Infection control precautions
Antacids, sedation, analgesics
Surgical repair
No steroids
Physical therapy
Wound care
New treatment
Plasmphoresis, hyperbaric oxygen
Prophylactic use of antimicrobial drugs (30-50% of antibiotic use) one dose given via
G.
IV piggyback, very effective, part of the time-out
Surgery
1.
bacterial endocarditis
2.
neutropenia low WBCs prone to infection, give them antibiotics to help out the
3.
bodys mechanism
Suprainfection/superinfection
H.
new infection that appears during the course of antibiotic treatment for a primary
1.
infection one infection is replaced by another infection
common side effect that occurs during antimicrobial therapy
2.
reduction or eradication of normal microbial flora caused by the agents eliminate
3.
the inhibitory influence of normal flora
risk dosage #agents used broad spectrum agents
4.
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II. Drugs that Weaken the Bacterial Cell Wall I: Penicillins (Chapter 84)
Penicillins [Penicillin G or V, nafcillin (Unipen), ampicillin (Omnipen),
1.
amoxicillin (Amoxil), piperacillin (Pipracil)]
a. also known as beta-lactam antibiotics
b. 4 types narrow-spectrum (penicillinase sensitive), narrow-spectrum
(penicillinase resistant), broad-spectrum, extended-spectrum (Table 84-1)
c. developed in 1940s, very inexpensive
d. action effective against gram-positive bacterial (less gram-negative)
e. indications
infections caused by gram-positive bacteria, gram-negative cocci, anaerobic
i.
bacteria, spirochetes (ex: pneumonia, meningitis, gangrene, tetanus, anthrax)
?prophylaxis bacterial endocarditis (no clear evidence to support this use)
ii.
f. side effects
diarrhea from destruction of normal flora
i.
taste alterations metallic taste common
ii.
N, V
iii.
fungal superinfections sore mouth; dark, discolored sore tongue; vaginal
iv.
infection very common in women
neurotoxicity seizures, confusion, hallucinations
v.
pain at sites of IM injection antibiotic that squeezes through like toothpaste,
vi.
need 18 G needle OUCH!
vii. allergic reactions
most common cause of drug allergy (0.4% - 7%)
a)
no direct relationship between dosage and intensity of response
b)
prior exposure is necessary for an allergic reaction
c)
ask all patients if they have experienced an allergic reaction to
i)
penicillins
allergy to one PCN is considered an allergy to all PCNs
ii)
history
of reaction avoid PCN, if mild reaction give cephalosporins
d)
1% cross sensitivity with cephalosporins
i)
skin
testing for penicillin allergy
e)
allergy should be documented
i)
can decrease over time
ii)
g. drug interactions potassium-conserving drugs, aminoglycosides
h. route penicillin G (IM, IV), penicillin V (oral)
i. nursing implications
Be extra cautious when giving it for the first time, stay for 15 min after
i.
administering the medication
IM injections verify correct placement
ii.
oral penicillins bind to food to effectiveness empty stomach, no food at
iii.
least one hour before or 2 hours after administration
complete the entire course of therapy
iv.
monitor for adequate renal function (check I & O)
v.
watch for K or Na symptoms
vi.
vii. instruct patient to report any signs of allergic response
viii. monitor WBC, fungal infections
Memory Tip: Oral side effects are associated with penicillins (taste alteration, sore
mouth, and dark, discolored sore tongue) SO: Imagine taking a pen and coloring
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your tongue a dark color. This would taste funny and make your mouth sore. Pens
are also very useful and you can buy them cheap like penicillins.
III.Drugs that Weaken the Bacterial Cell Wall II: Cephalosporins, Carbapenems,
Aztreonam, Vancomycin, Teicoplanin, and Fosfomycin (Chapter 85)
Cephalosporins [cefazolin (Ancef) cefepime (Maxipime)] cefA.
classified by generations 1, 2, 3, 4 (18 agents)
1.
a. activity against gram-negative bacteria
b. resistance to beta-lactamases (produced by gram- bacteria)
c. ability to reach CSF
action bactericidal, disrupt cell wall synthesis, activate enzymes that cleave cell
2.
walls
route oral, IM (painful), IV
3.
side effects
4.
a. allergic reactions (rash can develop several days after onset of treatment)
b. bleeding tendencies (hypoprothrombinemia)
c. thrombophlebitis at IV site (infuse slowly)
d. diarrhea, abdominal cramps, GI upset
e. superinfection
f. nephrotoxicity
contraindications: renal disease, bleeding disorders, anticoagulants, probenecid
5.
antabuse-type reaction to alcohol intake (alcohol intolerance)
6.
a. causes palpatations, jitteriness
nursing implications
7.
a. never ingest alcohol in any form
b. monitor for superinfections especially in the elderly
c. monitor bleeding times, PT, bun
d. take oral cephalosporins with food if gastric upset occurs
e. refrigerate oral suspensions
Carbapenems [imipenem/cilastatin (Primaxin), meropenem (Merrem)]
B.
broadest antimicrobial spectrum of any drug
1.
indications treating mixed infections (anaerobes + S. aureus + gram-)
2.
route IM, IV
3.
side effects
4.
a. N, V, diarrhea
b. hypersensitivity reaction aka allergy
c. superinfections
vancomycin (Vancocin)
C.
action inhibit cell wall synthesis, bactericidal
1.
indications
2.
a. gram-positive infections only
b. *only serious, drug-resistant infections (MRSA) last resort drug*
c. antibiotic-associated pseudomembranous colitis (AAPMC)
caused by C. difficile (Box 85-1)
i.
life threatening infection, 90% of CD caused by antibiotics
a)
#1 cause of nosocomial infections in community hospital, > MRSA
b)
transmission: oral-fecal route, replicates in the colon
c)
symptoms: diarrhea, mucus/blood in stool, fever, anorexia, abdominal pain
d)
highly resistant to disinfection (patient rooms)
e)
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research: 59% HCW, 75% MDs had hand cultures + for c. difficile
treatment: vancomycin (IV only), metronidazole (Flagyl), fidoxomicin
g)
(Dificid) (PO)
inflammation or necrosis of the mucosal layers of the bowel wall
ii.
symptoms
iii.
abdominal pain/cramping, gas, severe/bloody diarrhea, fever
a)
weight loss
b)
fluid and electrolyte disruptions
c)
elderly susceptible
iv.
medical intervention necessary
v.
d. serious infections with susceptible organisms in patients allergic to PCN
route IV, oral route only for infections of the intestines (C. difficile)
3.
side effects
4.
a. ototoxicity/hearing loss (often reversible but can be permanent)
b. nephrotoxicity BUN, creatinine*
c. N, V, taste alterations (for po route)
d. Extravasation make sure that the IV is placed properly, otherwise it can cause
necrosis of the tissue
e. red-man syndrome (RMS)/red-neck syndrome
histamine release, chills, fever, increased HR, pruritus, burning, red (intense
i.
flushing) + macular rash on face/neck/torso/arms, hypotension
caused infusing via IV too quickly, now being seen with slower rate infusions
ii.
implication never infuse vancomycin < 60 minutes
iii.
reactions more likely to occur with patients under 40 particularly children
iv.
may need to give antihistamines before administration
v.
f. thrombophlebitis with IV infusion
contraindications: renal impairment, concurrent use of other ototoxic agents
5.
(aminoglycosides, amphotericin B, ASA, lasix)
nursing implications
6.
a. determine presence of hearing loss before and after drug therapy initiates
b. monitor serum peak and trough levels can fight resistance with therapeutic
levels
c. dosing according to weight
d. IV route irritating, rotate sites or use central access, assess for extravasation
e. no bolus IV administration
Memory Tip: Picture a red neck (no bolus administration to prevent histamine release)
driving a van (not a truck) with big guns in the seat next to him. When he shoots off
his big guns, it makes him loose some hearing (ototoxicity). He likes to use kidneys
for his target practice (nephrotoxicity).
f)
Process
Cause
Incidence
VRE
[vancomycin-resistant enterococcus]
MRSA
[methicillin-resistant staphylococcus aureus]
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People at risk
Transmission
Prevention
Treatment
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antibiotic. Use with caution for pregnant women, breastfeeding women, and
children.
B.
C.
D.
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a. liver toxicity
b. infusion related thombophlebitis
nursing implications
3.
a. monitor LFTs
b. central line administration site preferred
c. very expensive ($3100)/5 days
V. Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis (Chapter 87)
Aminoglycosides [gentamicin (Garamycin), tobramycin (Nebcin), amikacin (Amikin)]
A.
action disrupt protein synthesis, production of abnormal proteins, bactericidal
1.
indications
2.
a. narrow-spectrum antibiotics (narrow use)
b. serious infections due to aerobic gram-negative bacteria (E. coli, Klebsiella
pneumoniae, Pseudomonas aeruginosa, Serratia)
c. synergistic effect with PCN
route IV, IM, oral only for treatment of intestinal infections, topical
3.
side effects
4.
a. ototoxicity (inner ear)
hearing (cochlea hearing loss, high-pitched tinnitus (ringing in ears)
i.
balance (vestibular apparatus HA, N, unsteadiness, dizziness, vertigo)
ii.
irreversible
iii.
b. nephrotoxicity proteinuria, dilute urine, BUN/creatinine
c. neurotoxicity tingling of extremities, muscle twitching, convulsions
d. peripheral neuritis tingling in fingers and toes
e. optical neuritis loss of vision
f. allergic/hypersensitivity response
contraindications
5.
a. patients with renal disease (dosage size or dosing interval)
b. concurrent use of nephrotoxic agents (vancomycin, cephalosporins, amphotericin
B)
c. concurrent use of ototoxic agents (Vanco) ototoxicity when renal disease
present or administration of doses for more than 10 days
d. caution with patient who have hearing impairment
e. can intensify neuromuscular blockade induced by skeletal muscle relaxants,
caution with patient who have myasthenia gravis
dosing schedules once daily dosing, easier to take
6.
nursing implications
7.
a. monitor audiograms, renal function studies, vestibular function studies before,
during, after treatment
b. monitor peak and trough levels (trough more sensitive indicator of renal status)
c. monitor BUN and creatinine (especially in elderly), I & O
d. IV administer slowly to prevent neuromuscular blockade
e. force fluids to minimize irritation to urinary tubules
VI. Antimycobacterial Agents: Drugs for Tuberculosis, Leprosy, and
Mycobacterium avium Complex Infection (Chapter 90)
Tuberculosis
A.
global epidemic kills more people (2-3 million) than any other infectious disease
1.
worldwide, 2 billion people infected
a. 1998-current efforts have reduced the incidence below 1985 level (9.3 cases per
100,000 people)
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2.
3.
4.
5.
6.
7.
8.
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B.
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VII.
A.
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B.
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B.
C.
D.
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2.
3.
4.
IX. Antiviral Agents I: Drugs for Non-HIV Viral Infections (Chapter 93)
acyclovir (Zovirax), valacyclovir (Valtrex)
A.
action suppressing synthesis of viral DNA
1.
indication drug of choice for herpes simplex viruses (genital herpes), herpes zoster
2.
(shingles) virus, varicella (chickenpox), cytomegalovirus (CMV)
does not cure herpes and will not prevent transmission of disease to others or
3.
recurrence, it will shorten the acute episode
route oral, IV, topical
4.
side effects
5.
a. N, V, diarrhea
b. phlebitis, inflammation at site of infusion
c. renal impairment, increase hydration
risk with dehydration hydrate during infusion and for 2 hours after with
i.
2000-4000cc/day
rapid infusion of IV route give slowly over 1 hour via IV pump
ii.
nursing implications
6.
a. monitor BUN, creatinine, I & O
b. use gloves to apply topical preparations
c. patient education
provide information about herpes (transmission, course, treatment)
i.
avoid sexual activity or use condom
ii.
take no longer than 6 months
iii.
wear loose-fitting clothes
iv.
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get PAP test at least every year higher risk of cancer with herpes
oseltamivir (Tamiflu), zanamivir (Relenza)
B.
indication prevention and treatment of influenza
1.
route oral, oral inhalation (Diskhaler) Relenza
2.
the sooner you give it, the better it works
3.
begin treatment early no later than 2 days after symptom onset
4.
a. when treatment is started within 12 hours of symptom onset symptom
duration by 3 days
b. when treatment is started within 24 hours of symptom onset symptom
duration by 2 days
c. when treatment is started within 36 hours of symptom onset symptom
duration by 29 hours
severity of symptoms and incidence of complications
5.
side effects
6.
a. N, V give with food for po route
b. cough, throat irritation inhalation route
nursing implications
7.
a. use bronchodilator (asthma) before inhalation of Relenza
b. inhalation dose 2x/day for 5 days
X. Antiprotozoal Drugs I: Antimalarial Agents (Chapter 98)
Malaria
A.
parasitic disease caused by 4 different species of the protozoa Plasmodium
1.
kills less than TB but more than any other infectious disease (1-3 million deaths/year)
2.
75% of deaths occur in Africa (mostly in children under 5 years old)
3.
generally limited to tropical and subtropical areas
4.
1200 deaths/year in US usually acquired infection from traveling abroad not
5.
taking antimalarial chemoprophylaxis, inadequate amounts of medication, incorrect
medications
seek medical attention if develop fever during or 2 years after return
6.
Treatment
goals
B.
treatment of acute attack chloroquine
1.
prevention of relapse primaquine
2.
prophylaxis (suppressive therapy) no drug is 100% effective for prevention take
3.
protective measures, get quality drugs before travel chloroquine, mefloquine,
doxycycline, atovaquone/proguanil
chloroquine (Aralen), hydroxychloroquine (Plaquenil) quine
C.
action effective against certain forms of malaria, mechanism of action unknown
1.
indication
2.
a. prophylaxis, acute episodes
b. Plaquenil RA, SLE
c. systemic lupus erythematosus
route oral, IM
3.
side effects
4.
a. visual disturbances
blurred vision, difficulty reading
i.
*corneal opacities cataracts
ii.
retinopathy irreversible blindness at high doses
iii.
b. pruritis, hair loss, discoloration of skin/nails/mouth, HA
c. blood disorders
v.
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D.
E.
mycin
cillin
cef, ceph, kef
ilo, ithro
cycline
oxacin
vir
azole
rif
Study Questions
1.
A patient has been on antibiotics for approximately 4 days and develops a superinfection.
In the nurses explanation to her about superinfections, the nurse tells her that
superinfections develop:
a.
Rarely with the use of single drug therapy.
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b.
c.
d.
2.
The rationale for the administration of prophylactic antibiotic therapy for a patient with
mitral valve prolapse is to prevent:
a.
Rheumatic fever recurrence after surgical treatment.
b.
Cardiovascular collapse during the dental work.
c.
Superinfections in the oral cavity.
d.
Subacute bacterial endocarditis.
3.
Intravenous Garamycin is discontinued, and a patient is sent home with a prescription for
tetracycline. It is crucial for the nurse to tell the patient to:
a.
Take the medication until he or she is feeling better.
b.
Avoid direct sunlight and ultraviolet rays during drug therapy.
c.
Keep the remainder of the medication in case of recurrence of infection.
d.
Take the medication with food and milk to minimize gastrointestinal irritation
4.
5.
Muscular weakness and abdominal distention reflect which of the following side effects
associated with the use of amphotericin B?
a.
Hypokalemia
b.
Hypercalcemia
c.
Leukocytosis
d.
Agranulocytosis
6.
Pyridoxine is often indicated with the use of isoniazid. This concurrent use of Pyridoxine
is to prevent which of the following?
a.
Renal failure
b.
Hepatotoxicity
c.
Metabolic encephalopathy
d.
Peripheral neuritis