Antimicrobial Drugs

M34_ADAM9811_03_SE_CH34.QXD 12/30/09 1:16 PM Page 496
496 Unit 5 The Immune System
NURSING PROCESS FOCUS
PATIENTS RECEIVING ANTIBACTERIAL THERAPY
Assessment
Potential Nursing Diagnoses
Baseline assessment prior to administration:
■ Understand the reason the drug has been prescribed in order to assess for
therapeutic effects.
■ Obtain a complete health history including neurologic, cardiovascular, respiratory,
hepatic or renal disease, and the possibility of pregnancy. Obtain a drug history
including allergies, including specific reactions to drugs, current prescription and
OTC drugs, herbal preparations, and alcohol use. Be alert to possible drug
interactions.
■ Assess signs and symptoms of current infection noting location, characteristics,
presence or absence of drainage and character of drainage, duration, and
presence or absence of fever or pain.
■ Evaluate appropriate laboratory findings (e.g., CBC, C&S, hepatic and renal
function studies).
Assessment throughout administration:
■ Assess for desired therapeutic effects (e.g., diminished signs and symptoms of
infection and fever).
■ Continue periodic monitoring of CBC, hepatic and renal function, urinalysis, C&S,
peak and trough drug levels.
■ Assess for adverse effects: nausea, vomiting, abdominal cramping, diarrhea,
drowsiness, dizziness, and photosensitivity. Severe diarrhea, especially containing
mucus, blood, or pus; yellowing of sclera or skin; and decreased urine output or
darkened urine should be reported immediately.
Planning: Patient Goals and Expected Outcomes
The patient will:
■ Experience therapeutic effects (e.g., diminished signs and symptoms of infection, decreased fever).
■ Be free from, or experience minimal, adverse effects.
■ Verbalize an understanding of the drug’s use, adverse effects, and required precautions.
■ Demonstrate proper self-administration of the medication (e.g., dose, timing, when to notify provider).
Interventions and (Rationales)
Ensuring therapeutic effects:
■ Continue assessments as described earlier for therapeutic effects. (Diminished
fever, pain, or signs and symptoms of infection should begin after taking the first
dose and continue to improve.The health care provider should be notified if fever
and signs of infection remain after 3 days or if entire course of the drug has been
taken and signs of infection are still present.)
Minimizing adverse effects:
■ Continue to monitor vital signs. Immediately report undiminished fever, changes
in level of consciousness (LOC), or febrile seizures to the health care provider.
(Fever should begin to diminish within 1 to 3 days after starting the drug. A
continued fever may be a sign of worsening infection, adverse drug effects, or
antibiotic resistance.)
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Continue to monitor periodic lab work: hepatic and renal function tests, CBC,
urinalysis, C&S, and peak and trough drug levels. (Many antibacterials are hepatic
and/or renal toxic. Periodic C&S tests may be ordered if infections are severe or
are slow to resolve to confirm appropriate therapy. Drug levels will be monitored
with drugs with known severe adverse effects.)
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Infection
Pain (related to infection)
Hyperthermia
Deficient Knowledge (drug therapy)
Risk for Injury (related to adverse drug effects)
Risk for Deficient Fluid Volume (related to fever, diarrhea caused by
adverse drug effects)
Risk for Noncompliance (related to adverse drug effects, deficient
knowledge, or cost of medication)
Implementation
Patient and Family Education
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Teach the patient to report a fever that does not diminish below
100°F within 3 days; increasing signs and symptoms of infection; or
symptoms that remain present after taking the entire course of the
drug.
Teach the patient to not stop antibacterial when “feeling better” but
to take the entire course of antibacterial; do not share doses with
other family members with similar symptoms; and return to the
health care provider if symptoms have not resolved after entire
course of therapy.
Teach the patient to immediately report a fever that does not
diminish below 100°F; febrile seizures; and changes in behavior or
LOC to the health care provider.
Instruct the patient on the need for periodic lab work.
# 102887 Cust: PE/NJ/CHET Au: ADAMS Pg. No. 496
Title: Pharmacology for Nurses Server: Jobs2
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