Antimicrobial Drugs

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M34_ADAM9811_03_SE_CH34.QXD 12/30/09 1:16 PM Page 497 NURSING PROCESS FOCUS Interventions and (Rationales) ■ ■ Monitor for hypersensitivity and allergic reactions, especially with the first dose of any antibacterial. Continue to monitor for up to 2 weeks after completing antibacterial therapy. (Anaphylactic reactions are possible, particularly with the first dose of an antibacterial. Post-use, residual drug levels, dependent on length of half-life, may cause delayed reactions.) Continue to monitor for hepatic, renal, and/or ototoxicity. (Antibacterials that are hepatic, renal, or ototoxic require frequent monitoring to prevent adverse effects. Increasing fluid intake will prevent drug accumulation in kidneys.) PATIENTS RECEIVING ANTIBACTERIAL THERAPY (Continued) Implementation Patient and Family Education ■ ■ ■ ■ Chapter 34 <strong>Drugs</strong> for Bacterial Infections 497 Teach the patient to immediately report any itching; rashes; swelling, particularly of face, tongue, or lips; urticaria; flushing; dizziness; syncope; wheezing; throat tightness; or difficulty breathing. Instruct the patient with known antibacterial allergies to carry a wallet identification card or wear medical identification jewelry indicating allergy. Teach the patient to immediately report any nausea; vomiting; yellowing of skin or sclera; abdominal pain; light or clay-colored stools; diminished urine output or darkening of urine; ringing, humming, or buzzing in ears; and dizziness or vertigo. Advise the patient to increase fluid intake to 2 to 3 L per day. ■ ■ ■ ■ ■ ■ Continue to monitor for dermatologic effects including red or purplish skin rash, blisters, and sunburning. Immediately report severe rashes, especially associated with blistering. (Tetracyclines, sulfonamides, and fluoroquinolones may cause significant dermatologic effects including Stevens–Johnson syndrome. Sunscreens and protective clothing should be used for antibacterials that cause photosensitivity.) Monitor for severe diarrhea. (Severe diarrhea may indicate the presence of antibiotic-associated pseudomembranous colitis, or AAPMC, a superinfection caused by Clostridium difficile.) Monitor for development of superinfections, e.g., AAPMC, or fungal or yeast infections. (Superinfections with opportunistic organisms may occur when normal host flora are diminished or killed by the antibacterial.) Monitor for significant GI effects, including nausea, vomiting, and abdominal pain or cramping. Give the drug with food or milk to decrease adverse GI effects. (Many antibiotics are associated with significant GI effects. Food or milk may impair absorption of some antibiotics such as macrolides, but if patient compliance with drug regimen can be ensured with lessened GI effects, give with a snack and continue to monitor for therapeutic effects.) Monitor for signs and symptoms of neurotoxicity, e.g., dizziness, drowsiness, severe headache, changes in LOC, and seizures. (Penicillins, cephalosporins, sulfonamides, aminoglycosides, and fluoroquinolones have an increased risk of neurotoxicity. Previous seizure disorders or head injuries may increase this risk.) Monitor for signs and symptoms of blood dyscrasias, e.g., low-grade fevers, bleeding, bruising, and significant fatigue. (Penicillins, aminoglycosides, and fluoroquinolones may cause blood dyscrasias with resulting decreases in RBCs, WBCs, and/or platelets. Periodic monitoring of CBC may be required.) ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Teach the patient to wear sunscreens and protective clothing for sun exposure and to avoid tanning beds. Immediately report any severe sunburn or rashes. Instruct the patient to report any diarrhea that increases in frequency, amount, or contains mucus, blood, or pus. Instruct the patient to consult the health care provider before taking antidiarrheal drugs, which could cause retention of harmful bacteria. Teach the patient to increase the intake of dairy products with live active cultures such as kefir, yogurt, or buttermilk, to help restore and maintain normal intestinal flora. Teach the patient to observe for changes in stool, white patches in mouth, whitish thick vaginal discharge, itching in urogenital area, blistering itchy rash, and to immediately report severe diarrhea as described earlier. Teach the patient infection control measures such as frequent hand washing, allowing for adequate drying after bathing, and to increase intake of live-culture–rich dairy foods. Teach the patient to take drug with food or milk but to avoid acidic foods and beverages or carbonated drinks. Teach the patient to observe for continuing signs of improvement in infection. Instruct the patient to immediately report increasing headache, dizziness, drowsiness, changes in behavior or LOC, or seizures. Caution the patient that drowsiness may occur and to be cautious with driving or other activities requiring mental alertness until the effects of the drug are known. Teach the patient to report any low-grade fever, sore throat, rashes, bruising or increased bleeding, and unusual fatigue or shortness of breath, especially after taking an antibiotic for a prolonged period. (Continued) # 102887 Cust: PE/NJ/CHET Au: ADAMS Pg. No. 497 Title: Pharmacology for Nurses Server: Jobs2 C/M/Y/K Short / Normal DESIGN SERVICES OF S4CARLISLE Publishing Services
M34_ADAM9811_03_SE_CH34.QXD 12/30/09 1:16 PM Page 498 498 Unit 5 The Immune System NURSING PROCESS FOCUS Interventions and (Rationales) ■ ■ ■ ■ ■ Monitor for development of red-man syndrome in patients receiving vancomycin. Report any significantly large area of reddening such as trunk, head or neck, limbs, or gluteal area especially if associated with decreased blood pressure or tachycardia. (Vancomycin hypersensitivity may cause the release of large amounts of histamine. If a significant area is involved, vasodilation from histamine may cause hypotension and reflex tachycardia. Giving IV drip more slowly may prevent or decrease the effects of the syndrome.) Monitor electrolytes, pulse, and ECG if indicated in patients on penicillins. (Some preparations of penicillin may be based in sodium or potassium salts and may cause hypernatremia and hyperkalemia.) Monitor patients on fluoroquinolones for leg or heel pain, or difficulty walking. (Fluoroquinolones have been associated with tendinitis and tendon rupture, especially of the Achilles tendon.) Assess for the possibility of pregnancy or breast-feeding in patients prescribed tetracycline antibiotics. (Tetracyclines affect fetal bone growth and teeth development, causing permanent yellowish-brown staining of teeth.) Women of child-bearing age taking penicillin antibiotics should use an alternative form of birth control to prevent pregnancy. (Penicillins may reduce the effectiveness of oral contraceptives.) Patient understanding of drug therapy: ■ Use opportunities during administration of medications and during assessments to discuss the rationale for drug therapy, desired therapeutic outcomes, most common adverse effects, parameters for when to call the health care provider, and any necessary monitoring or precautions. (Using time during nursing care helps to optimize and reinforce key teaching areas.) Patient self-administration of drug therapy: ■ When administering medications, instruct the patient and/or family/caregiver in proper self-administration techniques followed by return demonstration. (Proper administration increases the effectiveness of the drug.) PATIENTS RECEIVING ANTIBACTERIAL THERAPY (Continued) Implementation Evaluation of Outcome Criteria Patient and Family Education ■ ■ ■ ■ ■ ■ ■ Instruct the patient to immediately report unusual flushing, especially involving a large body area; dizziness; dyspnea; or palpitations. Teach the patient to promptly report any palpitations or dizziness. Instruct the patient to immediately report any significant or increasing heel, lower leg or calf pain, or difficulty walking to the provider. Advise women who are pregnant, breast-feeding, or attempting to become pregnant to advise their health care provider before receiving any tetracycline antibiotic. Teach women of child-bearing age on oral contraceptives to consult their health care provider about birth control alternatives if penicillin antibiotics are used. The patient and/or family/caregiver should be able to state the reason for the drug; appropriate dose and scheduling; what adverse effects to observe for and when to report; and the anticipated length of medication therapy. Teach the patient to take the medication as follows: ■ Complete the entire course of therapy unless otherwise instructed. ■ Avoid or eliminate alcohol. Some antibiotics (e.g., cephalosporins) cause significant reactions when taken with alcohol and alcohol increases adverse GI effects of the antibacterial. ■ Take the drug with food or milk but avoid acidic beverages. If instructed to take the drug on an empty stomach, take with a full glass of water. ■ Take the medication as evenly spaced throughout each day as feasible. ■ Do not take tetracycline with milk products, iron-containing preparations such as multivitamins, or with antacids. ■ Increase overall fluid intake while taking the antibacterial drug. ■ Discard outdated medications or those no longer in use. Review medicine cabinet twice a year for old medications. Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). See Tables 34.2 through 34.9 for lists of drugs to which these nursing actions apply. # 102887 Cust: PE/NJ/CHET Au: ADAMS Pg. No. 498 Title: Pharmacology for Nurses Server: Jobs2 C/M/Y/K Short / Normal DESIGN SERVICES OF S4CARLISLE Publishing Services
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Antimicrobial Drugs

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