Antimicrobial Drugs

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M34_ADAM9811_03_SE_CH34.QXD 12/30/09 1:16 PM Page 503 NURSING PROCESS FOCUS Interventions and (Rationales) ■ ■ ■ ■ ■ ■ Continue to monitor for hepatic, renal, and/or ototoxicity. (Antituberculosis drugs that are hepatic, renal, or ototoxic require frequent monitoring to prevent adverse effects. Increasing fluid intake will prevent drug accumulation in kidneys.) Monitor for signs and symptoms of neurotoxicity, particularly peripheral and optic neuropathy. (Neurotoxicity and peripheral neuritis are adverse effects of antituberculosis drugs.Vitamin B 6 may be ordered to decrease the risk of peripheral neuropathy.) Monitor blood glucose in patients taking isoniazid. (Isoniazid may increase glucose levels. Diabetic patients may require a change in their antidiabetic drug routine.) Monitor dietary routine in patients taking isoniazid. (Foods high in tyramine can interact with the drug and cause palpitations, flushing, and hypertension.) Patients taking rifampin should be cautioned that drug may turn body fluids (tears, sweat, saliva, urine) reddish-orange. (Effect is harmless but may stain soft, hydrophilic contact lenses or clothing.) Encourage infection control measures based on the extent of disease condition, and follow established protocol in hospitalized patients. (Infection control measures prevent disease transmission. Specific isolation precautions or use of specialized masks may be required for hospitalized patient.) Patient understanding of drug therapy: ■ Use opportunities during administration of medications and during assessments to discuss rationale for drug therapy, desired therapeutic outcomes, most commonly observed 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 will increase the effectiveness of the drug.) Chapter 34 <strong>Drugs</strong> for Bacterial Infections 503 PATIENTS RECEIVING ANTITUBERCULOSIS DRUGS (Continued) Implementation Evaluation of Outcome Criteria Patient Education/Discharge Planning ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Teach the patient to report any nausea, vomiting, yellowing of skin or sclera, abdominal pain, light or clay-colored stools, diminished urine output, darkening of urine, ringing, humming, or buzzing in ears, and dizziness or vertigo immediately. Advise the patient to increase fluid intake to 2 to 3 L per day and to eliminate all alcohol use. Instruct the patient to report drowsiness, dizziness, numbness or tingling in peripheral extremities, and vision changes. Eye pain, acute blurring of vision or loss of color sense, and sudden or increasing numbness or tingling in extremities should be reported immediately. Encourage the patient to increase the intake of vitamin B 6 rich foods (e.g., fortified cereals, baked potato with skin on, bananas, lean meats, garbanzo beans) and discuss vitamin B 6 supplements with the health care provider. Teach the diabetic patient to test glucose more frequently, reporting any consistent elevations to the health care provider. Advise the patient taking isoniazid to avoid foods containing tyramine, such as aged cheese, smoked and pickled fish, beer and red wine, bananas, and chocolate and to report headache, palpitations, tachycardia, or fever immediately. Teach the patient to consult with the eye care provider before using hydrophilic contact lenses. Consider wearing nonwhite clothing or use undergarments if sweating is excessive. Teach the patient adequate infection control and hygiene measures such as frequent hand washing, covering the mouth when coughing or sneezing, and proper disposal of soiled tissues. 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. The duration of the required therapy may be quite lengthy but it is necessary to prevent active infection. ■ Eliminate alcohol while on these medications.These drugs cause significant reactions when taken with alcohol. ■ 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. ■ Increase overall fluid intake while taking these drugs. Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”). See Table 34.10 for a list of drugs to which these nursing actions apply. # 102887 Cust: PE/NJ/CHET Au: ADAMS Pg. No. 503 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 504 504 Unit 5 The Immune System KEY CONCEPTS Chapter REVIEW The numbered key concepts provide a succinct summary of the important points from the corresponding numbered section within the chapter. If any of these points are not clear, refer to the numbered section within the chapter for review. 34.1 Pathogens are organisms that cause disease due to their ability to divide rapidly or secrete toxins. 34.2 Bacteria are described by their shape (bacilli, cocci, or spirilla), their ability to utilize oxygen (aerobic or anaerobic), and by their staining characteristics (gram positive or gram negative). 34.3 Anti-infective drugs are classified by their chemical structures (e.g., aminoglycoside, fluoroquinolone) or by their mechanism of action (e.g., cell-wall inhibitor, folic acid inhibitor). 34.4 Anti-infective drugs act by affecting the target organism’s unique structure, metabolism, or life cycle and may be bacteriocidal or bacteriostatic. 34.5 Acquired resistance occurs when a pathogen acquires a gene for bacterial resistance, either through mutation or from another microbe. Resistance results in loss of antibiotic effectiveness and is worsened by the overprescribing of these agents. 34.6 Careful selection of the correct antibiotic, through the use of culture and sensitivity testing, is essential for effective pharmacotherapy and to limit adverse effects. Superinfections may occur during antibiotic therapy if too many host flora are killed. 34.7 Host factors such as immune system status, local conditions at the infection site, allergic reactions, age, and genetics influence the choice of antibiotic. 34.8 Penicillins, which kill bacteria by disrupting the cell wall, are most effective against gram-positive bacteria. Allergies occur most frequently with the penicillins. 34.9 The cephalosporins are similar in structure and function to the penicillins and are one of the most widely prescribed anti-infective classes. Cross sensitivity may exist with the penicillins in some patients. 34.10 Tetracyclines have some of the broadest spectrums of any antibiotic class. They are drugs of choice for Rocky Mountain spotted fever, typhus, cholera, Lyme disease, peptic ulcers caused by Helicobacter pylori, and chlamydial infections. 34.11 The macrolides are safe alternatives to penicillin. They are effective against most gram-positive bacteria and many gram-negative species. 34.12 The aminoglycosides are narrow-spectrum drugs, most commonly prescribed for infections by aerobic, gramnegative bacteria. They have the potential to cause serious adverse effects such as ototoxicity, nephrotoxicity, and neuromuscular blockade. 34.13 The use of fluoroquinolones has expanded far beyond their initial role in treating urinary tract infections. All fluoroquinolones have activity against gram-negative pathogens, and newer drugs in the class have activity against gram-positive microbes. 34.14 Resistance has limited the usefulness of once widely prescribed sulfonamides to urinary tract infections and a few other specific infections. 34.15 A number of miscellaneous antibacterials have specific indications, distinct antibacterial mechanisms, and related nursing care. 34.16 Multiple drug therapies are needed in the treatment of tuberculosis, since the complex microbes are slow growing and commonly develop drug resistance. NCLEX-RN® REVIEW QUESTIONS 1 Superinfections are an adverse effect common to all antibiotic therapy. The best description of a superinfection is: 1. an initial infection so overwhelming that it requires multiple antimicrobial agents to treat successfully. 2. bacterial resistance that creates infections difficult to treat and often resistant to multiple drugs. 3. infections requiring high-dose antimicrobial therapy with increased chance of organ toxicity. 4. the overgrowth of normal body flora or of opportunistic organisms no longer held in check by normal, beneficial flora. 2 A patient has been discharged with a prescription for penicillin. Discharge instructions include that: 1. penicillins can be taken while breast-feeding. 2. the entire prescription must be finished. 3. all penicillins can be taken without regard to eating. 4. some possible side effects include abdominal pain and constipation. # 102887 Cust: PE/NJ/CHET Au: ADAMS Pg. No. 504 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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