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What interventions should the health care professional use when caring for a patient who is taking the antibacterial drug vancomycin (Vancocin)?
- Administer over 1 hr by IV infusion because hypotension and flushing of the face and trunk (red-person syndrome) occur with rapid IV infusion. Follow recommendations for dilution.
- Monitor vital signs during infusion.
- Monitor vancomycin blood levels.
- Determine baseline hearing acuity and monitor for hearing loss during treatment.
- Monitor BUN and creatinine levels because the drug can cause nephrotoxicity.
- Monitor IV infusion for redness and swelling.
- Ensure that the IV is patent during infusion.
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What interventions should the health care professional use when caring for a patient who is taking the cephalosporin drug cephalexin (Keflex)?
- Report bloody stools or watery diarrhea because the drug can cause pseudomembranous colitis.
- Report cephalosporin or penicillin allergy before giving drug.
- Prepare to treat rash/hives with antihistamines, and anaphylaxis with epinephrine and antihistamines.
- Monitor for thrombophlebitis during IV infusion; for occurrence, stop infusion and change IV site.
- Follow recommendations when diluting IV cephalosporins; infuse slowly.
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What interventions should the health care professional use when caring for a patient who is taking the penicillin drugs amoxicillin (Amoxil) and amoxicillin and clavulanic acid (Augmentin)?
- Monitor for gastrointestinal symptoms.
- Report bloody stools or long-term watery diarrhea because the drug can cause pseudomembranous colitis.
- Report candida infections of mouth or vagina.
- Treat candida infections with an antifungal agent.
- Ask about penicillin allergy before first dose.
- Monitor for allergy manifestations, and notify provider.
- For injectable penicillins (IM or IV), keep patient for 30 min after administration, and monitor for allergy.
- Prepare to treat rash or hives with antihistamines, and anaphylaxis with epinephrine and antihistamines.
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What interventions should the health care professional use when caring for a patient who is taking the antimycobacterial drug isoniazid (INH)?
- Report gastrointestinal symptoms.
- Encourage adherence to the drug regimen.
- Monitor levels of liver enzymes throughout therapy because the drug can cause liver damage, including hepatitis, liver failure.
- Report signs of liver damage.
- Administer pyridoxine (vitamin B6) as prescribed for neuropathy (numbness, tingling, pain in the hands or feet).
- Report CNS symptoms (dizziness, ataxia, seizures, psychotic symptoms).
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What interventions should the health care professional use when caring for a patient who is taking the antibacterial drug tetracycline (Sumycin)?
- Give with nondairy foods if nausea, vomiting, diarrhea, or abdominal pain occur.
- Report gastrointestinal symptoms (decreased dose may be required).
- Determine whether patient could be pregnant before giving to women of childbearing age because the drug permanently discolors deciduous teeth of fetus (after fourth month of gestation).
- Monitor liver function tests.
- Monitor for symptoms of liver damage.
- Monitor for signs of suprainfection.
- Monitor for skin reactions because the drug can cause photosensitivity
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What interventions should the health care professional use when caring for a patient who is taking the antimycobacterial drug rifampin (Rifadin)?
- Monitor liver enzyme levels throughout therapy because the drug can cause liver toxicity.
- Report symptoms of hepatitis.
- Monitor for red-orange discoloration of body fluids (urine, saliva, tears, sweat), a harmless effect.
- Observe for presence of soft contact lenses.
- Report persistent gastrointestinal symptoms.
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What interventions should the health care professional use when caring for a patient who is taking the sulfonamide drug trimethoprim and sulfamethoxazole (Bactrim, Septra)?
- Report severe gastrointestinal symptoms.
- Monitor for rash and hives.
- Report symptoms of blood cell deficiencies (thrombocytopenia, leukopenia, anemia).
- Report severe diarrhea or candida infection.
- Report rash and/or blisters because the drug can cause Stevens-Johnson syndrome.
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What interventions should the health care professional use when caring for a patient who is taking the antiparasitic drug metronidazole (Flagyl)?
- Report severe gastrointestinal symptoms.
- Report CNS symptoms; discontinue for seizure or neuropathy.
- Advise patient to expect dark urine (a harmless effect).
- Report candida infection in vagina or in mouth/throat.
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What interventions should the health care professional use when caring for a patient who is taking the antiviral drug acyclovir (Zovirax)?
- Report severe skin reactions.
- Report severe gastrointestinal symptoms, headache, or vertigo.
- Monitor BUN, creatinine levels because the drug can cause renal toxicity.
- Infuse IV form slowly; hydrate patient during and for 2 hr following infusion to maintain urine output.
- Report restlessness, tremors, psychosis, seizures.
- Carefully monitor IV during infusion because infiltration can cause tissue damage.
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What interventions should the health care professional use when caring for a patient who is taking the monobactam drug aztreonam (Azactam)?
- Monitor site for redness, swelling, or pain.
- Change IV sites if inflammation occurs.
- Monitor for and report candida infections of mouth or vagina.
- Expect to treat candida infections with an antifungal agent.
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What interventions should the health care professional use when caring for a patient who is taking the urinary tract antiseptic nitrofurantoin (Macrodantin)?
- Report gastrointestinal symptoms (dose may be reduced or form of drug may be changed to minimize symptoms).
- Report respiratory symptoms (drug will be discontinued).
- Report symptoms of neuropathy.
- Monitor laboratory values of blood components because the drug can cause blood cell dysfunction (anemia, including macrocytic anemia, thrombocytopenia, neutropenia).
- To prevent staining, do not crush capsules; dilute suspension in milk or juice before administration; instruct patient to rinse mouth if taking suspension.
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What interventions should the health care professional use when caring for a patient who is taking the antiparasitic drug chloroquine (Aralen)?
- Report any visual symptoms (blurred vision, photophobia).
- Report severe gastrointestinal symptoms.
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What interventions should the health care professional use when caring for a patient who is taking the fluoroquinolone drug ciprofloxacin (Cipro)?
- Report CNS symptoms (dizziness, headache; confusion in an older adult).
- Report gastrointestinal symptoms (a decrease in dose may be needed).
- Report tendon pain because the drug can cause Achilles tendon rupture (discontinue if pain occurs).
- Advise patients to protect skin from sun exposure with clothing and sunscreen.
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What interventions should the health care professional use when caring for a patient who is taking the polyene antibiotic drug amphotericin B (Fungizone)?
- Administer prescribed diphenhydramine (Benadryl) and acetaminophen (Tylenol) before beginning infusion to prevent infusion reactions.
- Monitor vital signs and for symptoms during infusion.
- Monitor BUN, creatinine, blood potassium every few days during treatment, and notify provider for abnormal value because the drug can cause renal toxicity.
- Monitor weight, and intake and output; notify provider of low output and weight changes.
- Monitor Hct, CBC, and notify provider for falling values because the drug can cause anemia.
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What interventions should the health care professional use when caring for a patient who is taking the aminoglycoside drug Gentamicin (Garamycin)?
- Report tinnitus and other symptoms of early ototoxicity.
- Monitor peak and trough blood levels.
- Monitor laboratory values (BUN, creatinine, urine for protein, casts) and report elevations because the drug can cause nephrotoxicity (polyuria, dilute urine, protein and casts in urine, elevated BUN, creatinine).
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What interventions should the health care professional use when caring for a patient who is taking the azole drug ketoconazole (Nizoral)?
- Report changes in liver function tests during treatment.
- Report severe gastrointestinal symptoms.
- Report CNS effects (dizziness, drowsiness).
- Report hormonal symptoms (gynecomastia, decreased libido, low sperm counts, menstrual irregularities).
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What interventions should the health care professional use when caring for a patient who is taking the macrolide drug erythromycin (E-Mycin)?
- Report gastrointestinal reactions (a decrease in the dose may stop symptoms).
- Monitor for concurrent use of other drugs that increase erythromycin blood levels.
- Question patient about history of prolonged QT because the drug can cause ventricular dysrhythmias.
- Report signs of ototoxicity (hearing loss, vertigo and tinnitus).
- Report suprainfection.
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What interventions should the health care professional use when caring for a patient who is taking the carbapenem drug imipenem (Primaxin)?
- Follow recommended rate when infusing IV form.
- Monitor for nausea during infusion; treat with antiemetic.
- Monitor IV site for redness and swelling during infusion.
- Assess for and report antibiotic allergy prior to infusing imipenem.
- Monitor for secondary infections, such as oral candidiasis
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