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  1. Know all key terms for these chapters.
    • • Resistance to antibacterials -natural/inherent resistance, acquired resistance, nosocomial infections, cross-resistance, MRSA, VRSA, VREF
    • •
  2. What are Staphylococci?
    - clusters of cocci (grape-like shape)•
  3. Bacteriostatic
    – drug inhibiting the growth of bacteria•
  4. Bactericidal drug-
    kill bacteria•
  5. What are Streptococci? -
    chains of cocci•
  6. What’s the term for tolerance to anti-bacterial drugs after being exposed to drugs with similar actions-
    cross resistance•
  7. What would you call drugs that inhibit the growth of bacteria? -
  8. What is the first penicillinase resistant penicillin?
    -methicillin (staphillin)•
  9. What is caused by prior exposure to antibacterial? -
    acquired resistance•
  10. Antibody proteins such as IgG and IgM are?
    - Immunoglobulins•
  11. Bacterial resistance that may occur naturally-
    natural resistance•
  12. Infections acquired when in a health care facility-
    nosocomial infection•
  13. Toxicity of drugs in the kidneys-
  14. Should be checked before administration of antibiotics-
    culture and sensitivity•
  15. Occurrence of a secondary infection when the flora of the body are disturbed -
  16. Substances that inhibit bacterial growth or kill bacteria-
  17. Narrow spectrum antibiotics-
    selective target, primarily against one bacterial type•
  18. Broad-spectrum antibiotics -
    effective against gram-positive and gram-negative. The go to when you don't know what someone has•
  19. Some body defenses are:
    age, nutrition, immunoglobin levels, circulation, and organ function
  20. Explain how normal flora protects the human host.
    • A diverse microbial flora is associated with the skin and mucous membranes of every human - normal microbial flora. The normal microbial flora is relatively stable, with specific genera populating various body regions during particular periods in an individual's life. Microorganisms of the normal flora may aid the host (by competing for microenvironments more effectively than such pathogens as Salmonella spp or by producing nutrients the host can use), may harm the host (by causing dental caries, abscesses, or other infectious diseases), or may exist as commensals (inhabiting the host for long periods without causing detectable harm or benefit). Even though most elements of the normal microbial flora inhabiting the human skin, nails, eyes, oropharynx, genitalia, and gastrointestinal tract are harmless in healthy individuals, these organisms frequently cause disease in compromised hosts. Viruses and parasites are not considered members of the normal microbial flora and protection against bad microbes through exclusion and production of bactericidal compounds.
    • Some examples of bactericidal compounds that are produced by normal flora are bacteriocins, lactic acid, H2O2 (by vaginal lactobacilli)
    • Exclusion is used by normal flora to protect human cells from bad microbes by bind host receptors, take up physical space
  21. Identify several human pathogens.
    • Papillomavirus/papovavirus -Wart, Cervical Cancer
    • Coronavirus/adenovirus -SARS, respiratory infection
    • Herpes Simplex Virus I (herpes virus) - Cold sores, fever blister
    • Herpes Simplex Virus II (herpesvirus) - Venereal Sores
    • Epstein-Barr virus (Herpesvirus) -Infectious mononucleosis
    • Polio Virus (picornavirus) –Polio
    • Rhinovirus (picornavirus) - Common Cold
    • Hepatitis A virus (picornavirus)- Hepatitis A
    • Togavirus/Flavivirus -Yellow Fever, Hepatitis C
    • Influenza (Orthomyxovirus) - Flu
    • Measles (paramyxovirus) - Measles
    • Mumps (paramyxovirus)- Mumps
    • HTLV I (Retrovirus)- Adult T cell Leukemia
    • HIV-I (retrovirus) -AIDS
    • Retrovirus -Infantile Gastroenteritis
    • Hepadnavirus-Hepatitis B
    • Treponema pallidum (spirochetes)- Syphilis
    • Borrelia burgdorferi (spirochetes)- Lyme Disease
    • Pseudomonas aeroginosa (gram negative aerobic cocci) abscesses, septicemia
    • Salmonella (gram negative facultatively anaerobic)- Food poisoning
    • Vibrio cholerae (gram negative facultatively anaerobic) - Cholera
    • Hemophilus influenzae (gram negative facultatively anaerobic) meningitis, bronchitis
    • Helicobacter pylori (gram negative facultatively anaerobic) - Ulcers
    • Rickettsia rickettsii (rickettsias) - Rock Mountain Spotted Fever
  22. Explain what clients are most likely to get an "opportunistic" infection
    • In our bodies, we carry many germs – bacteria, protozoa, fungi, and viruses. When our immune system is working, it controls these germs. But when the immune system is weakened by disease or by some medications, these germs can get out of control and cause health problems. Infections that take advantage of weakness in the immune defenses are called “opportunistic”. A compromised immune system, however, presents an "opportunity" for the pathogen to infect. Immunodeficiency or immunosuppression can be caused by:
    • • Malnutrition
    • • Fatigue
    • • Recurrent infections
    • • Immunosuppressing agents for organ transplant recipients
    • • Advanced HIV infection
    • • Chemotherapy for cancer
    • • Genetic predisposition
    • • Skin damage
    • • Antibiotic treatment leading to disruption of the physiological microbiome, thus allowing some microorganisms to outcompete others and become pathogenic (e.g. disruption of intestinal flora may lead to Clostridium difficile infection, disruption of vaginal flora may lead to Candida infection)
    • • Medical procedures
    • • Pregnancy
    • • Ageing
    • • Leukopenia (i.e. neutropenia and lymphocytopenia)
  23. Why are there so many bacteria that are resistant to the effects of antibiotics?
    • Antibiotic use promotes development of antibiotic-resistant bacteria. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria. Antibiotics should be used to treat bacterial infections, they are not effective against viral infections like the common cold, most sore throats, and the flu. Widespread use of antibiotics promotes the spread of antibiotic resistance. Smart use of antibiotics is the key to controlling the spread of resistance.
    • Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm. Bacteria can do this through several mechanisms. The use of antimicrobial drugs will result in the development of resistant strains of bacteria, complicating clinicians' efforts to select the appropriate antimicrobial for treatment.
    • Drug Resistance is acquired through mutation, conjugation between DNA (learn what is fighting them)
  24. How can the nurse contribute to the prevention of the spread of microorganisms in the hospital setting?
    • Nurses have the unique opportunity to directly reduce health care– associated infections through recognizing and applying evidence-based procedures to prevent HAIs among patients and protecting the health of the staff. Nurses performing, monitoring, and assuring compliance with aseptic practices; providing environmental decontamination to prevent transmission of microorganisms from patient to patient; and serve as the primary resource to identify and refer ill visitors or staff:
    • Hand hygiene promotion should be an institutional priority.
    • Use EPA-registered chemical germicides for standard cleaning and disinfection of medical equipment that comes into contact with more than one patient.

    • -If Clostridium difficile infection has been documented, use hypochlorite-based products for surface disinfection as no EPA-registered products are specific for inactivating the spore form of the organism.
    • -Ensure compliance by housekeeping staff with cleaning and disinfection procedures, particularly high-touch surfaces in patient care areas (e.g., bed rails, carts, charts, bedside commodes, doorknobs, or faucet handles).
    • -When contact precautions are indicated for patient care (e.g., MRSA, VRE, C. difficile, abscess, diarrheal disease), use disposable patient care items (e.g., blood pressure cuffs) wherever possible to minimize cross-contamination with multiple drug-resistant microorganisms.
    • -Advise families, visitors, and patients regarding the importance of hand hygiene to minimize the spread of body substance contamination (e.g., respiratory secretions or fecal matter) to surfaces.
  25. Identify the therapeutic effects and the adverse effects (Table 29-2) that may occur when treating the client with antimicrobial therapy.
    • -common side effects of Amoxicillin- nausea, vomiting, diarrhea, rash, stomatitis, seizures, colitis, edema, insomnia, and dysphage
    • -common side effects of Dicloxacillin - abdominal pain, flatuence, nausea, vomitting, diarrhea, rash, stomatitis, seizures, colitis
    • -adverse reactions of Amoxicillin and Diocloxacillin - Superinfections, blood problems, steven-johnson syndrome
    • - Amoxicillin adverse affect- Respiratory distress
    • - Dicloxacillin adverse affect - liver toxicity
  26. Define bacteriostatic and bactericidal.
    • Bacteriostatic – drug inhibit the growth of bacteria
    • Bactericidal drug- kill bacteria
  27. What are the indications for penicillin use? What are the indications for amoxicillin and ampicillin? Contraindications? Therapeutic effects? Side Effects? Adverse Reactions?
    Penicillin: Penicillin is bactericidal, cheap, old, effective, resistance is high, allergy common, MRSA, great for strep
  28. What to look for during a Penicillin assessment: asses for allergies to PCN or Cephalosporin
    • Evaluate culture and sensitivity along with liver testing
    • Record urine output in case drug dose needs to change
    • Penicillin Risks- infection related to invasion of bacteria via surgical incision, impaired skin related to rash, females careful with BC
    • Penicillin Diet when taking it: take meds with food to avoid gastric upset.
    • Penicillin evaluation of therapy? fever, pain, inflammation down. Better appetite, sense of wellbeing, and better WBC
    • Penicillin drug interactions- decrease oral contraceptives, K supplements increase serum K when taken with PCN G/V. When mixed with aminoglycoside in IV antagonistic.
  29. Drugs that weaken the cell wall are?
    Penicillin, cause bacteria to take up excessive water and lysis.
  30. What do penicillin derive from?
    • mold/fungus often seen on fruit or bread. active against wider variety of bacteria.
    • Allergies most common with Penicillin- Steven-Johnson Syndrome, and Angioedema.
  31. Penicillin allergies occur in what three forms?
    Immediate (2-30min), accelerated (1-72hrs), and Late (days-weeks)
  32. PCN G and Amox. can be giving via what routes?
    IM but mostly PO q 6-8hrs
  33. Basic penicillin;
    penicillin G
  34. What are two Broad spectrum penicillin's?
    amoxicillin (amoxil) and ampicillin (Omnipen)
  35. Examples of a Penicillinase (resistant penicillins) are?
    • nafcillin and oxcillin
    • Extended - spectrum penicillins; geocillin, zosyn, and timentin
    • Amoxicillin: -broad -spectrum penicillin, work on gram - and + bacteria.
  36. What are common side effects of Amoxicillin?
    nausea, vomitting, diarrhea, rash, stomatitis, seizures, colitis, edema, insomnia, and dysphagia
  37. What are common side effects of Dicloxacillin (penicillinase-resistant penicillin, use for penicillin-resistant staph in bone, joint, skin)?
    abdominal pain, flatuence, nausea, vomitting, diarrhea, rash, stomatitis, seizures, colitis
  38. What are adverse reactions of Amoxicillin and Diocloxacillin?
    Superinfections, blood problems, steven-johnson syndrome, blood dyscrasias, thrombocytopenia, neutropenia, hemolytic anemia, bone marrow depresion
  39. Amoxicillin adverse affect?
    Respiratory distress
  40. Dicloxacillin adverse affect?
    liver toxicity
  41. Cephalosporin Orally administered cephalosporin include:
    Keflex, duricef, ceclor, ceftin, zinacef, ominicef, and cedax
  42. Cephalosporin side/adverse effects include:
    GI disturbances, alteration in blood clotting time, nephrotoxicity.
  43. What to look for during a cephalosporin Assessment:
    • allergy to Cephalosporin or PCN,
    • vital signs and urine output (high temp/decreased urine)
    • renal/liver failure
  44. Cephalosporin Risks-
    impaired skin/rash, infection related to invasive procedure, noncompliance to drug regimens
  45. Cephalosporin Diet -
    take with medication and advise extra fluids
  46. Cephalosporin drug interactions include-
    • alcohol, increase rate of uric acid
    • cephalosporins similar to PCN, bactericidal, safe/effective, broad spectrum, allergy common (cross with PCN), bleeding issues, Rocephin 3rd gen, hepatic excretion BIG GUN
  47. Do cephelosporins work with gram neg or gram pos?
  48. Cephalexin (Keflex) route, gen, uses?
    PO, 1st, Uncomplicated post-op wound infections, and non-systemic infections (Bug bite). Hasn't spread
  49. First generation Cephalosporin?
    destroyed by beta-lactamases, ancef
  50. Second generation Cephalosporin?
    broader against gram neg then the rest cefaclor
  51. Third generation Cephalosporin?
    less effective against gram poss cefdinir
  52. Fourth generation Cephalosporin?
    broader against gram poss than the 3rd gen. cefepime
  53. Why would the prescriber use a beta-lactamase inhibitor?
    Prevents the breakdown of amoxicillin by creating resistance to drug. Beta Lactamase Inhibitors are combination drugs to widen the spectrum, penicillin with beta lactamase enzyme inhibitors augments (adds to) the action of the antibiotic.
  54. When you compare penicillins to cephalosporins, why would cephalosporin be used????
  55. What are the most important nursing actions related to the delivery of penicillins and cephalosporins?
    • Assessment. Before initiating therapy, obtain a history reactions to penicillins or cephalosporins
    • Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy. Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results. Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing).. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction.
    • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy. Assess patient for skin rash frequently during therapy. Discontinue at first sign of rash; may be life-threatening.
    • Teaching- Pt. to report signs of superinfection (mouth ulcers, discharge from anal or genital area)
    • -Pt. to ingest buttermilk, yogurt to prevent superinfection of intestinal flora
    • - finish course completely, even symptoms have ceased
    • - infuse IV cephalosporin over 30 min to prevent pain and irritation
    • - observe for hypersensitivity reactions
    • - observe for allergy specially after 2-3 dose
    • - take with food, drink a lot of fluids
    • - additional form of birth control(PNC)
    • - wear allergic bracele
  56. List several adverse effects of beta-lactamase:-toxicity with other highly protein-bound drug
    Beta-Lactam should be decreased when - If kidney function/ urinary output are slowed, excreted via kidney, assess renal function (BUN, serum creatinine), severe allergic reaction-anaphylactic shock- close monitoring during administration.
  57. What are the indications for cefazolin -
    • First generation Cephalosporin, destroyed by beta-lactamases, (Ancef) for infections:
    • otitis media, skin, bone, respiratory or urinary tract
    • Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins.
    • Side Effects CNS: SEIZURES (HIGH DOSES). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, cramps. Derm: STEVENS-JOHNSON SYNDROME, rash, pruritis, urticaria. Hemat: leukopenia, neutropenia, thrombocytopenia. Local: pain at IM site, phlebitis at IV site. Misc: allergic reactions including anaphylaxis and serum sickness, superinfection.
    • Therapeutic Effects Binds to bacterial cell wall membrane, causing cell death: Bactericidal action against susceptible bacteria.
    • Cefaclor Second generation Cephalosporin, broader against gram neg than the rest, effective against gram-negative organisms, except PSEUDOMONAS AERUGINOSA, for respiratory, urinary, bone, joint, skin infections, otitis media, prophylaxis surgical infections, septicemia, gonorrhea, e.coli, s.aureus, srep.pneumoniae
    • Contraindications-hypersensitivity to cephalosporin, gallbladder disease, pseudomembranous colitis, bleeding, receiving calcium salts IV
    • Therapeutic effects-inhibit of bacteria cell wall synthesis, bactericidal effect
    • Side Effects- anorexia, nausea, vomiting, diarrhea, flatulence, rash, flushing, diaphoresis, dyspepsia, abdominal cramps, fever, pruritus, headache, dizziness, vertigo, edema, weakness.
    • Adverse Reactions- superinfections, bleeding, epistaxis, angioedema, palpitations, biliary obstructions, cholelithiasis , jaundice, hematuria. Life-threatening- seizures, anaphylaxis, agranulocytosis, aplastic anemia, hemolytic anemia, leukopenia, thrombocytopenia, neutropenia, pancytopenia, Stevens-Johnson syndrome.
  58. What are macrolides active against?
    To treat mild to moderate infections of the respiratory tract, sinuses, gastrointestinal tract, skin, soft tissue, diphtheria, impetigo contagiosa, STIs. Currently available macrolides are erythromycin and the newer agents clarithromycin, azithromycin, roxithromycin, dirithromycin, and telithromycin. Generally, macrolides are active against gram-positive cocci (mainly staphylococci and streptococci) and bacilli, and less against gram-negative bacteria. With the exception of Bordetella pertussis, Campylobacter, Chlamydia, Helicobacter, and Legionella species, gram-negative bacilli are generally resistant to the macrolides. Macrolides are also active against Mycobacteria, Mycoplasma, Ureaplasma, spirochetes, and other organisms. Macrolides inhibits RNA-dependent protein synthesis by reversibly binding to the 50 S ribosomal subunits of susceptible microorganisms.
  59. What is the first macrolide?
    The first macrolide antibiotic, erythromycin, was isolated in 1952 from products produced by Streptomyces erythreus, funguslike bacteria. PO and IV
  60. Why are macrolides, lincosamides, glycopeptides and ketolides similar? What are the uses and considerations for each? (Table 30-1)
    • Macrolides, lincosamides, glycopeptides and ketolides have similar spectrum antibiotic effectiveness as penicillin, but differ in structure, used as penicillin substitute.
    • Macrolides(Zithromax-azithromycin,erythromycin)-for upper and low respiratory tract infect, skin and soft tissue infect. Report persistent diarrhea
    • lincosamides(clindamycin-Cleocin lincomycin)- for serious infect, available in capsules. Take with full glass of water, not affected by food. May cause fatal colitis.
    • Glycopeptides: vancomycn-Vancocin, – for S.aureus-resistent infect and cardiac surgical proflaxis for Pt with PNC allergy. Adverse reactions-vascular collapse, ototoxicity, nephrotoxicty, redneck syndrome
    • telavancin—Vibatin- complicat skin infection, MRSA, Adverse reactions: hearing loss, redneck syndrome, blood dyscrasias.
    • ketolides(telithromycin-Ketek) –community-acquired pneumonia. may be hepatotoxic and worsen myasthenia gravis. PO meds.
  61. What infections would be treated with tetracycline?
    Tetracycline is used to treat many different bacterial infections, such as urinary tract infections, acne, gonorrhea, chlamydia, and others. Tetracycline may also be used for other purposes not listed in this medication guide. Do not use tetracycline if you are pregnant.
  62. Is it likely that a gram-negative organism would be resistant to tetracycline?
    No, it is works for gram-positive and gram-negative, mycobacteria, rickettsiae, spirochetes, chlamydiae. Has bacteriostatic effect.
  63. What situation would be a contraindication to the use of tetracycline?
    • Do not use tetracycline for pregnant women, could cause harm to the unborn baby, including permanent discoloration of the teeth later in life. Tetracycline can make birth control pills less effective. Use a second method of birth control while you are taking this medicine to keep from getting pregnant. Tetracycline passes into breast milk and may affect bone and tooth development in a nursing baby. Do not take this medication without telling your doctor if you are breast-feeding a baby. Do not give this medicine to a child younger than 8 years old. Tetracycline can cause permanent yellowing or graying of the teeth, and it can affect a child's growth.
    • Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Tetracycline can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.
    • Do not take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking tetracycline. These products can make this medicine less effective. Throw away any unused tetracycline when it expires or when it is no longer needed. Do not take this medicine after the expiration date on the label has passed. Expired tetracycline can cause a dangerous syndrome resulting in damage to the kidneys.
  64. What is Azithromycin
    • –Pharmacologic: macrolides. Upper respiratory tract infections, including streptococcal pharyngitis, acute bacterial exacerbations of chronic bronchitis and tonsillitis,, Lower respiratory tract infections, including bronchitis and pneumonia,, Acute otitis media,, Skin and skin structure infections,, Nongonococcal urethritis, cervicitis, gonorrhea, and chancroid. Prevention of disseminated Mycobacterium avium complex (MAC) infection in patients with advanced HIV infection. Extended-release suspension (ZMax) Acute bacterial sinusitis and community-acquired pneumonia in adults. Unlabelled Use: Prevention of bacterial endocarditis. Treatment of cystic fibrosis lung disease. Therapeutic Effects: Bacteriostatic action against susceptible bacteria. Spectrum: Active against the following gram-positive aerobic bacteria:: Staphylococcus aureus,, Streptococcus pneumoniae,, S. pyogenes (group A strep). Active against these gram-negative aerobic bacteria:: Haemophilus influenzae,, Moraxella catarrhalis,, Neisseria gonorrhoeae. Also active against:: Mycoplasma,, Legionella,, Chlamydia pneumoniae,, Ureaplasma urealyticum,, Borrelia burgdorferi,, M. avium. Not active against methicillin-resistant S. aureus. Contraindicated in: Hypersensitivity to azithromycin, erythromycin, or other macrolide anti-infectives; History of cholestatic jaundice or hepatic dysfunction with prior use of azithromycin.
    • Use Cautiously in: Severe liver impairment (dose adjustment may be required); Severe renal impairment (CCr <10 mL/min); Myasthenia gravis (may worsen symptoms); OB/Lactation: Safety not established; Pedi: Children <5 yr (safety not established).
    • Side Effects/ Adverse Reactions: CNS: dizziness, seizures, drowsiness, fatigue, headache. CV: chest pain, hypotension, palpitations, QT interval prolongation (rare). GI: HEPATOTOXICITY, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea, cholestatic jaundice, ? liver enzymes, dyspepsia, flatulence, melena, oral candidiasis, pyloric stenosis. GU: nephritis, vaginitis. Hemat: anemia, leukopenia, thrombocytopenia. Derm: STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, photosensitivity, rash. EENT: ototoxicity. F and E hyperkalemia. Misc: ANGIOEDEMA.
  65. When are aminoglycosides used?
    Used against gram-negative bacteria E.coli, Proteus spp., pseudomonas aeruginosa. Aminoglycosides are for serious infections, pelvic inflammatory disesase, MRSA, preop bowel antiseptic, intestinal amebiasis, tapeworm infections
  66. When would aminoglycosides be contraindicated?
    • Hypersensitivity, severe renal disease, pregnancy, pseudomembranous colitis
    • Side effects?-anorexia, nausea, vomiting, rash, numbness, visual disturbances, headache, confusion, depression, tremors, tinnitus, hearing loss, pruritis, muscle crumps, photosensitivity, alopecia, arthralgia. Adverse reactions? – Oliguria, urticarial, palpitations, superinfections, peripheral neuropthy, laryngeal edema, ypokalemia, hypomagnesemia, hyponatremia. Life-thretening :ototoxiity, nephrotoxicity, thrombocytopenia, agranulocytosis,liver damge, neuromuscular blockage
  67. What are the therapeutic effects of gentamicin sulfate (Garamycin)?
    To treat serious infections caused by gram-negative organisms- Proteus spp., Pseudomonas aeruginosa, to trwat pelvic inflammatory disease, MRSA infections. Mode of action- inhibits bacterial protein synthesis, bactericidal effect.
  68. Name one of the body systems that are often invaded by fluroquinolone sensitive organisms.
    • Respiratory tract: comm. Acquired pneumonia, chronic bronchitis, ace sinusitis.
    • Urinary tract: UTI, skin infections.
  69. Discuss the choice of multiple daily dosing versus single daily dosing of an aminoglycoside.
  70. How can the nurse decrease the chances for aminoglycoside toxicity
    careful drug dosing very important with younger and older patients, assess changes in Pt. hearing balance,, urinary output, closely monitor specific serum aminoglycoside levels.
  71. List several nursing actions necessary for client safety when client is receiving an aminoglycoside?
    Increase fluid intake, check for hearing loss, and evaluate laboratory results and compare with baseline, report abnormalities. Monitor VS (note if body temperature has decreased, check if drug monitoring ordered for peak and trough drug level, blood draw 45-60min after drug admin( peak values 5-8 mcg/ml, trough 0.5-2 mcg/ml.
  72. After giving a fluroquinolone, what observations should the nurse make?
    Administer drug 2 hours before of after antacids and iron products, give with a full glass of water. Check for S/S of superinfections, stomatitis(mouth ulcers), furry black tongue,anal or genital discharge and itching. Monitor serum theophylline levels, check for symptoms of CNS stimulation:nervousness, insomnia, anxiety,tachycardia. Monitor blood sugar
  73. Are macrolides effective against both gram positive and gram negative organisms?
    is active against most gram-positive bacteria and some gram-negative organisms (eg. B.pertussis, M. pneumoniae, L. pneumophilia).
  74. Why is erythromycin used less often?
    Serious adverse effects of Erythromycin -Change in EKG, ventilation, tachy, regular adverse effects of Erythromycin hypersensitivity, reversible hearing loss (tinnitus), hepatotoxicity, dysrhythmias. Contraindications of Erythromycin Pt's with pre-exisiting liver disease, and those with a hypersensitivity to Don't give IM or IV push; take it orally; don't break or crush it. Give 1 hr before or 2 hr after meal with a full glass of water.PCN. What don't you give along with Erythromycin Antihistamines, asthma meds, anticonulsants, anticoagulants
  75. If the client has a history of penicillin allergy, can a macrolide be used?
    Yes, macrolide drugs for Pt with penicillin allergies.
  76. Could a macrolide be used to treat a respiratory infection caused by streptococci?
    Yes, if they allergic to PNC.p417
  77. Your are given two orders; 1)Stat Culture and Sensitivity 2) Azithromax (Zithromycin) 500 mg Stat and 250 mg QD for 4D. Which order do you implement FIRST?
    Stat Culture and Sensitivity before azithromycin therapy, antibiotic can be initiated after obtaining culture sample. p417.
  78. What are the adverse effects that you might expect after giving Zithromax (azithromycin)?
    Superinfections, vaginitis, urticarial, stomatitis, hearing loss, dehydration, angioedema, seizures. Life-threatening: hepatotoxicity, anaphylaxis, Stevens-Johnson sundrome.p417
  79. What drugs decrease the effectiveness of Zithromax (azithromycin)?
    Antacids p417
  80. What client situations would require therapy with a sulfonamide?
    As alternative drug for patients who allergic to PNC, for UTI, ear infections, newborn eye prophylaxis, bronchitis, strep.pneumonae, cystitis.
  81. List nursing actions related to the delivery of sulfonamide drugs.
    Check med.history: contraindicated for Pt with renal or liver disease, hypersensitivity to sulfanomides: erythema multiforme, exfoliative dermatitis p432 Admin with full glass of water, , record I &O( output less then 1200ml/day-risk of crystalluria, monitor VS, observe for hematologic reaction- risk for anemias(sore throat, purpura, low WBC, low platelet, superinfections(stomatitis-mouth ulcers, furry black tongue, anal and genital discharge, itching.
  82. What drug interactions would be problematic in a client ordered to receive Bactrim?
    Drugs (sulfonylureas) Oral antidiabetic increase hypoglycemic effect, use warfarin increase anticoagulant effect, increase potassium with ACE inhibitors and potassium-sparing diuretics, increase digoxin level, increase phenytoin and methotrexate toxicity.p431
  83. What would be some side effects of being on Bactrim?
    Adverse reactions? Mild to moderate rashes, anorexia, nausea, vomiting, diarrhea, stomatitis, crystalluria, photosensitivity, headache, insomnia. Serious adverse reactions rare; agranulocytosis, aplstic anemia, allergic myocarditis, seizures, leukopenia, increase bone marrow depression, angioedema, crystalluria, renal failure
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