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normal flora
everybody has normal flora on skin, in colon, diff areas of body that help body cope w/organisms that are not supposed to be there
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sterile areas
inside lungs, bladder, etc.
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colonized areas
- include skin...things that are on outside of body that shouldnt go into skin.
- upper respiratory tract, mouth, external genitalia, colon (things that are in colon that can help digest food)ex: cdiff lives there, but is not supposed to be a large population
- -eat yogert to replace normal flora (ex: when on antibiotic)
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when you have a systemic infection
you may have to do a blood test to determine...may not always have a fever.
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factors that increase risk of infection
- -skin that has been broken
- -neutropenia & other blood disorders (reverse isolation may be used)
- -malnutrition (if we dont eat how we should, immune system goes down)
- -poor personal hygiene (ex: female wiping back to front, person not cleaning cut)
- -suppression of normal bacterial flora (antibiotics wipe normal flora out)
- -suppression of immune system (ex: cancer, anemia)
- -diabetes & other chronic diseases (ex: COPD-potential for fluids to retain in body)
- -advanced age
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nosocomial
is usually antibiotic resistant type of opportunistic infection
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Interventions to decrease risk of infections
- -wash hands
- -promote general health and well being (teach hand washing etc.)
- -treat all body fluids as infections
- -(children w/exema are high risk for staph inf)
- -always wear your gloves!
- -PPD (TB skin test)
- -
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Interventions to decrease risk of infections cont....
- -standard universal and isolation precautions (treat everyone (be aware of thier body fluids) as if they have HIV to protect yourself)
- -Hand washing (cdiff is not killed by sanitizer-only soap & water)
- -flu & pneumonia vaccines
- -sterile technique
- -assess fluid and nutrition status (ex: if have UTI drink cranberry juice)
- -decrease levels of stress
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Question:
A nurse is teaching a mother about the medicine for her child's respiratory problem. The nurse should include which of the floowing in her teaching
- A. Administer the medicine if the child is afebrile
- B. The secretions will become thicker and darker to due the tx.(treatment)
- C. Keppe any remaning antibiotics for the next illness
- D.Remember to wash your hands frequently to reduce the risk of infection
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Drug Selection Criteria-Match the drug to the bug
- -culture and sensitivity----this should be done before 1st dose of antibiotic
- (-with an infant...they have done the culture....but you dont have the sensivity (the results) back yet.)
- -pt tolerance, allergy and contraindications (if benifit outweighs detriment to pt-will be ordered)
- -specificity to infectious organism (ex: if fungal infection-will give antifungal)
- -site of infectionl(-depending on site, ex: UTI agents help eliminate bacteria from UT, there are also broad-spectrum antibiotics)
- -dosage requirements
- -cost (is pt going to be able to afford the medication?)
- -culture
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Emergence of Resistant organisms:
Methicillin Resistant Organisms-MRSA
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Methicillin Resistant Staphylococcus Aureus-MRSA
- -most common site is in the skin and urine and respiratory tract
- -most coommon treatment is vancomycin
- 80% of staph in hospitals are resistant to methicilin
- -the organism may be resistant to penicillins, erythromycin, clindamycin, tetracycline, aminoglycosides, and cephalosporins
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Emergence of Resistant organisms
Vancomycin resistant enterococcus-VRE
- accounts for 12% of nosocomial infections
- mortality rate of 40%
- major contributing factor is the frequent use of vancomycin to treat other resistant organisms such as mrsa
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Penicllin resistant steptococcus pneumonia
- -over the past 5 years resistance to penicillin has increased by more than 300%
- (resistance to claforan (cefotaxime) has increased by more than 1000%)
- -contributing factors to resistant organisms
- -overuse and misuse of antibiotics in human and animal medicine
- -global transmission of resistant bacteria
- -increasing cost of develping new antibiotics
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shigella
causes dysenterry
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CDC has 12 step approah to preventing resistance
- -vaccinate
- -get the catheters out (they build up baceria-they must be changed)
- -target the pathogen (take the culture before hang the antibiotic)
- -access the expert (dr will consult w/expert on subject)
- - practice antimicrobial control (WASH HANDS)
- -use local data
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12 steps continued
- treat the infection not the contamination
- treat the infection and not the colonization
- know when to say "no" to vancomycin
- stop antimicrobial treatment (ex: dont treat cold w/antibiotic)
- -isolate the pathogen
- -break teh chain of infection
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nursing care when administering antimicrobials:
accuracy, adverse effects, drug interctions
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accuracy
- intervals
- with or without food
- reconstituting
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adverse effects
- hypersensitivity
- super-infection
- toxicity
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drug interactions
- -special consderations
- -children
- -elderly
- -peri-operative
- -renal impairment
- -hepatic impairment
- critical illness
- -superinfection
- -catergories of antibacterials
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catergories of antibacterials
- penicillins
- cephalosporins
- aminoglycosides
- fluroquinolones
- tetracyclines
- sulfonamides
- macrolides
- miscellaneous
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penicillin:
- PCN is the safest and most effective for children
- -rapidly excreted by the kidneys and produce a high drug concentration in the urine, except for nafciliilin which is excreted by the liver. (so good for UTI's
- -children are usually prescribed amoxcilin (the pink stuff)
- contraindications-allergies to penicillin or to its agents (so cant take any "cillin")
- -be careful when using Erythromycin, AMinoglycosides, or Tetracylines in concoitant with one another (hepatic and renal complications can occur)
- potential for cross sensitivity with cephalosporins
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Adverse effects of penicillin
- -allergic reaction- rash, serum sickness (etc: glomerulonefphritis of the kidney), anaphylaxis
- -loss of normal flora-black furry tongue (thrush), vaginal candidas, diarrhea (c-diff)
- -hematologic-hemolytic anemia or leukopenia
- -nephropathy-nephritis
- -electorlyte imbalances (side eff of antibiotic-its not caused by the infection...this imbalance may happen b/c of the diahrrhea or lack of appetite)
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Cephalosporins
(EX: keflex, Ancef, rocephin)
- -similar to penicillins. Used as a surgical prophylaxis tx for rep. infections, skin, soft tissue, brain, spinal cord, and bloodstream.
- -most common is Keflex po.
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Contraindications for Cephalosporins
- -allergy to cephalosporin agents
- -careful of cross sensitivity with penicillins
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Adverse effects
- -pseudomembranous colitis
- -GI disturbances- nauseau, diahrrhea, vomiting
- -allergy-rash, anaphlaxis
- -superinfection
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Amnoglycosides
- -among the most used for psudomonas, proteus, e. coli, enterobacter species
- -bacteriocidal
- -examples: neomycin, kanamycin, gentamicin
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Adverse effects of aminoclycosides
- -ototoxicity
- -nephrotoxicity
- -tremors
- -urticaia
- -pruritus
- -rash
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Fluroquinolones
- -broad spectrum agent particularly effective against gram neg organisms
- -disrupts bacterial replication
- -examples: cipro, tequin, levaquin
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Indications for fluroquinolones
- -soft tissue infections
- -respiratory infections
- -gi & gu infections
- -multidrug resistant tuberculosis
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