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Q4: What intervention can the nurse employ to reduce the risk of kidney damage by amphotericin B?

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Q4: What intervention can the nurse employ to reduce the risk of kidney damage by amphotericin B?

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Maintain a high fluid intake of 2-3 L of fluid if not directed otherwise

Longer infusion time

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6. what role can nurses and other HCP play in reducing infections and antibiotic resist 

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6. what role can nurses and other HCP play in reducing infections and antibiotic resist 

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The nurse should reassure the caller that many times the ear pain will get better without treatment, especially if it is part of a viral illness. Additionally, many doctors have adopted the “wait and see” approach to ear pain.  To make the patient more comfortable, warm compresses, Tylenol or Ibuprofen can be given.  Children tend to sleep more comfortably when propped up because when flat, the pressure from the fluid in the middle ear can push on the eardrum which can be painful.

The caller should be informed of what symptoms to call back for, such as pain that is not controlled with OTC pain relievers, high fevers, redness or swelling behind the ear accompanied with a fever, or for any symptoms that are worsening after trying home care measures. If the symptoms persist, antibiotics will most likely be prescribed. Antibiotic treatment will generally be seven to 10 days. It is very important that the patient continues to take the medication through the entire time period to avoid the infection coming back.

Prevention:  The following reduce the risk factors that cause otitis media:

Vaccinations- influenza and the 13-valent pneumococcal conjugate vaccine (PCV13)

Washing hands often

Avoid smoke

Avoid sick children

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Acyclovir: adverse effects - headache, light headedness, lethargy, fatigue, tremors, confusion, seizures, dizziness, nausea, vomiting, diarrhea, glomerulonephritis, renal pain, renal tubular damage, acute renal failure, rash, urticaria, pruritus, burning, stinging, sensation, irritation, sensitization, inflammation or phlebitis at injection site, sloughing, thrombocytopenic, pupura/hemolytic uremic syndrome Monitor when administering: observe infusion site, monitor I&O & hydration status, monitor for S&S of reinfection, resistance, acute renal failure, monitor for adverse effects, monitor lab tests (renal functions test)
Amphotericin B: adverse effects: hypersensitivity, fever, chills, headache, sedation, muscle pain, arthralgia, weakness, hypotension, cardiac arrest, ototoxicity with tinnitus, vertigo, loss of hearing, nausea, vomiting, diarrhea, epigastric, cramps, anorexia, weight loss, hypokalemia, hypomagnesemia, nephrotoxicity, anemia, thrombocytopenia, urine with low specific gravity, dry skin, erythema, puritis, burning, allergic contact dermatitis, lesions, pain, arthralgias, superinfections, thrombophlebitis Monitor: S&S of local inflammation or thrombosis at infection site, monitor cardiovascular and respiratory status and observe patient closely for adverse effects during initial IV therapy. monitor I&O and weight, monitor if BUN exceeds 40mg/dL or serum creatine rises above 3mg/dL, baseline culture sensitivity, report and evidence of hearing loss or complaints of tinnitus. Vancomycin: Adverse effects: Special senses: ototoxicity Urogenital: nephrotoxicity leading to uremia Body as a whole: Hypersensitivity reactions (chills, fever, skin rash, urticaria, shock-like state) anaphylactoid reaction with vascular collapse, superinfections, severe pain, thrombophlebitis at injection site, generalized tingling following rapid IV infusion Hematologic: transient leukopenia eosinophilia GI: nausea, warmth Other: Injection reaction that includes hypotension accompanied by flushing and erythematous rash and face and upper body following rapid IV infusion. Monitoring: - Monitor BP and HR continuously through period of drug administration

- Assess hearing. Drug may cause damage to auditory branch of eighth cranial nerve, with consequent deafness which may be permanent.

- Be aware that serum levels of 60-80mcg.mL are associated with ototoxicity. Tinnitus and high-tone hearing loss may proceed deafness, which may progress even after drug is withdrawn. Older adults and those on higher doses are especially susceptible.

- Monitor I&O: report changes in I&O ratio and pattern. Oliguria or cloudy or pink urine may be a sign of nephrotoxicity

- Monitor lab tests: periodic renal function tests, urinalysis, and WBC count; serial vancomycin blood levels (peak and trough)

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Q 1: What dose will be given fro gentamycin?

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Q 1: What dose will be given fro gentamycin?

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120mg/dose
125/2.2=56.8kg
56.8kg x 2mg=113.6mg
Round to the nearest 20 mg -> 120mg/dose

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5. Suggestions to prevent antibiotic resistance:

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5. Suggestions to prevent antibiotic resistance:

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-avoid use of antibiotics if you don't have a bacterial infection
-try to prevent getting infections by using proper and regular hand hygiene
-avoid using broad spectrum antibiotics

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Q 2: What are the classifications, mechanism of action, potential adverse effects, and nursing considerations for these drugs?

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Q 2: What are the classifications, mechanism of action, potential adverse effects, and nursing considerations for these drugs?

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Cefotetan
Classification: antibiotic; second-generation cephalosporin
Mech. of action: binds to one or more of the penicillin-binding proteins located on cell walls of susceptible organisms. This inhibits the third and final stages of bacterial wall synthesis, thus killing the bacterium.
Adverse: diarrhea, thrombocytopenia, fever, chills, pain at injection site
Considerations: hypersensitivity to cefotetan, penicillins, or other drugs, preexisting coagulopathy

Metronidazole
Classification: antitrichomonal, amebicide
Mech. of action: Interacts with DNA to cause loss of DNA structure and strand breakage resulting in inhibition of protein synthesis and cell death in susceptible organisms.
Adverse: overgrowth of candida, nausea, hypersensitivity (rash, urticaria, pruritus, flushing)
Considerations: metronidazole may interfere with certain chemical analyses for AST, resulting in decreased value, be cautious of preexisting Candidaisis

Gentamycin
Classification: aminoglycoside antibiotic
Mech. of action: Broad-spectrum aminoglycoside antibiotic that binds irreversible to 30S subunit of bacterial ribosomes, blocking a vital step in protein synthesis, and attachment of RNA molecules to bacterial ribosomes resulting in cell death.
Adverse: thrombocytopenia, nephrotoxicity, decreased creatinine clearance
Considerations: hx of hypersensitivity to, or toxic reaction with any aminoglycoside antibiotic

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Question 2: What is the mechanism of action and classification of these medications: Acyclovir and Amphotericin?

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Question 2: What is the mechanism of action and classification of these medications: Acyclovir and Amphotericin?

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Acyclovir Classification: Antiviral; antiherpes
Mechanism of Action:  Interferes with DNA synthesis of herpes simplex I and II and varicella zoster virus; therefore inhibiting  viral replication

Amphotericin Classification:  Antifungal
Mechanism of Action: Exerts antifungal action on both resting and growing cells by selectively binding to sterols in fungus membranes resulting in fungal cell death ( Fungicidal at higher concentrations)

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1. How can the nurse explain these changes in antibiotic prescription patterns? How are antibiotics misused?

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1. How can the nurse explain these changes in antibiotic prescription patterns? How are antibiotics misused?

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With new research it is evident that antibiotics should only be used if absolutely necessary because they cause rapid cell death and are not absorbed well by the GI system. They also destroy people's natural flora causing yeast infections. Therefore, antibiotics should mainly be used for systemic infections as they are easily misused. Many people misuse antibiotics because they do not understand how they work. After a few days on antibiotics people feel better so they stop taking them but, the drug has not killed all of the bacteria yet. This often leads to a superinfection.

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Question 5. Why is it important for the prescriber to first order a 1mg test dose of amphotericin B before starting full therapy.

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Question 5. Why is it important for the prescriber to first order a 1mg test dose of amphotericin B before starting full therapy.

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Acute reactions including fever, shaking chills, hypotension, anorexia, nausea, vomiting, headache, and tachypnea are common 1 to 3 hours after starting an intravenous infusion. These reactions are usually more severe with the first few doses of amphotericin B and usually diminish with subsequent doses.

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Q3: Why would 3 antibiotics be prescribed for the same patient?

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Q3: Why would 3 antibiotics be prescribed for the same patient?

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The mechanism of action for this drugs all vary, and target different microbes. The use of 3 different antibiotics help to fight infection against a large spectrum of microbes.
Cefotetan is a cephalosporin that acts to weaken the cell wall and cause cell lysis (bactericidal). It is active against gram-positive bacteria, and only effective against bacteria that is undergoing growth and development.
Metronidazole is used for protozoal infections and infections caused by obligate anaerobic bacteria only.
Gentamycin is an aminoglycoside that treats serious infections caused by aerobic gram-negative bacilli (mainly targets P. aeruginosa  and the Enterobacteriaceae), which are often resistant to other bacteria.

The use of cephalosporins (weakens cell wall) in combination with aminoglycosides will increase the effectiveness of the aminoglycoside.

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Q4: What assessments and laboratory results should be monitored while this patient is on this drug therapy?

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Q4: What assessments and laboratory results should be monitored while this patient is on this drug therapy?

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Cefotetan: Monitor for signs of antimicrobial effects (reduction of infection), allergic reaction, bleeding, thrombophlebitis, hemolytic anemia, C. diff infection.
Blood should be tested for RBCs and WBCs.

Gentamicin: Monitor for aminoglycoside levels for peaks and troughs, inner ear function (hearing and balance), and kidney function. Monitor for ototoxicity, nephrotoxicity, and neuromuscular blockage.
Blood tests should be done regularly for measuring peak levels (30 min after IV injection), and for trough levels).

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Question 9: Red Man Syndrome & Nursing Implications

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Question 9: Red Man Syndrome & Nursing Implications

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Red Man Syndrome: rapid infusion can cause a hypersensitivity reaction, 'red man syndrome,' characterized by flushing, rash, pruritus (itchy), urticaria (hives), tachycardia, and hypotension. to minimize risk, infuse vancomycin slowly over 60 min or longer.
other drugs that can cause a similar reaction: ciprofloxacin, amphotericinB, rifampicin and teicoplanin that stimulate the release of histamine.
SYPTOMS:
- Hypotension, SOB, dizziness, headache, fever, chills, headache and chest pain.
NRSG:
- Peak: 30 min after end of infusion; Half life: 4-8 hours
- monitor BP and HR continuously through period of drug administration
- assess hearing. hearing loss may be permanent
- Tinnitus (ringing) and high-tone hearing loss may precede deafness. OA are especially susceptible
- monitor I&O: report changes in ration and pattern.
- Oliguria or cloudy or pink urine may be a sign of nephrotoxicity (also elevated BUN, albumin, and hyaline and granular casts in urine)
- monitor lab tests: periodic renal function tests, WBC count, serial vancomycin blood levels (peak and trough) in patients with borderline kidney function, in infants and neonates, and in patients older than 60yo
- PICCs are the best choice for Vancomycin admin. Avoid midline-CVCs
- Use a pump for delivery
- infuse over 1 hour or 1.5 hours
- use a dilute solution and rotate the infusion site
- exercise caution in patient's with renal impairment
- check creatine clearance regularly (check labs)
- Vancomycin is generally given in BID, and the dose is determine by the patient's weight, renal function and overall health
- Continue to monitor patient for S&S of red man syndrome & of AE: nephrotoxicity leading to uremia, shock-like state, anaphylactoid reaction with vascular collapse and leukopenia which are life threatening. Common AE are hypotension accompanied by flushing and erythematous rash on face and upper body (i.e. red man syndrome).

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Question 6. why must the drug be mixed this way. 50mg of powder to 0.1 mg per mL. 

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Question 6. why must the drug be mixed this way. 50mg of powder to 0.1 mg per mL. 

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to dilute amphotericin B into a therapeutic level, Making it less toxic to the body (especially to the kidneys). The sterile water must not contain bacteriostatic agents due to making amphotericin B ineffective.
Can cause precipitant in the vein

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Q1: What doses will you give for acyclovir and amphotericin B?

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Q1: What doses will you give for acyclovir and amphotericin B?

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-Acyclovir: 273mg q12h
-Amphotericin B: 164mg/daily

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9. The patient will be going home on oral ciprofloxacin. You will be explaining the medication to the patient. What information is important to share about this medication?

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9. The patient will be going home on oral ciprofloxacin. You will be explaining the medication to the patient. What information is important to share about this medication?

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Potential adverse effects: diarrhea, dizziness, drowsiness, headache, stomach upset, abdominal pain, nausea, agitation, sleep problems, rash.
The patient should avoid dairy products.

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Q5:  Describe the assessments the nurse should perform to detect nephrotoxicity and ototoxicity.

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Q5:  Describe the assessments the nurse should perform to detect nephrotoxicity and ototoxicity.

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Nephrotoxicity = the nurse would look for signs and symptoms such as decreased urine output, SOB, fluid retention and monitor the lab values of creatinine, BUN and sodium etc. Also would monitor the trough and peak of gentamicin.
Ototoxicity = the nurse would monitor signs such as hearing loss, nausea and dizziness

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2. What type of chronic pediatric condition would warrant earlier treatment of sinus and ear infections?

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2. What type of chronic pediatric condition would warrant earlier treatment of sinus and ear infections?

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Chronic Otitis Media,
HIV

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Q6: How does nephrotoxicity increase the risk of developing ototoxicity?

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Q6: How does nephrotoxicity increase the risk of developing ototoxicity?

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when the kidneys can't excrete toxic amounts of a drug, it will then build up in the body and will have a higher risk of becoming ototoxic and distribute and cause issues in other areas of the body

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Question 7. what nursing measures should the nurse take when infusing amphotericin to prevent infusion- related adverse effects?

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Question 7. what nursing measures should the nurse take when infusing amphotericin to prevent infusion- related adverse effects?

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Intravenous Amphotericin frequently produce fever, chills, rigors, nausea and headache. Mild reactions can be reduced by pretreatment with diphenhydramine plus acetaminophen (aspirin can also help but may increase kidney damage). Intravenous Meperidine or Dantrolene can be given if rigors occur. Infusion reactions are less intense with lipid-based amphotericin formulation then with the conventional formulation.

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Q7: Which toxicity is most likely to be permanent?

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Q7: Which toxicity is most likely to be permanent?

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Ototoxicity (hearing loss) is usually permanent and bilateral.

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Q8: How can the nurse prevent drug interactions?

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Q8: How can the nurse prevent drug interactions?

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- know reason for taking each medication
-know how to take it
-ensure medications that are being taken are not contraindicated
-if there are potential symptoms, the nurse should look out for those and ensure there are no adverse effects

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3. The neighbor states that she has antibiotics left over from the last infection. "I always have some in case I need it." She asks the nurse if it is okay to give this drug to her son since it was prescribed for him. How should the student nurse respond?

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3. The neighbor states that she has antibiotics left over from the last infection. "I always have some in case I need it." She asks the nurse if it is okay to give this drug to her son since it was prescribed for him. How should the student nurse respond?

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The neighbor should not give her son the left over antibiotics because antibiotics can lose their effectiveness over time. Furthermore, the full dose of antibiotics should have been taken for the last infection he had.

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AS PER MEL - big bag over long period; 250mL over 1.5 hours once every 24h
Clinical: Dose 1g/24 hours @1000 in 250mL NS 0.9
Monograph:
Reconstitute 500 mg or 1 gram vial with 10 mL or 20 mL sterile water, respectively, for a final concentration of 50 mg/mL.
Intermittent infusion: Further dilute with NS or D5W to a maximum concentration of 5mg/mL and infuse over at least 60
minutes.
Doses less than or equal to 1 g will be infused over 1 hour. Doses greater than 1 and up to 2 g to be infused over 90 minutes. Doses greater than
or equal to 2 g to be infused over 120 minutes.
Continuous infusion: May dilute daily dosage in sufficient volume of IV fluid to be run over 24 hours.
For fluid restricted patients, vancomycin can be given at a concentration of 10 mg/mL at a maximum rate of 10 mg/min.
IV ADMIN
intermittent: give a single dose at a rate of 10mg/min or over not less than 60min (whichever is longer)
- avoid rapid infusion, which may cause sudden hypotension
- monitor IV site closely; necrosis and tissue sloughing will result from extravastation

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2. Q: What type of antibiotic would the nurse expect to be ordered and why? 

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2. Q: What type of antibiotic would the nurse expect to be ordered and why? 

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The antibiotic that was ordered (piperacillin) is a broad-spectrum antibiotic that would be used for the time being until C&S results are obtained. The severity of the patient's current condition calls for immediate action, thus a broad-spectrum antibiotic will be used until the exact infection is identified. At which point, it is likely treatment will switch to a narrow-spectrum antibiotic.

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10. What new problem might the patient develop while taking the antibiotic

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10. What new problem might the patient develop while taking the antibiotic

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Tendinitis
Swelling and pain in muscles and joints
Depression, anxiety or other mental health changes
Sensation changes pr nerve damage in hands, feet, arms or legs
These symptoms have been reported as long term, and may be considered permanent.

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4. Describe the clinical significance of bacterial resistance.

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4. Describe the clinical significance of bacterial resistance.

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Antibiotic resistance occurs when bacteria are able to survive and grow in the presence of other antibiotics. This leads to even more and expensive drug use to fight infection, prolonged hospitalization or extended treatment (greater risk of adverse effects), and increased mortality rates.

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What changes in the dosages of medications would be necessary if the patient were 80 yrs old instead of 15?
Cefotetan-  Adult dosage: IV/IM 1g q4h or 2 g q6-8h up to 12g/day
-GI disease
-renal impairment

Gentamicin-  Adult: IV/IM 1-2mg.kg loading dose followed by 3-5mg/kg/day in 3 divided doses
-check for renal function

Metronidazole- Adult: PO 7.5mg/kg q6h (max:4g/day)

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What precautions does the nurse need to take when administering these two antibiotics through the same IV site?
Assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
-check for precipitate
-flush the iv line
-monitor IV site

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Q11: the nurse notices that the patients INR is 3.5. What should she do? 

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Q11: the nurse notices that the patients INR is 3.5. What should she do? 

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Reduce the amount because the drug has surpassed its therapeutic effect.
notify Physician
risk for bleeding
Watch for signs and symptoms

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Q12. Three days post-operatively, the patient has progressed to a soft diet and develops severe watery diarrhea. what are the possible causes of the diarrhea?

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Q12. Three days post-operatively, the patient has progressed to a soft diet and develops severe watery diarrhea. what are the possible causes of the diarrhea?

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A ruptured appendix spreads infection throughout your abdomen, the bacteria multiples rapidly after this occurs causing watery diarrhea. A sign of c.diff.

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Q13: What are possible electrolyte imbalances that could occur and what are their symptoms? 

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Q13: What are possible electrolyte imbalances that could occur and what are their symptoms? 

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possible electrolyte imbalances can be sodium retention and lithium elevation, changes in the potassium (ECG for the heart) The symptoms are nausea, vomiting and diarrhea, signs of dehydration

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1. What are nursing responsibilities regarding these orders?

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1. What are nursing responsibilities regarding these orders?

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monitor IV, collect sputum sample, administer piperacillin

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3. Discuss the classification and mechanism of action of the medications ordered.

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3. Discuss the classification and mechanism of action of the medications ordered.

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extended - spectrum penicillin
acts by interfering with synthesis of mucopeptides; bactericidal

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5. the physician orders cipro 1g IV bid. What is the classification and mechanism of action of this drug? 

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5. the physician orders cipro 1g IV bid. What is the classification and mechanism of action of this drug? 

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quinolone antibiotics inhibit DNA gyrase + topoisomerase

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6. what would the nurse monitor for when admin this drug

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6. what would the nurse monitor for when admin this drug

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GI reactions; I + O; lab results

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7. what in the p/t hx. may contribute to drug-drug interactions 

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7. what in the p/t hx. may contribute to drug-drug interactions 

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anticoagulents

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8. what assessments should be monitored by nurse to determine clinical response to the antibiotic 

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8. what assessments should be monitored by nurse to determine clinical response to the antibiotic 

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resp, vitals, neuro