Exam 3: Topics 8, 9, & 10 Flashcards
acute heart failure
Heart muscle weakens and enlarges.
Loses ability to pump blood adequately
Compensatory mechanisms fail.
Lungs and periphery become congested.
right sided heart failure
blood backs up to the periphery (extremities)
Left sided heart failure
blood backs up into the lungs (pulmonary edema)
left ventricle doesn’t contract and can’t get blood into the periphery so it stays in the Lungs
nonpharm treatment for heart failure
limit salt and saturated fat intake
limit or avoid alcohol intake
stop smoking (it causes vasoconstriction)
perform MILD exercise
what is the therapeutic serum level of digoxin fro heart failure?
0.5-1ng/mL
what effects does digoxin have on the heart muscle
increase myocardial contractility
decrease heart rate
decrease conduction
increase CO
What are common signs of digoxin toxicity
anorexia, vomitting, diarrhea,
blurred vision, green or yellow halos
bray cardia, abnormal heart rhythms
what is given for digitalis toxicity
digoxin immune fab
what is angina
acute cardiac chest pain caused by INADEQUATE BLOOD FLOW to the myocardium (decreased o2 to the heart)
what are some things that can cause angina
plaque occlusion
coronary artery spasms
sometimes stress and exertion can cause it
what referred pain is associated with angina
pain will radiate down the left arm
what are the types of antianginal drugs
nitrates
beta blockers
calcium channel blockers
prior to starting antibiotics, what must happen?
blood cultures must be drawn
what is the process of taking a blood culture?
draw when temperature is rising
collect before takin antibiotics
clean skin per protocol
DO NOT DRAW SPECIMEN FROM IV LINE
draw 2 specimens from 2 different sites
draw 10-15 ml of blood
sed specimen to lab immediately
bactericidal
kills bacteria
kills fast
bacteriostatic
inhibits bacterial growth
slows growth of bacteria
killing slowly
What are antibiotics mechanism of action
inhibition of bacterial cell wall synthesis
alteration of membrane permeability
inhibition of protein synthesis
inhibition of synthesis of bacterial RNA and DNA
interfere w metabolism within the cell
what are some factors that influence the body’s ability to fight infection
age
nutrition
immunoglobulins
circulation
WBCs
organ function
inherent resistance
occurs without previous exposure to antibacterial drug
acquired resistance
caused by prior exposure to an antibiotic. This can cause an antibiotic to not be effective as it once was for a certain bacteria.
what are some health care acquired infections
MRSA
VREF
VRSA
what are examples of antibiotic misuse
antibiotics taken unnecessarily (for viral infxn, when no bacterial infxn is present, and taking antibiotics incorrectly like skipping doses)
what happens with antibiotic misuse
it increases antibiotic resistance
cross resistance
resistance to one antimicrobial agent because of its similarity to another antimicrobial agent (may be in the same class)
what are the general antibacterial adverse reactions
allergic reaction
superinfection
organ toxicity
allergic reaction
hypersensitivity, rash, pruritus, hives, anaphylactic shock
superinfection
secondary infection when normal flora is killed
what are the usual sites for super infection
mouth, skin , respiratory tract, GU tract, intestines
organ toxicity
ear (ototoxicity), liver (hepatotoxicity), kidney (nephrotoxicity)
narrow spectrum
Primarily effective against one bacteria type
Examples: penicillin, erythromycin
broad spectrum
ability of a drug to be effective against a wide range of microorganisms (gram positive and gram negative)
ex: amoxicillin
When is broad-spectrum useful?
when the pathogen is unknown and has not been identified by culture and sensitivity test
structure of penicillin
Beta-lactam ring structure
types of penicillins
basic penicillins
broad spectrum penicillins
penicillinase resistant penicillins
extended spectrum penicillins
penicillin action
inhibits cell wall synthesis
bacteriostatic and bactericidal
cephalosporin structure
beta lactam structure
often if you are allergic to ____ you are also allergic to _____
penicillin
cephalosporin
action of cephalosporins
inhibit bacterial cell wall synthesis
bactericidal
what does cephalosporin treat
respiratory, urinary, skin, bone, joint, genital infection
How many generations of cephalosporins are there?
5 generations
action of macrolides
inhibit protein synthesis
broad spectrum
what is often given if a patient has a penicillin allergy
azithromycin (Zithromax)
action of tetracyclines
inhibit protein synthesis
broad spectrum
what do tetracyclines treat
acne, antrax, plague, gingivitis, cholera, STI, skin urinary and respiratory infection
most antibiotics cause…
ototoxicity (hearing loss)
action of aminoglycosides
inhibit protein synthesis
bactericidal
What do aminoglycosides treat?
serious infections of the blood, such as meningitis, infective endocarditis, septicemia,etc
Action of Fluoroquinolones
interfere with enzyme DNA gyrase needed to synthesize bacterial DNA
bactericidal
What are fluroquinolones used to treat?
anthrax, skin, soft tissue, bone/joint, gynecologic, intrabdominal, urinary and respiratory tract infection
action of sulfonamides
inhibit bacterial synthesis of folic acid
bacteriostatic
use of sulfonamides
OM, meningitis, malaria, respiratory infxn, UTI
Tuberculosis Etiology
Mycobacterium tuberculosis (acid-fast bacillus)
Tuberculosis transmission
Person to person via droplets; coughing, sneezing
patients at risk for tuberculosis
immunocompromised
living or working in high risk residential setting
injection of illegal drugs
healthcare workers with high risk patient
symptoms of tuberculosis
cough, fever, night sweats
gi distress weight loss
positive acid fast bacilli in sputum or bloody sputum
when is prophylaxis TB recommended
close/active contact is TB pt
HIV + or immunocompromised
conversion from - to + TB
latent TB infection
injection drug users
recent immigration from high prevalence country
Antitubercular drug therapy
single drug therapy (ineffective)
multi drug therapy (decrease bacterial resistance, tx duration decrease)
special population for TB
pregnancy, HIV, peds
fungal infection
Candidiasis
Local fungal infections
mucous membrane, hair, skin, nails, moist skin areas
mild fungal infection
oral candidiasis, thrush, vaginal candiaisas
system fungal infection
sever can affect organs, abdomen , CNS
transmission method for viruses
droplets: coughing, sneezing, talking
common viral infections
Influenza, common cold, chickenpox (varicella), Hep B(hepatitis), HIV
helminths
parasitic worms
4 groups of helminths
cestodes (tapeworms)
Trematodes (flukes)
intestinal nematodes (round worms)
tissue invading nematodes (tissue round worms)
transmission method for helminths
from infected soil to human via contaminated food, bites of carrier insects, direct penetration of skin
helminths often affect what sites
intestines
lymphatic system, blood vessels, liver
peptide action
interferes with bacterial cell wall causing cell death
peptide classification
antiviral, antibacterial ,Antifungals, anti-parasitic
patient safety to avoid antibiotic resistance
ask HCP if they can be treated w/o antibiotics
take antibiotics as prescribed
NEVER skip doses and complete all of the antibiotic even if they feel better
never take someoneelses antibiotic
An antiviral drug used for the treatment of herpes simplex virus
Acyclovir (Zovirax)
A penicillin that is commonly used for otitis media, tonsillitis, and urinary tract infections that is a broad spectrum antibiotic
amoxicillin
A reaction to a drug that many time starts with shortness of breath and can lead to vascular collapse, laryngeal edema, bronchospasms, and cardiac arrest.
anaphylactic reaction
OTC drugs that should not be taken at the same time as azithromycin (Zithromax) or levofloxacin (Levaquin)
antacids
Antibiotic that inhibits the steps of protein synthesis and is used for bacterial conjunctivitis, STIs, and skin infections. This drug works well for those who are allergic to penicillin/cephalosporin.
Azithromycin (Zithromax)
Antibiotics that are effective against gram-positive and gram-negative bacteria are known as this type of antibiotic
broad spectrum antibiotics
Labs needed before giving antibiotics to determine the ability to metabolize and excrete the drug.
BUN, creatinine, liver enzymes
A broad spectrum antibiotic that is used for otitis media, meningitis, and surgical infection prophylaxis that have a disulfiram-like reaction
Cephalosporins
If a client is allergic to penicillin they can also be allergic to this classification of drugs
Cephalosporins
The signs/symptoms of this superinfection include multiple episodes of watery, diarrhea that may be bloody, abdominal cramping, and a possible increased temperature
Clostridium difficile
A reaction a client may have if metronidazide (Flagyl) or ceftriaxone and drinking alcohol
Disulfiram-like reaction
Antibiotic that is used to treat acne, E. coli, MRSA and anthrax that should not be taken with milk
Doxycycline
An azole antifungal that is used for candida infections and prophylactically for those undergoing bone marrow transplant. Drinks with caffeine are contraindicated when taking this drug.
Fluconazole (Diflucan)
An antibiotic that is administer via IM or IV and used for endocarditis, septicemia, bone/joint infection, and meningitis and may cause alopecia or photosensitivity
Gentamicin Sulfate
An anthelmintic medication used to treat clients with parasitic worms such as roundworm.
Ivermectin (Stromectol)
An expected side effect of isoniazid and ceftriaxone that the nurse should monitor but does not require discontinuation of the medication
Injection site redness
Antibiotic that interferes with the enzyme DNA gyrase and is used to treat cellulitis, impetigo and skin infections. May cause abdominal cramps, restlessness, depression and injection site reaction.
Levofloxacin (Levaquin)
A peptide medication that is used for anaerobic infections including rosacea.
Metronidazide ((Flagyl)
Antibiotics that are effective against only one bacterial type are known as this type of antibiotic
Narrow spectrum antibiotic
Medication that may have reduced effects when taken with doxycycline
Oral Contraceptives
An adverse reaction to many antibiotics that starts with ringing of the ears
Ototoxicity
A disease-producing microorganism
Pathogen
A lab test that is drawn 30 - 60 minutes after administration of a medication to determine the amount of medication in the system
Peak Level
A broad spectrum classification of antibiotics that inhibits bacterial cell wall synthesis and has a beta-lactam ring structure
Penicillin
A potential side effect of IV administration of acyclovir that requires that the nurse assess the IV site prior to administration, frequently throughout the administration of the drug, and after administration.
Phlebitis
Medication that may be required when taking an anti-TB drug
Pyridoxine (Vitamin B6)
First step for the nurse when a client presents with possible anaphylactic reaction to IV antibiotics
Stop infusion
Classification of antibiotic that inhibits bacterial synthesis of folic acid
Sulfonamides
A secondary infection caused when the normal flora is killed when taking an antibiotic
Superinfection
Two antibiotics that are combined that causes bacterial resistance to develop more slowly than if one of the drugs were used alone
TMP-SMX
The first test a person should receive if they have come in contact with an individual with TB
TB Skin Test
Another name of oral candidiasis that is typically treated with the antifungal drug Nystatin
Thrush
A side effect of doxycycline that can affect women in the last trimester of pregnancy and children younger than 8 years old
Tooth discoloration
Lab test that is drawn right before the time of the scheduled administration of the next dose of antibiotic to determine the amount of medication in the sytem
Trough Level
The length of time TB meds such as isoniazid need to be taken
Up to 2 Years
Blood test that is used to detect infection and determine if an antibiotic has been effective in eliminating the infection
White Blood Cells Count
What does the nurse need to educate a patient taking an anti-hypertensive drug?
rise slowly due to HTN
reduce salt intake to 2g/day
DO NOT abruptly stop medication because they can have rebound hypertension
Will most likely need to take their whole life even if they feel better
encourage exercise AFTER getting permission from HCP
If African American patient, most have to combine antihypertensives with diuretics to be effective
Educate makes about erectile dysfunction, but tell them the benefits of this drug
If a pt. is on spironolactone, what is it important to educate that patient about?
Don’t eat foods high in potassium/potassium supplements because it can increase risk of hyperkalemia
What CAMS should you avoid with anti-hypertensives?
PARSLEY (makes the drug ineffective)
A patient is on nitroglycerine for angina, what is important to educate the patient about?
If the first does dosen’t help in the first 5 minutes, CALL 911 then take the second dose
Do not exceed 3 SL doses
Take patch off nightly to avoid tolerance/resistance
A patient is places in isoniazid, if a client or a nurse is exposed to a positive patient, what is he first thing they will do?
a TB skin test
If a patient is places on an isoniazid, what is important to educate the patient about?
Treatment bay be up to 2 years (24 months)
Causes photosensitivity
What would a nurse teach a patient about tetracyclines?
antibiotic is not properly absorbed with any milk products, better to be taken on an EMPTY stomach
A female pt. and tetracycline is ordered, what is important to find out/educate on?
TELL HCP PT IS PREGNANT so that a different antibiotic can be ordered as PERMANENT TOOTH DISCOLORATION and fetal anomalies can happen
Tell pt. to use additional contraceptive to prevent pregnancy
Long term antibiotics can result in…
superinfection (secondary infection)
especially in females (vaginitis)
What should a nurse remember before antibiotics are administered?
Do a CBC and blood culture
Check WBC (decreased WBC mean drug is working)
What is Nystatin used for and how is it taken
Candidiasis (oral thrush)
Taken as prescribed, even if they feel better
If the patient is on aspirin daily, what would they be taking it for?
It is used as an anti-platelet to prevent clots
What is the use of a thrombolytic?
clot buster, dissolve clots
How does rosuvastatin work?
Inhibits HMG COa enzyme to decrease LDL levels
What is the antidote for Warfarin?
Vitamin K
Why is Warfarin used if a patient has to be on it for a long time, compared to heparin?
It has a longer half life
so the patient doesn’t have to take warfarin as much as they would have to take heparin
What is the antidote for heparin?
protamine sulfate
What lab is drawn fro warfarin and heparin to check serum level
Heparin: PTT/aPTT
Warfarin: INR
A patient is on digoxin, what is important to do prior to administration?
check BPM and DO NOT administer if BPM <60
if less than 60 hold medication and contact HCP
What is the therapeutic serum level for digoxin?
0.5-1 ng/mL
If a serum drug level id 5ng/mL for digoxin, what do you do?
Hold med, contact HCP
If you have an antibiotic ordered through IV, what is important to do prior to administration?
Check IV site for infiltration, especially when giving antibiotics because it can cause necrosis
Why would you not be able to give Alteplase (tPA)?
if a patient has a head injury, hemorrhagic stroke, surgery
can cause further bleeding
If a patient is taking metronidazole (Flagyl), what is important to educate them about?
DO Not consume alcohol (it may cause them to feel flushed, palpitations)
What is fluconazole (diflucan) used for?
candidiasis
Which two labs are important to review before admin medication?
renal and hepatic labs
If a patient is on clopidogrel (plavix) and they are taking it with an anti-platelet, it is important for them to do what?
stop taking it 7 days prior to surgery
can cause increased bleeding
If you have two antibiotics given together, why would you give them together?
Helps to kill bacteria
decrease bacterial resistance
If your patient is on rosuvastatin (Crestor), what is it important to educate them about?
Take with water
DO NOT stop taking abruptly
if they have weakness or muscle spasms contact HCP
When a pt. is on an anticoagulant which CAM is important to avoid?
gingko
When furosemide (Lasix) is being taken with any amino glycoside, it can cause what?
OTOTOXICITY!
one sign of this is tinnitus
