Infection Control Flashcards
Safety precautions, Antibiotics and Immune System Drugs
Standard Precautions
Standard Precautions apply to 1) blood; 2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain visible blood; 3) nonintact skin; and 4) mucous membranes.
Use Standard Precautions, or the equivalent, for the care of all clients.
Handwashing
Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn.
Wash hands immediately after gloves are removed, between client contacts, and when otherwise indicated to avoid transfer of microorganisms to other clients or environments.
It may be necessary to wash hands between tasks and procedures on the same
client to prevent cross-contamination of different body sites.
Use soap and water for routine handwashing.
GLoves
Wear gloves (clean, nonsterile gloves are adequate) when touching blood, body fluids, secretions, excretions, and contaminated items.
Put on clean gloves just before touching mucous membranes and nonintact skin.
Change gloves between tasks and procedures on the same client after contact
with material that may contain a high concentration of microorganisms.
Remove gloves promptly after use, before touching noncontaminated items
and environmental surfaces, and before going to another client, and wash hands immediately to avoid transfer of microorganisms to other clients
or environments.
Mask
Wear a mask and eye protection or a face shield to protect mucous
membranes of the eyes, nose, and mouth during procedures and client-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.
Gown
Wear a gown (a clean, nonsterile gown is adequate) to protect skin and to prevent soiling of clothing during procedures and client-care activities that are likely to generate splashes or sprays of blood, body
fluids, secretions, or excretions.
Remove a soiled gown as promptly as possible, and wash hands to avoid transfer of microorganisms to other clients or environments.
Client Care Equipment
Handle used client-care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous
membrane exposures, contamination of clothing, and transfer of microorganisms to other clients and environments.
Ensure that reusable equipment is not used for the care of another client until it has been cleaned and reprocessed appropriately.
Ensure that single-use items are discarded properly.
Linens
Handle, transport, and process used linen soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures and contamination of clothing and that avoids transfer of microorganisms to other clients and environments.
Needle disposal
Used needles and any “sharps” are placed directly into puncture - resistant containers. Do not recap or use two hand technique. Sharps with built-in safety features are used when available.
Contact Precautions
Contact Precautions are designed to reduce the risk of transmission of microorganisms by direct or indirect contact.
Direct-contact transmission involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person, such as occurs when personnel turn clients, bathe clients, or perform other client-care activities that require physical contact.
Direct-contact transmission also can occur between two clients.
Indirect-contact transmission involves contact of a susceptible host with a
contaminated intermediate object, usually inanimate, in the client’s environment.
In addition to Standard Precautions, use Contact Precautions, or the equivalent,
for specified clients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct
contact with the client (hand or skin-to-skin contact that occurs when performing
client-care activities that require touching the client’s dry skin) or indirect contact (touching) with environmental surfaces or client-care items in the client’s
environment.
Contact Precautions: Client Placement, Glove and Handwashing,
Client Placement:
Place the client in a private room.
When a private room is not available, place the client in a room with a client(s) who has active infection with the same microorganism but with
no other infection
Glove:
During the course of providing care for a client, change gloves after having contact with infective material that may contain high concentrations of
microorganisms (fecal material and wound drainage).
Remove gloves before leaving the client’s room and wash hands immediately with an antimicrobial agent or a waterless antiseptic agent. For a client with a C. difficile do not use an alcohol-based, hand rub because it is not effective
on C. difficile. Instead use soap and water.
After glove removal and handwashing, ensure that hands do not touch
potentially contaminated environmental surfaces or items in the client’s
room to avoid transfer of microorganisms to other clients or environments.
Contact Precautions: Gown and Client Transport
Gowns:
In addition to wearing a gown as outlined under Standard Precautions, wear a gown (a clean, nonsterile gown is adequate) when entering the
room if you anticipate that your clothing will have substantial contact with the client, environmental surfaces, or items in the client’s room, or if
the client is incontinent or has diarrhea, an ileostomy, a colostomy, or wound drainage not contained by a dressing.
Remove the gown before leaving the client’s environment.
After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces to avoid transfer of microorganisms
to other clients or environments.
Client Transport:
Limit the movement and transport of the client from the room to essential
purposes only.
If the client is transported out of the room, ensure that precautions are maintained to minimize the risk of transmission of microorganisms to other clients and contamination of environmental surfaces or equipment
Aire Borne Precautions
Airborne Precautions are designed to reduce the risk of airborne transmission of
infectious agents.
Airborne Precautions apply to clients known or suspected to be infected with pathogens that can be transmitted by the airborne route. In addition to Standard Precautions, use Airborne Precautions, for clients known or suspected to be infected with microorganisms transmitted by airborne droplet nuclei or evaporated droplets containing microorganisms that remain suspended in the air and that can be dispersed widely by air currents within a room or over a long distance.
Airborne Precautions: Client Placement
Client Placement:
Place the client in an airborne infection isolation room (AIIR), which is a private room that has: 1) monitored negative air pressure in relation to the
surrounding areas, 2) 6 to 12 air changes per hour, and 3) appropriate discharge of air outdoors or monitored high-efficiency filtration of room air
before the air is circulated to other areas in the hospital.
Keep the room door closed and the client in the room.
Client should have a private room.
When a private room is not available, place the client in a room with a client
who has active infection with the same microorganism but with no other infection.
Airborne Precautions: Resp Protection and Client Transport
Respiratory Protection:
Wear respiratory protection (N95 respirator) when entering the room of a client with known or suspected infectious pulmonary tuberculosis.
Susceptible persons should not enter the room of clients known or vsuspected to have measles (rubeola) or varicella (chickenpox) if other immune
caregivers are available. If they must enter, they should wear a respirator mask
Client Transport:
Limit the movement and transport of the client from the room to essential
purposes only.
If transport or movement is necessary, place a surgical mask on the client
Droplet Precautions
Droplet Precautions are designed to reduce the risk of droplet transmission
of infectious agents.
Droplet transmission involves contact of the conjunctivae or the mucous
membranes of the nose or mouth of a susceptible person.
Droplets are generated from the source person primarily during coughing,
sneezing, or talking and during the performance of certain procedures such as suctioning and bronchoscopy.
Transmission via large-particle droplets requires close contact between source and recipient persons, because droplets do not remain suspended
in the air and generally travel only short distances, usually 3 ft or less, through the air.
Because droplets do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission.
Droplet Precautions apply to any client known or suspected to be infected with pathogens that can be transmitted by infectious droplets.
In addition to Standard Precautions, use Droplet Precautions, or the equivalent, for a client known or suspected to be infected with microorganisms transmitted by droplets.
Place the client in a private room.
When a private room is not available, place the client in a room with a client(s) who has active infection with the same microorganism but with no
other infection.
Droplet Precautions: Mask and Client Transport
In addition to wearing a mask as outlined under Standard Precautions, wear a mask when working within 3 ft of the client. (Logistically, some hospitals may want to implement the wearing of a mask to enter the room.)
Limit the movement and transport of the client from the room to essential purposes
only.
If transport or movement is necessary, place a surgical mask on the client.
Amebiasis/Dysentery
Contact precautions.
Spread through Feces.
Isolated for duration of illness until symptom free.
Bronchiolitis
Contact Precautions (for infants and young children only).
Spread through respiratory secretions.
Duration of illness until
symptom free. If respiratory
syncytial virus (RSV) antigen positive, refer to RSV.
Various etiologic agents have been associated with this syndrome, i.e., respiratory syncytial virus (RSV), parainfluenza viruses,
adenoviruses, influenza viruses.
Chickenpox (Varicella)
Airborne and Contact
Precautions
Airborne droplets and skin lesions are infective
Isolated until all lesions are crusted (at least 5 days after onset of lesions)
Susceptible persons should not enter the room. Persons immune from previous varicella infection may enter the room without a mask. Those immune by vaccination should wear a mask when entering the room. A specially vented room is necessary. The door
to the client’s room should remain closed. The client must wear a mask when leaving their room. Susceptible clients who have been exposed should be placed on Airborne Precautions beginning 10 days after exposure and continuing through day 21 after last
exposure (up to 28 days if VZIG has been given). Clients are
considered infectious 2 days before onset of rash and up to 5 days after onset of lesions. After exposure, use varicella zoster immune
globulin (VSIZ) as recommended by Infectious Diseases Service.
Clostridium difficile enterocolitis
Contact Precaution
Spread through feces
Isolated until symptom- free
Common Cold
Droplet Precautions (for infants and young children only)
Spread through respiratory secretions
Isolated for duration of illness until symptom free
Rhinoviruses are most frequently associated with the
common cold. Infection is usually mild in adults, but may be severe in infants and young children. Other etiologic agents
such as respiratory syncytial virus (RSV) and parainfluenza
viruses may also cause this syndrome.
Conjunctivitis,
viral (acute hemorrhagic)
Contact Isolation
Spread through eye drainage
Isolated until symptom free
Decubitus
ulcer, infected, major
Contact Isolation
Spread through Wound drainage
Isolation depends on the extent and condition of the
ulcer.
Major: No dressing or dressing does not adequately
contain drainage.
Diphtheria: Cutaneous
Contact precautions - Wound Drainage
Isolation until cultures from infected sites are negative for Corynebacterium diphtheriae on two separate days. Collect cultures > 24 hours apart and not sooner than 24 hours after the last dose of antibiotics.
Diphtheria: Pharyngeal
Droplet precautions - Respiratory secretions
Isolation until cultures from infected sites are negative for Corynebacterium diphtheriae on two separate days. Collect cultures > 24 hours apart and not sooner than 24 hours after the last dose of antibiotics.
Ebola
Contact and Droplet Precautions
Infective material is Direct contact through broken skin or mucous membranes (eyes, nose
and mouth) Blood and body fluids Objects contaminated
with Ebola virus (needles/syringes)
Infected animals
Isolated for duration of the illness
Client rooms should have negative pressure and contain their own lab facilities. Those treating clients or entering room should wear PPE: full-body, hazmat suits. Droplet precautions are needed, but health care providers would also wear a
special respirator mask that filters airborne particles, such as an N95 mask. Client needs dedicated medical equipment (preferably disposable)
Epiglottitis
Droplet Precautions
Spread through respiratory secretions
Isolated until 24 hours after
start of effective therapy
Epiglottis is often due to Haemophilus influenzae.
Treatment for both systemic infection and carrier state
is needed.
For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
Escherichia coli gastroenteritis
eropathogenic, enterotoxigenic,
enteroinvasive, entero hemorrahagic
Contact Precautions
Spread through feces
Fifth’s Disease/ Erythema Infectiosum (Parvovirus B19)
Droplet Precautions
Spread through respiratory secretions
Isolated until onset of rash
(not considered infectious after
appearance of rash).
German Measles (Rubella)
Droplet Precautions (does not require room with negative pressure and external exhaust)
Spread through Respiratory
secretions and urine
Isolated for 7 days after onset of rash
Susceptible persons should not enter the room. Persons
immune by vaccination or natural illness may enter the
room without a mask. Susceptible clients who have
been exposed should be placed on Droplet Precautions
beginning 7 days after exposure and continuing through day 21 after last exposure. Clients are considered infectious a few days before to7 days after onset of rash
German Measles - Congenital Rubella
Contact Precautions (does not require room with negative pressure and external exhaust)
Spread through Respiratory secretions and urine
Isolation is required during any admission for the first year after birth, unless nasopharyngeal and urine cultures after 3 months of age are negative for rubella
Susceptible persons should not enter the room. Persons
immune by vaccination or natural illness may enter the
room without a mask. Susceptible clients who have
been exposed should be placed on Droplet Precautions
beginning 7 days after exposure and continuing through day 21 after last exposure. Clients are considered infectious a few days before to7 days after onset of rash.
Haemophilus influenzae, invasive - Epiglottitis
Droplet Precautions
Spread through Respiratory secretion
Isolated until 24 hours after start of effective therapy
Treatment for both systemic infection and carrier state
is needed. For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
Haemophilus influenzae,
invasive - Meningitis
Droplet Precautions
Spread through Respiratory secretion
Isolated until 24 hours after start of effective therapy
Treatment for both systemic infection and carrier state
is needed. For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
Haemophilus influenzae,
invasive - Pneumonia
Droplet Precautions
Spread through Respiratory secretion
Isolated until 24 hours after start of effective therapy
Treatment for both systemic infection and carrier state
is needed. For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
Hand, foot, and
mouth disease
Contact Precautions
Spread through respiratory secretions feces
Isolated for 7 days after onset
Hepatitis, Viral - Type A
Contact Precautions (for diapered or incontinent clients)
Spread through Feces
Isolated for duration of the illness
Herpes Simplex -Mucocutaneous Disseminated
severe or primary
Contact Precautions
Spread through lesion secretions
Isolated until symptom free
Herpes Simplex - Neonatal
Contact Precautions
Isolated until lesions dry and crusted
Herpes Zoster (Shingles) - Disseminated
Airborne and Contact Precautions
Spread through Lesion and respiratory secretions
Isolated until all lesions are crusted
Persons susceptible to varicella should not
enter the room.
Clients who have been exposed should be managed in consultation with Infection
Control.
Impetigo
Contact Precautions
Spread by lesions
Isolated for 24 hours after
start of effective antibiotic therapy.
Influenza
Droplet Precautions
Spread through respiratory secretions
Isolated until symptom free
In the absence of an epidemic, influenza may be difficult to diagnose on clinical grounds.
During epidemics, the accuracy of diagnosis increases. Co-horting of clients may be
considered during periods of high census. Immunization is strongly encouraged for health
care providers and clients at risk for serious complications. Contact Infectious Diseases
Service for recommendations regarding the use of prophylaxis for non-immunized persons.
Lice
Contact Precautions
Spread through infested area
Isolated until effective
treatment has been
completed and room/ personal items adequately disinfected.
Employees with direct contact should be examined for
infestation. Clothing and bedding may be disinfected by machine washing and drying *use hot cycles). Dry cleaning or storing items in a plastic bag for 10 days is also effective. Use of an environmental insecticide is not needed.
Measles ( Rubeola, Red Measles)
Airborne Precautions (use a monitored room with negative pressure and external exhaust)
Spread through respiratory secretions
Isolated for 4 days after onset
of rash. For immunocompromised patients, maintain precautions for
duration of illness.
Promptly notify Infection Control. Susceptible persons should
stay out of the room. All other persons should wear a mask upon entry. A specially vented room is necessary. The client must wear a mask when leaving the room. The door to the client’s
room should remain closed. Susceptible clients who have been exposed should be placed on Airborne Precautions beginning 5 days after exposure and continuing through day 21 after last exposure. Clients are considered infectious 4 days before to 4 days after onset of rash.
Meningococcal pneumonia
Neisseria meningitidis
Droplet Precautions
Spread through respiratory secretions
Isolated until 24 hours after the start of effective therapy
Treatment for both system infection and carrier state is
needed. For recommendations regarding prophylaxis after
exposure, call infectious Diseases Service (for clients and family) and Occupational Health (for employees).
Meningococcemia (meningococcal
sepsis) (Neisseria
meningitidis)
Droplet Precautions
Spread through Respiratory Secretions
Isolated until 24 hours after start of effective therapy
Treatment for both systemic infection and carrier state is
needed. For recommendations regarding prophylaxis after
exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
Meningitis
Haemophilus influenzae, known or suspected
Droplet Precautions
Respiratory secretions
Isolated until 24 hours
after start of
effective therapy
Treatment for both systemic infection and carrier state is
needed. For recommendations regarding prophylaxis after
exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees)
Meningitis
Neisseria meningitis
(meningococcal), known or
suspected
Droplet Precautions
Respiratory Secretions
Isolated until 24 hours
after start of
effective therapy
Treatment for both systemic infection and carrier state is
needed. For recommendations regarding prophylaxis after
exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees)
Meningitis
Viral (aseptic or
nonbacterial)
Contact Precautions ( For infants and young children only)
Feces
Isolated for duration of illness until symptom free
Enteroviruses are the most common cause of aseptic
meningitis.
Mumps
Droplet Precautions (does not require a room with negative pressure and external exhaust)
Feces
Isolated for 9 days after onset of swelling.
Susceptible personnel who have been exposed should be excluded from work from the 12th day after exposure through the 26th day after exposure, or if symptoms develop until 9 days after the onset of parotitis.
Methicillin-resistant Staph. Aureus (MRSA) infection or
colonization
Contact Precautions
Wound drainage and/or secretions/ excretions from
colonized/infected sites
Until 2 cultures obtained after completion of antibiotic treatment are negative on 2 separate days, from all previously colonized/ infected sites (including nasal colonization, if applicable).
Previously positive clients must be placed on Contact Precautions when readmitted to the hospital until repeat cultures are negative as per criteria under “Duration of Isolation.”
Vancomycin resistant
enterococcus (VRE)
Contact Precautions
Wound drainage and/or secretions/ excretions from
colonized/infected sites
Until 2 cultures obtained after completion of antibiotic treatment are negative on 2 separate days, from all previously colonized/ infected sites (including nasal colonization, if applicable).
Previously positive clients must be placed on Contact Precautions when readmitted to the hospital until repeat cultures are negative as per criteria under “Duration of Isolation.”
Necrotizing Fasciitis
Contact Precautions
Rarely spread from person to person. Direct contact through broken skin or mucous membranes (eyes, nose and mouth) Blood and body fluids Objects contaminated with bacteria(needles/ syringes)
Isolated for duration of illness until symptom free and
wounds healed.
Group A strep is considered the most common cause, but can also be caused by Klebsiella, Clostridium, E coli, Staph aureaus and Aeromonas hydrophila. Good wound care is the best prevention. Prompt treatment with IV antibiotics is needed. Patients are usually managed in a burn center or surgical ICU setting.
Pharyngitis
Droplet Precautions (for infants and young children only)
Respiratory Secretions
Isolated until 24 hours after start of effective treatment
Plague (Pneumonic)
Droplet Precautions
If client requires transport, must have mask on.
Pneumonia (Adenovirus)
Droplet and Contact
Precautions (for infants
and young children only)
Respiratory secretions and feces
Isolated until symptom free
Pneumonia (Bacterial)
Droplet Precautions (for infants and young children only)
Respiratory Secretions
Isolated until symptom free
Pneumonia ( Etiology unknown)
Droplet Precautions (for infants and young children only). Use Contact Precautions during RSV season, during an RSV outbreak, or if RSV is in the diagnostic differential. Resume Droplet Precautions if RSV is ruled out.
Respiratory Secretions
Isolated for duration of illness until symptom free. If respiratory syncytial
virus (RSV) antigen
positive, refer to RSV.
Pneumonia ( Haemophilus influenzae)
Droplet Precautions (for infants and young children only)
Respiratory Secretions
Isolated until 24 hours after
start of effective therapy
Pneumonia (Herpes Simplex)
Droplet Precautions
Respiratory secretions
Isolated until symptom free
Pneumonia - Meingococcal
Droplet Precautions
Respiratory Secretions
Until 24 hours after the start of effective therapy
Respiratory syncytial virus (RSV) infection or suspected
Contact precautions
Respiratory secretions
Until symptom free and nasopharyngeal antigen test is negative for RSV (at least 1 week after positive test) on 2 consecutive days.
To avoid the possibility of false-negative test results, the “calgi swab” method should be used to obtain nasopharyngeal
specimens.
Rotavirus infection
Contact Precautions
Feces
Duration of illness and stool study negative for rotavirus on 2 separate days
SARS
Airborne and contact precautions with goggles over eyes
Respiratory droplets
Scabies
Contact Precautions
Infested area
Isolated for 24 hours after
start of effective therapy and
room/ personal items adequately disinfected.
Employee with direct contact should be examined for infestation. Clothing and bedding may be disinfected by machine washing and drying (use hot cycles). Dry cleaning or
storing items in a plastic bag for 10 days is also effective. Use of an environmental insecticide is
not needed.
Scarlet Fever
Droplet Precautions (for infants and young children only)
Respiratory Secretions
Isolated for 24 hours after effective therapy
Smallpox
Airborne and Contact precautions (strict gown/
glove)
Spread through large and small
respiratory droplets, skin lesions, secretions.
Isolated from onset of rash
to separation of scabs (approximately 3 weeks)
Private rooms preferred. In event of large outbreak, clients with same diagnosis can
share respiratory isolation room.
Limit client transport, if necessary, client wears mask
Syphilis
Skin and mucous
membrane, including congenital, primary, and
secondary
Contact Precautions
Lesion secretions, blood, body fluids spread the disease
Isolated for 24 hours after start of effective therapy
Tuberculosis: Pulmonary, confirmed or suspected (sputum smear is AFB positive and/ or chest x-ray appearance strongly suggests active TB, i.e., cavitary lesions; or laryngeal.
Airborne Precautions (use a monitored room with negative pressure and external exhaust)
Spread through Airborne droplet nuclei
A specially vented room is necessary. The door to the patient’s room should
remain closed. Persons entering the room should wear specially fitted NIOSH
approved respiratory protection. The client should leave the room only for
essential purposes, particularly if the client has multidrug-resistant TB. When
leaving the room, the client should wear a high-filtration surgical mask; for
mechanically-supported ventilation, add a bacterial filter to filter the client’’ exhaled air.
Typhoid Fever (Salmonella typhi)
Contact precautions (for diapered and incontinent children)
Spread through feces
Isolated for duration of illness - symptom free
Whooping cough (pertussis)
Droplet Precautions
Spread through respiratory secretions
Isolated for 7 days after start of effective therapy
For recommendations regarding
prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
Zika Virus
Standard/Contact Precautions only - unless in the labor
and delivery setting. Apply practices and personal protective equipment (PPE) to
prevent exposure as indicated by labor and delivery procedure.
Spread through Body fluids
(blood, urine, saliva and amniotic
fluid).
Pregnancy: Men should wait for 6 months after symptoms started (if they get sick) before trying to conceive with their partner. Women should wait at least 8 weeks after travel (or 8 weeks after symptoms started if they get sick) before trying to get pregnant. The waiting period is longer for men because Zika stays in semen longer than in other body fluids.
Patients post exposure should protect themselves for 3 weeks from mosquito bites order to prevent further spread of virus. Zika virus is primarily transmitted through the bite of the mosquito, but sexual transmission has
also been documented. Zika virus RNA has been detected in body fluids (blood, urine,
saliva and amniotic fluid). Zika can also be spread during pregnancy from mother to fetus
causing birth defects. There are no reports of transmission through breastfeeding. CDC
does not recommend Zika virus testing for asymptomatic men, children, or women who
are not pregnant.
Aminoglycosides: Tobramycin (Nebcin),
Gentamycin (Garamycin),
Neomycin, Amikacin
(Amikin), Streptomycin*
Common Uses: Serious gram (-) infections Given parenterally for systemic use. *Generally restricted to TB treatment.
Contraindications:
Renal disease
Hearing impairment
Pregnancy
Interactions: Increased risk of ototoxicity with loop diuretics.
Increased risk of
nephrotoxicity with
furosemide.
MoA: Interferes with protein synthesis in bacterial cells. DisAdvantages: Can cause irreversible ototoxicity and nephrotoxicity. Poorly absorbed from the GI tract. Baseline hearing test recommended
Side Effects:
Confusion Depression,
Numbness Vertigo
Nausea/Vomiting
Adverse Effects: Seizures Ototoxicity Nephrotoxicity Renal failure Anaphylaxis
Interventions: Monitor peak and trough levels. Monitor BUN and Creatinine levels. Increase fluids to 1500-2000 mL per day. I&O Daily weight
Education:
Teach to report headache or dizziness.
Drink adequate fluids.
Antibacterial/Antiprotozoal : Metronidazole
H-pylori/GI tract disorders UTI Septicemia Meningitis
Contraindication:
Pregnancy
Hepatic Disease
PO/IV/Topical
Interactions: Avoid alcohol and alcohol
containing medications
for at least 48 hours after treatment complete.
MoA: Impairs DNA function of susceptible bacteria
Advantages: Dual action on bacteria and protozoa
(parasites).
Side Effects: Dark/reddish brown urine Nausea/vomiting Metallic or bitter taste Headache Dizziness Depression Irritability Insomnia
Adverse Effects:
Thrombophlebitis
Bone marrow suppression
Neurotoxicity
Interventions:
Monitor urine output and color changes
Assess ECG and neuro changes during medication administration
Proper handwashing and hygiene after bowel cleansing.
Education:
DO NOT use alcohol or medications with alcohol for 48
hours after treatment complete.
Teach that urine may turn dark/reddish brown in color
May have metallic or bitter taste in mouth
Use proper hygiene with bowel movements and cleansing
Vancomycin
DOC for MRSA Cellulitis Bone infections Colitis Meningitis
Contraindications:
Pregnancy
Renal disease
PO/IV Interactions: Interacts with some vitamins and herbal products. Avoid use when on Amikacin, gentamicin or streptomycin.
MoA:
It works by killing bacteria or preventing bacterial growth. Best for severe Gram + infections
Side Effects: Dry mouth Muscles cramps Diarrhea Nausea/vomiting Abdominal cramping Headache Flushing Hypotension Tachycardia
Adverse:
Blloody urine - Nephrotoxicity
Loss of hearing - Ototoxicity
Anaphylaxis
Interventions: Monitor peak and trough levels. Infuse over at least 60 minutes on an infusion pump. Monitor BUN and Creatinine levels. Increase fluids to 1500-2000 mL per day. I&O, Daily weight Baseline hearing test recommended
Education: Teach to report headache or dizziness. Drink adequate fluids. Report bloody urine or dizziness, ringing in the ears or loss of hearing
Antihelminthics: Mebendazole (Vermox) Ivermectin (Stromectol) Pyrantel pamoate (Pin-X)
Parasites: pinworms, tapeworms, hookworms, roundworms Trichinosis
Don't use in children under 2 PO Interactions: Effectiveness decreased by some anticonvulsants. Increased absorption with high fat meal.
MoA: Inhibits glucose uptake and degeneration of microtubules in the cell: parasite dies and is excreted.
Advantages: Treatment is easy and usually well tolerated by all requiring medication.
Side Effects:
Diarrhea Abdominal pain
Nausea/vomiting
Dizziness Headache
Adverse:
Seizures (rare)
Intestinal blockage as parasited die
Interventions:
Entire family and close contacts must be treated to prevent reinfestation
Proper handwashing and hygiene with bowel movements
Monitor stools for presence of worms/parasites
Monitor CBC, BUN, Creatinie and liver enzymes during treatment
EDucation:
Teach proper hygiene and cleansing of clothes and
linens to prevent reinfestation.
Infected person should sleep alone until treatment
complete.
Teach to wear shoes when out doors
Teach proper cleansing of fresh fruits and vegetables
Antivirals - HIV : Zidovudine or AZT
Retrovir
HIV/AIDS
Unlabeled uses:
Epstein-Barr virus
Hepatitis B
Contraindications:
Pregnancy
PO/IV/30-60mins
Interactions: Bone marrow depression with antineoplastics. Decreased platelets and granulocytes
MoA: Inhibit viral replication and prevents synthesis of DNA of the HIV virus
Disadvantages:
Does not cure AIDS but will control symptoms: compliance with treatment required.
SIde Effects: Nausea/vomiting Diarrhea Anorexia Flatulence Rash Flushing Headache Dizziness Dyspepsia Insomnia
ADverse Effects: Seizures Hepatomegaly Anemia/Granulocytopenia Anaphylaxis
Nursing Interventions:
Monitor Vital signs and signs of bleeding problems
Monitor CBC, BUN and creatinine closely
Education:
Teach that GI complaints and insomnia resolve after 3-4
weeks of treatment.
Report symptoms of suprainfections
Teach to not take with OTC products like Tylenol or aspirin.
Broad Spectrum Antibiotics: Clindamycin
Oral/Skin Infections
Contraindications:
Pregnancy
Breast feeding
Hepatic Disease
PO/IM/IV/Topical Interactions: Blocked by erythromycin, chloramphenicol. Decreases absorption of kaolin.
MoA: Inhibition of bacterial protein synthesis. These drugs are bacteriostatic and suppress bacterial growth.
Advatages: Can be used to treat MRSA
Side Effects: Dry mouth Muscles cramps Diarrhea Nausea/vomiting Abdominal cramping Headache Flushing Anorexia Rash
ADverse Effects: Pseudomembranous colitis Stevens-Johson syndrome Exfoliative dermatitis Suprainfections
Interventions:
Culture before medication started for accurate results
Monitor Vital signs, urine output and stools
Monitor AST, ALT if on long term therapy
Assess for skin reactions frequently
EDucation: Take with food to reduce GI upset Complete entire course of medication Take with full glass of water Report any symptoms of suprainfections and extreme diarrhea
Cephalosporins: 4 Generations: 1st: cefazolin sodium (Ancef); cephalexin (Keflex) 2nd: cefaclor (Ceclor) 3rd: cefixime (Suprax); ceftriaxone (Rocephin) 4th: cefepime (Maxipime)
Septicemia
UTI’s
Respiratory infections
Skin/bone infections
PO/IM/IV Interactions: Some interact with alcohol. Uricosurics increase the excretion rate of uric acid and can decrease the excretion of cephalosporins causing serum level increase
ADvantages: Usually well tolerated when other antibiotics cannot be administered
Disadvantages: Frequent cross hypersensitivity to penicillins
Side Effects: Nausea/vomiting Diarrhea Anorexia Flatulence Rash Flushing Headache Dizziness Dyspepsia
Adverse Effects: Increased bleeding Nephrotoxicity Seizures Anaphylaxis Leukopenia/Neutropenia
Interventions:
Culture the infected area before medications are started.
Monitor for adverse reactions and/or super infections
Education:
Keep drugs out of reach of children
Report sign of superinfections like mouth ulcers or
anal discharge
Advise use of probiotics when taking medications.
Take medications with food if GI upset occurs
Fluoroquinolones: Ciprofloxacin (Cipro,Septra) Gatifloxacin (Tequin, Zymar) Levofloxacin (Levaquin) Moxifloxacin (Avelox)
Common Uses: Broad spectrum antibiotic Anthrax Respiratory infections Cystic Fibrosis
Contraindications:
Pregnancy
Infants and young
children
PO/IV/Topical
Interactions: Antacids, minerals and multivitamins
interfere with absorption.
Concurrent use with amiodarone, disopyramide. Erythromycin, some antipsychotics and tricyclic antidepressants increases risk of torsade de pointes in susceptible individuals. Concurrent use with
corticosteroids may increase risk of tendon rupture.
Side Effects: Diarrhea Nausea/vomiting, Abdominal pain Dizziness Drowsiness Sleep problems Headache
Adverse Effects: Suprainfection Phototoxicity Cardiotoxicity Tendon/joint toxicity (associated with a small risk of tendon rupture
Interventions:
Monitor I&O
Monitor BUN and creatinine levels
Store medication away from heat, moisture, and direct sunlight
CLient Education:
Take with a full glass of water. Do not take on an empty stomach.
Notify primary healthcare provider of swelling of the face and
throat, swallowing problems, shortness of breath, rapid heartbeat,
tingling of fingers or toes, itching or hives.
Stop taking the medicine immediately if swelling in tendon occurs.
Avoid being in direct sunlight and use a sunscreen; do not use
tanning beds.
Do not take antacids that contain aluminum, calcium or magnesium
Macrolides: Azithromycin (Z-Pak,
Zithromax) Clarithromycin (Biaxin) Erythromycin (Erythrocin)
Broad-spectrum Antibiotic for Pneumonia, pertussis, diphtheria, chlamydia, Group A strep infections.
Interactions: Increases the plasma levels of theophylline, carbamazepine, and warfarin. Conversely, plasma levels of erythromycin can be reduced when used with verapamil, diltiazem, HIV protease inhibitors and azole antifungal drugs. Contraindicated with astemizole, cisapride, pimozide or terfenadine.
MoA: Inhibition of bacterial protein synthesis. These drugs are bacteriostatic and suppress bacterial growth and replication but do not cause microbial death.
Advantages: Good alternative for clients with penicillin
allergies
Side Effects:
Nausea/vomiting
Diarrhea
Abdominal pain
Adverse Effects: Suprainfections Hepatotoxicity Dysrhythmias (prolonged Q-T interval) Ototoxicity Anaphylaxis Pseudomembranous colitis
Interventions:
Administer on an empty stomach -destroyed by gastric acids and acidic fruit juice.
Education:
Notify primary health care provider if prolonged diarrhea
occurs.
For capsule administration, take 1-2 hours before meals.
Direct sunlight (UV) exposure should be minimized during
therapy.
Non-HIV Antivirals : Rimantacine HCL (Flumadine) Oseltamivir phosophate (Tamiflu)
Acyclovir (Zovirax)
Influenza
Herpes viruses
Cytomegalovirus (CMV)
PO/IV Interactions: Decreases effect of phenytoin. Increases nephro-neurotoxicity with aminoglycosides, probenecid and interferon.
MoA: Inhibit viral replication by interferring with viral cell synthesis
Disadvantages: Cannot stop the viral infection but will
reduce the severity of symtoms and length of infection.
Side Effects: Nausea/vomiting Anorexia Diarrhea Headache Agitation Lethargy Rash Pruritis
Adverse: Anemia Crystalluria Nephrotoxicity Thrombocytopenia Leukopenia
Interventions:
Monitor Vital signs and urine output closely
Monitor CBC, BUN, creatinine and liver enzymes
Increase fluid intake to 1500-2000 mL per day
Assess gums for bleeding
EDucation:
Teach proper hydration while taking medications
Report changes in urine output or signs of bleeding
Report CNS changes and safety related to orthostatic
hypotension
Penicillin: Ampicillin (Principen), Amoxicillin (Amoxil, Trimox), Penicillin G (Bicillin), Penicillin V (PenVK), Ampicillin/Sulbactam (Unasyn), Amoxicillin/ Clavulanate (Augmentin), Ticarcillin (Ticar), Peperacillin/ Tazobactam (Zosyn)
Used in: Meningitis Gram (+) infections Respiratory infections Endocarditis Septicemia Otitis media GI infections GU infections
Interactions; Give separately
from aminoglycosides: May inactivate medication
Side Effects: Mild rash Nausea/vomiting Diarrhea Stomatitis Vaginitis
Adverse Effects: Anaphylaxis Glomerulonephritis Bone marrow depression Leukopenia
Interventions:
Administer with water, not acidic juices.
Administer around the clock on empty stomach for better absorption.
I&O
Monitor CBC
EDucation: Take medication with plenty of water 1-2 hours before meals or 2-3 hours after meals).
Report sore throat, fever, fatigue, diarrhea as they may
indicate superinfection
Sulfonamides: Trimethoprim/
Sulfamethoxazole
(Bactrim, Septra)
Sulfisoxazole (Gantrisin)
UTI’s Ear infections Newborn eye prophylaxis Respiratory infections
PO/IV/topical Interactions: Risk of thrombocytopenia with thiazide diuretics; hyperkalemia with other diuretics
MoA: Bacteriostatic - inhibit bacterial synthesis of folic acid which is essential for bacterial growth.
Advantages: Good for client with penicillin allergy
Side Effects: Nausea/vomiting Diarrhea Anorexia Crystalluria Rash Flushing Headache Dizziness Dyspepsia Photosensitivity
Adverse Effects: Nephrotoxicity Hyperkalemia Stevens-Johnson syndrome Anaphylaxis
Nursing interventions:
Increase fluids to 2000-3000 mL per day
Assess I&O, BUN and creatinine regularly
Monitor Vital signs closely
Assess for early signs of anemia or superinfections
Education:
Drink lots of fluid daily when taking medications
Take 1 hour before or 2 hours after meals
Wear sunglasses and avoid direct sunlight
Report any excess bruising or bleeding
Tetracyclines :
Doxycycline (Vibramycin)
Tetracycline (Sumycin)
Broad spectrum use
Respiratory infections
Skin infections
STD/STI’s
Contraindicated in Pregnancy and Hepatic disease
Interactions: Do not take with antacids or calcium products
Side Effects: Nausea/vomiting Diarrhea Abdominal pain Stains teeth Color vision changes
Adverse:
Nephrotoxicity Hepatotoxicity Suprainfections Anaphylaxis Severe Photosensitivity Hyperglycemia
Interventions:
Monitor Vital signs and urine output closely
Monitor liver and renal function lab tests
Avoid antacids and calcium products when taking medication
EDucation:
Teach whether medication prescribed should be taken
with food or without and time frame for best absorption.
Avoid sun and use sunglasses/WEAR LONG SLEEVES
Do not take with milk products, iron or antacids
Take liquid forms via straw to prevent staining of teeth
Do not take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking doxycycline. Absorption will be altered. For instance, iron can bind to doxycycline in the gastrointestinal tract, which may prevent their absorption into the bloodstream and possibly reduce their effectiveness. To avoid or minimize the interaction, iron containing medications and doxycycline should preferably be taken at least three hours apart in most cases.
Take on an empty stomach to maximize absorption, although may not be tolerated unless administered with food.
Antiviral Monoclonal Antibody : Palivizumab (Synagis) RSV Immune globin (RespiGam)
Prevents RSV in premature infants and infants born with certain lung disorders or heart disease.
Contraindications:
Bleeding or clotting
disorders
Low platelet count
IM
MoA: A man-made antibody to respiratory syncytial virus (RSV).
Side Effects: Fever Crying or fussiness Change in appetite or sleeping patterns
Adverse Effects:
Cyanosis
Black tarry stools
Bleeding gums
Interventions:
Dosage is based on weight of infant and must be calculated with
every dose
Education:
Must take it monthly during the RSV season – November
through April
Local reactions may occur to injection: tenderness, hives and
swelling
May interfere with other live vaccines and may need to
revaccinated if taken with 10 months after completed
Biologic: adalimumab
Humira
Crohn’s disease,
Psoriatic arthritis
Rheumatoid arthritis
Sub Q
Interactions: Anakinra (Kineret) also used
to treat rheumatoid arthritis, vaccines
MoA: Biologics work by targeting and blocking the effects of a protein in your body called TNF – alpha. In autoimmune disorders, there
is too much of this protein which can cause the body to attack itself. In rheumatoid arthritis, too much of this protein can cause pain, stiffness and swelling in the joints. In ulcerative colitis or Crohn’s, adalimumab can decrease the symptoms and put the client
in remission
Advantages: Provide very specific targeting of the involved cells
Disadvantages: Expensive and not always covered by
insurance. Significant adverse symptoms.
Side Effects: Headache Nausea Sinus infections Rash at the injection site
Adverse Effects:
Cancers
Sepsis
Fungus and other opportunistic infections
Interventions:
Check for injection site reactions.
Assess for TB prior to therapy
Assess for blood dyscrasias: CBC, differential periodically
Education:
Learn proper administration of med in the thigh, abdomen
and upper arm
Rotate sites at least one inch from old site.
Advise no vaccines
Report signs of infection immediately
Immune Serum : Tetanus Immune
Globulin (Baytet)
Exposure to tetanus
IM/ 2 days
Interactions: These vaccines may not work
as well if received shortly after a tetanus injection: Measles, mumps, rubella
(MMR), poli
MoA: Tetanus immune globulin works by giving your body the antibodies it needs to protect it against tetanus infection. This is
called passive protection. This passive protection lasts long enough to protect your body until your body can produce its own
antibodies against tetanus.
Side Effects: Itching Redness at injection site Anorexia Mild fever Pain at injection site
Adverse Effects: Facial edema Difficulty swallowing Tightness of chest Dyspnea
Interventions
Monitor for signs of significant reaction (eg, wheezing; chest
tightness; fever; itching; bad cough; blue skin color; seizures;
or swelling of face, lips, tongue, or throat).
Education:
Reason for medication
Educate client about signs of a significant reaction (eg, wheezing;
chest tightness; fever; itching; bad cough; blue skin color; seizures;
or swelling of face, lips, tongue, or throat).
Immune System Agents/ Immunosuppressant/ Anti-rejection: tacrolimus (Prograf) cyclosporine
(Sandimmune
Autoimmune
diseases
Prevent organ
transplant rejection
Contraindications: Hypersensitivity Use cautiously in: Diabetes, HTN Hyperkalemia Hyperuricemia
PO/IV Interactions: Aminoglycosides: increased toxicity Antifungals and calcium channel blockers: increase blood levels Vaccines decrease effect
Side Effects: Insomnia Back pain Fever UTI’s Nausea/vomiting Muscle spasms
Adverse Effects: Infection Hypertension Hepatotoxicity Nephrotoxicity Pulmonary edema
Interventions:
Monitor liver functions test: AST, ALT, amylase, and bilirubin
Monitor serum creatinine and BUN and output - 75% of patients will
experience a decrease in urinary output
Watch for anaphylaxis
Monitor blood studies
Education:
Advise to report if pregnancy is planned
Report fever, rash, severe diarrhea, chills, sore throat,
because serious infections can occur.
Report clay colored tools or cramping as it may indicate
hepatotoxicity.
Avoid crowds or persons who are sick to reduce infections.
Avoid eating raw shellfish.
Vaccines - Biologic Response Modifiers (BRMs) : Hepatitis B recombinant viral antigen
HPV recombinant
viral antigen
Prevention of Hepatitis
B which can lead to liver
cancer.
Prevention of cervical, anal,
oropharyngeal cancers;
genital warts
MoA:
Hepatitis B vaccine recombinant is used to prevent infection by the hepatitis B virus. The vaccine works by causing your body
to produce its own protection (antibodies) against the disease. It cannot give you the hepatitis B virus (HBV) or the human
immunodeficiency virus (HIV).
HPV: When a client receives the vaccine, the immune system produces antibodies against these proteins so if the body ever
encounters them again in the form of the actual HPV virus it is well equipped to deal with and destroy the virus.
Advantages:
HPV: Available for both men and women ages
9-26 years of age.
HepB : : Does not treat Hep B
Intervention: Observe client for s/s of adverse reaction to vaccines.
Keep epinephrine readily available for immediate use in case of anaphylactic
reaction.
Provide client with record of immunizations received.
Education:
Discuss vaccine-preventable diseases
Answer questions regarding vaccine safety and efficacy
Advise female clients of childbearing age to avoid
pregnancy for 1 month.
Provide Vaccine Information Statements from CDC
Vaccines and Toxoids:
Tetanus Toxoid
Prevention of tetanus
Contraindications: Hypersensitivity Active infection Poliomyelitis outbreak Immunosuppression Febrile illness
SubQ/IM/2 weeks
Interactions: Increased immunosuppression if given with warfarin, corticosteroids, or cancer chemotherapy drugs
MoA: Vaccines work by causing the body to produce its own protection (antibodies). Tetanus vaccine is usually first given to infants with 2 other vaccines for diphtheria and whooping cough (pertussis) in a series of 3 injections. This medication is usually used as a “booster” vaccine after this first series. Booster injections may be needed at the time of injury in older children and adults if it has been 5-10 years since the last
tetanus vaccine was received. Booster injections should also be given every 10 years even if no injury has occurred.
Disadvantages: Do not use the vaccine on children younger
than 7 years if it has the preservative thimerosal in it, as this may contain mercury
Side Effects: Mild fever Joint pain Muscle aches Nausea Tiredness Pain/itching/redness at injection site
Adverse Effects: Tingling of hands/feet Hearing problems Trouble swallowing Muscle weakness Seizures Swelling of face/tongue
Interventions:
Have epinephrine infection (1:1,000) readily available should an acute
anaphylactic reaction occur.
Monitor for signs of anaphylactic reaction.
Record the date, lot number and manufacturer of the vaccine on the
immunization record
Education:
Make sure the client/parents were fully informed of benefits
and risks of immunization by the PHCP.
Provide a copy of the immunization record with the date, lot
number and manufacturer of the vaccine listed.
Antitubercular agent: Rifapentine
Rifapentine (Priftin), a derivative of rifampin, is an antitubercular agent used with other drugs (eg, isoniazid) as a combination therapy in active and latent tuberculosis infections. Both rifampin and rifapentine reduce the efficacy of oral contraceptives by increasing their metabolism; therefore, this client will need an alternate birth control plan (non-hormonal) to prevent pregnancy during treatment
Clients taking rifampin or rifapentine (Priftin) as part of antitubercular combination therapy should be taught to prevent pregnancy with non-hormonal contraceptives, notify the health care provider of any signs or symptoms of hepatotoxicity (eg, jaundice, fatigue, weakness, nausea, anorexia), and expect red-orange-colored body secretions.
