Mycobacterial, Fungal, and Parasitic Infections

Question 1

What are acid-fast bacteria?

Answer 1

These are bacteria that cause TB

called that because of the staining technique used to identify them

Question 2

What is the big issue with TB treatment? How long can it take?

Answer 2

TB is very slow growing

This means that treatment takes longer (up to 24 months)

Question 3

With the longer term treatment for TB what does this increase the risk of?

Answer 3

Toxicity

poor client adherence

resistance to develop (bacteria)

Question 4

What is the therapeutic response of antimycobacterials?

Answer 4

bacteriostatic by inhibiting bacterial protein synthesis; indicated for active and inactive TB

Question 5

What is another first line antimycobacterial other than INH?

Answer 5

rifampin (Rifadin)

Question 6

Will multiple antimycobacterial drugs be used simultaneously during treatment sometimes?

Answer 6

YES YES YES (3-4 usually)

Question 7

What are some adverse effects of antimycobacterials?

Answer 7

peripheral neuropathy (from B6 (pyridoxine) deficiency) - INH

hepatotoxicity - both

hyperglycemia in diabetics - both

doscolored bodily fluids - Rifampin

Question 8

What are some nursing considerations for antimycobacterials?

Answer 8

Take multivitamin with 50-200mg B6 daily (INH peripheral neuropathy)

monitor liver function and report symptoms of dysfunction (both)

monitor BG in diabetics (both hyperglycemia)

discolored body fluids is harmless (Rifampin)

Question 9

What are some patient teaching points for antimycobacterials?

Answer 9

THE USUAL!!

avoid alcohol (both)

report signs of liver failure… abd pain, jaundice, n/v, decreased appetite (both)

take B6 daily (INH)

body fluid changes are harmless (Rifampin)

take 1 or 2 hours before meals on empty stomach (both)

Question 10

What is the desired outcome of antimycobacterial treatment?

Answer 10

resolution of symptoms

AND

3 negative sputum cultures (usually takes 3-6 months)

Question 11

What is the therapeutic outcome of antiprotozoals?

Answer 11

cell death resulting in relief of symptoms

BROAD SPECTRUM (SUPRAINFECTION RISK)

Question 12

What are antiprotozoals used to treat?

Answer 12

protozoal infections (giardiasis (STI), trichomoniasis (STI), C. diff)

Question 13

What are some adverse effects for antiprotozoals?

Answer 13

n/v

dry mouth

METALLIC TASTE

CNS - HA, ataxia, peripheral neuropathy

darkening of urine - harmless

Question 14

What are some nursing considerations for antiprotozoals?

Answer 14

report n/v, dry mouth, metallic taste

report and stop taking medication if CNS symptoms arise (HA, ataxia, peripheral neuropathy)

darkening of urine is harmless (make sure patient knows)

Question 15

What are some patient teaching points for antiprotozoals?

Answer 15

THE USUAL

avoid with alcohol - disulfiram reaction!

Question 16

What is the therapeutic action of antifungals?

Answer 16

fungacidal or fungastatic depending on the drug and fungus.

Question 17

What are some adverse effects for antifungals?

Answer 17

hepatotoxic

irregular menstrual cycles, gynecomastia, erectile dysfunction

Question 18

What are some nursing considerations and patient teaching points for antifungals?

Answer 18

monitor and report signs of liver dysfunction

monitor and report irregular menstrual cycles, gynecomastia, and ED

Question 19

What is amphotericin B? What is it used for?

Answer 19

a fungacidal (antifungal) that is reserved for life-threatening infections because of its toxicity.

ONLY GIVEN IV IN THE HOSPITAL

Question 20

What are some adverse effects of amphotericin B?

Answer 20

nephrotoxicity

bone marrow suppression

hypokalemia

Question 21

What are some nursing considerations for amphotericin B?

Answer 21

monitor and report signs of nephrotoxicity (labs,urine output), administer 1-2L of fluids on days of administration

monitor baseline CBC and monitor CBC weekly, monitor for bleeding, bruising, and signs of infection as well (bone marrow suppression)

Monitor and administer potassium supplements as ordered (hypokalemia)

Question 22

What are two things we have to worry about that have to do with administration of amphotericin B? What is the best way to prevent these?

Answer 22

INFUSION REACTION (fever, chills, rigidity, HA) 1-3 hours after infusion has begun) pretty common… - infuse over 2-4 hours (nurses sometimes stay in patients room for whole infusion while charge nurse cares for nurses other patients), administer a 1mg test dose through IV slowly, pretreat with antihistamines or acetaminophen.

Thrombophlebitis at infusion site - closely monitor for erythema and swelling, use a large vein or central line for administration.

Question 23

if an infusion reaction happens with amphotericin B, what should the nurse do?

Answer 23

Stop the infusion and wait for further orders from the doctor, usually meperidine (Demerol), dantrolene (Dantrium), and hydrocortisone are given to reduce symptoms.