treatment of infection part 1 Flashcards
what is infection?
an infection occurs when microorganism invades a host, attaches to host cell receptors, and multiples to a sufficient number to cause injury
infection stimulates…
bodies immune response
what can cause infection?
- bacteria
- viruses
- fungi
- parasites
we have lots of bacteria in our body, it only becomes a problem when…
they invade spaces they dont belong
ex. ecoli
what are the systemic signs/symptoms of infection
- fever
- chils
- sweats
- diffuse myalgia (muscle aches)
- tachycardia
- fatigue, malaise, lethargy
- tachypnea
- altered mental status
- hypotension (worst - septic shock)
what are the local signs/symptoms of infection
- pain
- erythema (or other discoloration)
- edema
- heat
- exudate (can be from wound or coughed up)
what labs can be expected for signs/symptoms of infection
- cultures (blood/urine/sputum) to see what pathogen is in there
- increased or decreased WBC
what host factors may increase risk of infection
- imapaird skin integrity (first way to prevent pathogens from entering)
- impaired blood supply (need to get those WBCs in there)
- neutropenia (low WBC)
- malnutrition (need proteins, vitamins, and nutrients)
- poor hygiene
- suppression of normal bacterial flora
- immune system supression
- diabetes mellitus (creates environment pathogens love)
- advanced age
name some common bacteria and what they cause
- streptococcus pneumoniae (pneumonia)
- E. coli (UTIs)
- staph aureus (skin infections and open wounds)
describe streptococcus pneumoniae
seen a lot in pneumonia, usually occurs when patient doesn’t have a good cough reflex so they cant expel the bateria
describe E coli
- normal flora in the intestinal tract
- in other parts of the body it is a pathogen
- frequently seen in UTIs and enters the urinary tract though stool
describe staph aureus
- part of our normal flora of the skin and resp track
- spreads by direct contact with people who are infected or carriers
- causes skin infections and may occur in open wounds
what are some general principles of antimicrobial therapy
- match the right drug to the right bug
- empriric (broad spectrum) versus definitive (narrow spectrum) = use broad spectrum only until we found out what is causing the infection because it can kill normal flora and cause super infection)
- sometimes combination needed
- account for host characteristics
- benefit the individual and community
- watch for improvement in s/sx once drug started(first 24-26hrs are crucial, if symptoms are not improving it may be a resistant bacteria)
what are the steps to accurate diagnosis
1) obtain exposure history (school/work/travel)
2) determine site of infection (may be difficult)
3) define the host characteristics
4) establish a microbial diagnosis (get a culture and figure it out)
what should you always do before starting antibiotics
get cultures
describe the nursing process for infection treatment
- assessment of signs/symptoms of the infection
- assess allergies (lots of antimicrobials can cause reactions)
- assess for advers reactions
- patient education
whats important to include in patient education for antimicrobials
- infection control practices
- diet
- take all prescribed doses (only stop if provider says to)
- discard all discontinued drugs
- what side effects to expect
- report allergic reactions
name the most common adverse reactions to anti-infective therapy
- kidney damage(can make crystals that block urine flow - stay hydrated)
- neurotoxicity(range from mild ototoxicity to complete neuromuscular block or seizures)
- hypersensitivity reactions
- GI toxicity (more of a side effect, seen especially with oral antibiotics, N/V/D)
- superinfections (occurs when we wipe out our normal flora, usually caused by broad spectrum, yeast infections and cdiff are possible)
the nurse is planning to administer an anti-infective agent to the patient. the nurse knows treatment is effective when what occurs?
improvement in symptoms
we want to see improvement in symptoms in 24-36 hours after the antibiotic is started. if symptoms do not improve, we are worried about antibiotc resistance
describe aminoglycosides and what they are used for
- super potent anitmicrobial
- often used in combination therapy
- narrow therapeutic index
- used for severe infections like sepsis, resp/urinary tract, and intra abdominal
give examples of aminoglycosides
- Gentamicin
- Neomycin
- Amikacin
- Tobramycin
- Streptomycin
gentamicin is most common
what are some adverse effects of aminoglycosides
- black box warning for nephrotoxicity and ototoxicity
- CNS effects = peripheral neuropathy
- renal effects
- GI effects = N/V
- cardiac effects = edema
describe the black box warning for aminoglycosides
black box warning for nephrotoxicity and ototoxicity
drug accumulates in inner ear and renal tubules which causes the toxicity
nephrotoxicity may cause oliguria and increased BUN/Cr and is more likely to occur if pt has had renal impairment in the past, although this should resolve after drug is discontinued
ototoxicity may not be reversible
what are some contraindications/cautions for aminoglycosides
- renal/hepatic dysfunction
- pre-existing hearing loss
- active infection w/ herpes
- myasthenia gravis/paskinsonians
- pregnancy
what are some nursing considerations for aminoglycosides
- if given with penicillin, do not mix meds and give penicillin 1hr before or after the aminoglycosides
- monitor urinalysis, BUN/Cr
- appropriately timed peak (30 min after drug is finished) and trough (right before next dose) concentrations
- watch infection signs and symptoms
- hearing
describe beta-lactam antibacterial agents
- widely prescribed group of antibiotics
- need intact beta-lactam ring for drugs to work
- often combined with beta-lactamase inhibitor
bactrim and augmentin
name the four subclasses of beta-lactam antibacterial agents
- carbapenems
- cephalosporins
- monobactams
- penicillin
beta-lactam antibacterial agents
name some carbapenems
- meropenem (most commonly used)
- ertapenem
- imipenem
beta-lactam antibacterial agents
what are some adverse effects of carbapenems
- GI: associated with pseudomembraneous ulcerative colitis
- CNS: can cause seizures
- renal: can cause kidney damage
- superinfections: associated with cdiff
beta-lactam antibacterial agents
what are some cautions/contraindications of carbapenems
- kidney dysfunction
- inflammatory bowel disease
- no IM in severe shock or AV block (Im contains lidocaine)
- known carbapenum/penicillin/cephalosporin allergies (cross sensitivity
beta-lactam antibacterial agents
what are some nursing considerations for carbapenems
- monitor EKG
- IM give with lidocaine (very painful)
beta-lactam antibacterial agents
name some cephalosporins
- cefazolin
- cephalexin
- cefuroxime
- ceftreixone
- cefepime
- ceftaroline
beta-lactam antibacterial agents
what are some adverse effects of cephalosporins
- GI
- renal
- bleeding risk (depletes vitamin K in normal gut flora)
- superinfections
beta-lactam antibacterial agents
what are soem contraindications/cautions with cephalosporins
- known cephalosporing/penicillin/carapenem allergies
- renal dysfunction (adjust dose)
beta-lactam antibacterial agents
what are some nursing considerations for cephalosporins
- monitor CBC
- monitor patients on anticoagulants
beta-lactam antibacterial agents
what is the only monobactum?
aztreonam
beta-lactam antibacterial agents
how is aztreonam administered?
IV, IM, or inhalation(for cystic fibrosis)
beta-lactam antibacterial agents
what are the steps to aztreonam inhalation
- bronchodilator first
- wait 30mins
- mucolytic second
- wait 30mins
- aztreonam
beta-lactam antibacterial agents
is there cross allergy between aztreonam and other beta-lactams?
nope
beta-lactam antibacterial agents
what are some adverse reactions to aztreonam
- rash
- GI (pharyngeal pain)
- loacalized thrombophlebitis (hard on veins)
beta-lactam antibacterial agents
name some penicillins
- penicillin
- amoxicillin
- ampicillin
- pipacillin (with tazobactam)
beta-lactam antibacterial agents
what are some adverse effects of penicillins
- hypersensitivy: highest risk of hypersensitivity reaction
- GI
- renal: interstitial nephritis
- CNS: confusion, lethargy, seizures, coma
beta-lactam antibacterial agents
what is the black box warning for penicillins?
penicillin G when given accidentally can lead to cardiac arrest
beta-lactam antibacterial agents
what are some contraindications/cautions for penicillins
- allergies to penicillin/cephalosporins/carapenems
- renal dysfunction
beta-lactam antibacterial agents
what are some nursing considerations for penicillins?
ig given with aminoglycosides…
do not mix meds and give penicillin 1hr before or after the aminoglycoside
name some fluoroquinolones
- ciprofloxacin
- levofloxacin
what is the black box warning for fluoroquinolones
tendonitis, tendon rupture
what are some adverse effects of fluoroquinolones
- CNS: muscle weakness
- GI
- endocrine: hyper or hypo glycemia in diabetics
- skin: very severe photosensitivity
- cardiac: QT prolongation
who is at a higher risk for adverse effects with fluoroquinolones and what is done about them?
patient over 60yrs with comorbidities
complications of this med are really shitty so drug needs to be d/c asap to have the reactions stop but they could be permanent and debilitating
what are some contraindications/cautions with fluoroquinolones
- allergy
- renal dysfunction
- myasthenia gravis
- not for patients <18 years
- QT prolonging meds
what are some nursing considerations for fluoroquinolones
- educate on suncreen and wearing long sleeves
- monitor EKG/QT
- monitor blood glucose
the patient is receiving ciprofloxacin. the is most concerned if the patient complains of which of the following symptoms?
1) diarrhea
2) achilles tendon pain and redness
3) blood glucose of 100
4) urine output 500cc in 8hrs
2) achilles tendon pain and redness
fluoroquinolones can cause tendon reupture which is a serious adverse reaction
the patient is receiving gentamicin. the nurse is most concerned with which of the following complaints?
1) diarrhea
2) numbness and tingling in the extremities
3) tinnitus and difficulty hearing
4) temp 36C
3) tinnitus and difficulty hearing
black box warning for aminoglycosides is ototoxicity
