NURS 133 Metronidazole, Rifaximin, and Bacitracin

jasmine's version from 2016-04-19 14:03

Section 1

Question Answer
Metronidazole An antibiotic that fights bacteria in body; Used to treat bacterial infections of the vagina, stomach, skin, joints, and respiratory tract; It will not treat vaginal yeast infections
Metronidazole actions Disrupts DNA and protein synthesis in susceptible organisms
Metronidazole therapeutic uses bactericidal, trichomonacidal, or amebicidal action. Most notable for activity against anaerobic bacteria
Elimination/Excretion of Metronidazole Partially metabolized by the liver (30-60 percent), partially excreted unchanged in the urine, 6-15 percent eliminated in the feces
Adverse/Side Effects of Metronidazole Seizures, dizziness, headache, aseptic meningitis (IV), encephalopathy (IV), abdominal pain, anorexia, nausea, Stevens Johnson syndrome
Contraindications of Metronidazole Hypersensitivity; Hypersensitivity to parabens (topical only); OB: first trimester of pregnancy
Drug/Food interactions of Metronidazole Cimetidine may decrease metabolism; Phenobarbital and rifampin increase metabolism and may decrease effectiveness; Metronidazole increase the effects of phenytoin, lithium, and warfarin; Disulfiram-like reaction may occur with alcohol ingestion; May cause acute psychosis and confusion with disulfiram. Increase risk of leukopenia with fluorouracil or azathioprine
Medication administration of Metronidazole PO, IV, Topical, Vag
Nursing interventions of Metronidazole Assess for infection at beginning of and throughout therapy; Obtain specimens for culture and sensitivity before initiating therapy; Monitor neurologic status during and after IV infusions; Monitor intake and output and daily weight, especially with patients on sodium restriction; Assess for rash periodically during therapy. May cause Stevens Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia; Giardiasis: monitor three stool samples taken several days apart, beginning 3-4 weeks after treatment; Lab test considerations: may alter results
Client education of Metronidazole Instruct patient to take drug as directed; Advise patients treated for trichomoniasis that sexual partners may be asymptomatic sources of reinfection and should be treated concurrently; Caution patient to avoid intake of alcoholic beverages or preparations containing alcohol during and for at least 3 days after treatment with metronidazole, including vaginal gel; May cause dizziness-caution patient to avoid driving or other activities requiring alertness until response to drug is known; Instruct patient to notify health care professional promptly if rash occurs; Inform patient drug may cause an unpleasant metallic taste; Advise patient frequent mouth rinses, good oral hygiene, and sugarless gum or candy may minimize dry mouth; notify health care professional if dry mouth persists for more than 2 weeks; Inform patient drug may cause urine to turn dark; Advise patient to consult health care professional if no improvement in a few days or signs and symptoms of superinfection develop; Vag: Instruct patient in correct technique for intravaginal instillation; Advise patient to avoid intercourse during treatment with vaginal gel; Topical: Instruct patient on correct technique for application of topical gel; cosmetics may be used after application of gel
Evaluation/Desired outcomes of Metronidazole Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on organism and site of infection; Significant results should be seen within 3 weeks of application of topical gel; Application may be continued for 9 weeks
Potential nursing diagnoses of Metronidazole Risk for infection (indications); Diarrhea (indications)

Section 2

Question Answer
RifaximinAntibiotic that fights bacterial infection only in the intestines; It works differently from other antibiotics due to it passes through the stomach and into the intestines without being absorbed into the blood stream. Due to treating only the intestinal tract, it will not treat infections of other parts of the body; It is used to treat traveler’s diarrhea caused by E. Coli in adults and children who are at least 12 years of age, and also used to treat irritable bowel syndrome in adults whose main symptom is diarrhea. Rifaximin is also used to lower the risk of worsened brain function in adults with liver failure. Brain function can be affected when the liver stops working and cannot remove toxic substances from the body
Rifaximin actions Inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase
Rifaximin therapeutic uses Decreased severity of traveler’s diarrhea. Decreased episodes of overt hepatic encephalopathy
Elimination/Excretion of Rifaximin Almost exclusively excreted unchanged in feces
Adverse/Side Effects of RifaximinDizziness, peripheral edema, pseudomembranous colitis (inflammation of the large intestine resulting from infection with Clostridium difficile, a spore-forming bacterium. It causes an infectious diarrhea called C. difficile associated diarrhea)
Contraindications of Rifaximin Hypersensitivity to rifaximin or other rifamycins; Diarrhea with fever or bloody stools; diarrhea caused by other infections agents; Lactation: Potential for adverse effects in the infant. Switch to formula for duration of treatment. OB: Use only if benefit to mother outweighs risk to fetus; Pedi: Safety not established in children < 18 years of age (hepatic encephalopathy) or < 12 years of age (traveler’s diarrhea)
Drug/Food interactions of Rifaximin Although rifaximin induces the CYP 3A4 enzyme system, since it is not absorbed, drug interactions are unlikely
Medication administration of Rifaximin PO
Nursing interventions of RifaximinTraveler’s diarrhea: Assess frequency and consistency of stools and bowel sounds prior to and during therapy; Assess fluid and electrolyte balance and skin turgor for dehydration; Hepatic encephalopathy: Assess mental status periodically during therapy; Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis-may begin up to several weeks following cessation of therapy; Lab test considerations: may cause lymphocytosis, monocytosis, and neutropenia
Client education of Rifaximin Instruct patient to take rifaximin as directed and to complete therapy; Caution patient to stop taking rifaximin if diarrhea symptoms get worse, persist more than 24-48 hours, or are accompanied by fever or blood in the stool; consult health care professional if these occur. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medicine. Caution patient to avoid driving and other activities requiring alertness until response to medicine is known; Advise female patients to notify health care professional if pregnant or if pregnancy is suspected, or if breast feeding
Evaluation/Desired outcomes of Rifaximin Decreased severity of traveler’s diarrhea; Reduction in risk of overt hepatic encephalopathy recurrence
Potential nursing diagnoses of Rifaximin Diarrhea (indications); Risk for deficient fluid volume (indications)

Section 3

Question Answer
Bacitracin A polypeptide antibiotic produced by a strain of B. subtilis. Administration is topical. Due to systemic administration can cause serious toxicity, and due to superior systemic agents are available, bacitracin is no longer available for systemic infections. Anti-infective combinations including bacitracin are also commercially available in combination with corticosteroids for topical use. However, corticosteroids in topical anti-infective combination preparations may mask clinical signs of bacterial, fungal, or viral infections, or may suppress hypersensitivity reactions to the antibiotics or other ingredients in the formulations; weigh benefits against risks
Bacitracin actions Inhibits synthesis of the bacterial cell wall, thereby promoting cell lysis and death. It damages the bacterial plasma membrane and is active against protoplasts. The drug is active against most gram-positive bacteria. Most gram-negative bacteria are resistant. Acquisition of resistance by sensitive organisms is uncommon. Stops the growth of certain bacteria.
Bacitracin therapeutic uses Antibiotic; Used for topical treatment of bacterial infections. Very active against staphylococci, the pathogens that cause most acute infections of the skin. Due to this activity, it has been marketed in a variety of topical preparations for treatment of skin infections. Many of these preparations contain additional antibiotics, usually polymyxin B, neomycin, or both. Used to prevent minor skin infections caused by small cuts, scrapes, or burns. It only prevents bacterial infections; It will not work for virus or fungus infections
Elimination/Excretion of Bacitracin No longer used IM. If was, 10-40 percent excreted in urine within 24 hours; Bioavailability: Not absorbed to any appreciable extent from intact or denuded skin, wounds, or mucous membranes
Adverse/Side Effects of Bacitracin Rarely, topical bacitracin causes local hypersensitivity reactions. Rash, pseudomembranous colitis, nausea, vomiting; Parenteral (IM) administration, which is no longer done, can produce severe nephrotoxicity
Contraindications of Bacitracin Hypersensitivity; Avoid use in atopic individuals; Lactation: safety and effectiveness unknown
Drug/Food interactions of Bacitracin The effects of some drugs can change if take other drugs or herbal products at same time. Can increase risk for serious side effects or may cause medications not to work correctly. These drug interactions are possible, yet do not always occur.
Medication administration of Bacitracin Topical; Apply ointment or powder topically to cleansed area. May cover affected area with sterile bandage.
Nursing interventions of Bacitracin Assess lesions prior to and periodically during therapy; Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. Lab test considerations
Client education of BacitracinInstruct patient to discontinue and consult health care professional if itching, burning, inflammation, or other signs of sensitivity occur; Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional; Advise patient that topical bacitracin preparations are intended for external use only; Advise patient to avoid contact with eyes and applying it over large areas of the body; Advise patient that first consult a health care professional when considering use for self-medication for deep or puncture wounds, animal bites, or serious burns; Inform patient may cause contact dermatitis or pruritus (severe itching of the skin, as a symptom of various ailments); Advise patient to discontinue use and consult health care professional if condition persists or worsens when used to prevent infection in minor skin injuries (e.g., cuts, scrapes, burns); Advise patient to not exceed use for > 1 week unless directed by health care professional; females: Advise patient the importance of informing health care providers if they are or plan to become pregnant or plan to breast feed.
Evaluation/Desired outcomes of Bacitracin Resolution of infection
Potential nursing diagnoses of Bacitracin Risk for infection (indications)