NURS 133 Vancomycin and Tetracycline

jasmine's version from 2016-04-25 06:31

Section 1

Question Answer
Vancomycin Antibiotic and anti-infective; Fights bacteria in the intestines; Used to treat an infection of the intestines caused by C. diff, which can cause watery or bloody diarrhea; Also used to treat staph infections that can cause inflammation of the colon and small intestines; Drug of choice for treating most MRSA infections
IV use of Vancomycin Treatment of potentially life-threatening infections when less toxic anti-infectives are contraindicated; Particularly useful in staphylococcal infections, including: endocarditis, meningitis, osteomyelitis, pneumonia, septicemia, soft-tissue infections in patients who have allergies to penicillin or its derivatives or when sensitivity testing demonstrates resistance to methicillin; Part of endocarditis prophylaxis in high-risk patients who are allergic to penicillin
PO use of Vancomycin Treatment of staphylococcal enterocolitis or diarrhea due to C. diff
Vancomycin actions Binds to bacterial cell wall, resulting in cell death
Vancomycin therapeutic usesBactericidal action against susceptible organisms; Spectrum: Active against gram-positive pathogens, including: Staphylococci, group a beta-hemolytic streptococci, S. pneumoniae, Corynebacterium, C. difficile, E. faecalis, E. faecium
Elimination/Excretion of Vancomycin Oral doses excreted primarily in the feces; IV vancomycin eliminated almost entirely by the kidneys
Adverse/Side effects of Vancomycin Nephrotoxicity; phlebitis; ANAPHYLAXIS
Contraindications of Vancomycin Hypersensitivity; Use cautiously in OB, Lactation: Safety not established
Medication/Food interactions of Vancomycin May cause additive ototoxicity and nephrotoxicity with other ototoxic and nephrotoxic drugs (aspirin, aminoglycosides, cyclosporine, cisplatin, loop diuretics). May enhance neuromuscular blockade from non-depolarizing neuromuscular blocking agents. Increase risk of histamine flush when used with general anesthetics in children
Medication administration of Vancomycin IV; IT; PO
Nursing interventions of Vancomycin Assess patient for infection; Obtain specimens for culture and sensitivity prior to therapy. Monitor IV site closely; Monitor BP throughout IV infusion; Evaluate eighth cranial nerve function by audiometry; Monitor intake and output ratios and daily weight; Assess patient for superinfection; Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify health care professional immediately if these problems occurs. Keep epinephrine, an anti-histamine, and resuscitation equipment close by in case of an anaphylactic reaction. Pseudomembranous Colitis: Assess bowel status throughout therapy. Lab test considerations: Monitor for casts, albumin, or cells in the urine or decreased specific gravity, CBC, and renal function periodically during therapy
Patient/Family teaching of Vancomycin Advise patient to take as directed; Instruct patient to report signs of hypersensitivity, tinnitus, vertigo, or hearing loss; Advise patient to notify health care professional if no improvement is seen in few days; Patients with a history of rheumatic heart disease or valve replacement need to be taught importance of using antimicrobial prophylaxis prior to invasive dental or medical procedures; Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding
Evaluation/Desired outcomes of Vancomycin Resolution of signs and symptoms of infection. Length of time for complete resolution depends on organism and site of infection; Endocarditis prophylaxis
Potential nursing diagnoses of Vancomycin Risk for infection (indications); Disturbed sensory perception (auditory) (side effects)

Section 2

Question Answer
Tetracycline Antibiotic; Broad spectrum; Used to treat many different bacterial infections, such as urinary tract infections (UTI), acne, rosacea, gonorrhea, chlamydia, and others; Treatment of gonorrhea and syphilis in penicillin-allergic patients; Prevention of exacerbations of chronic bronchitis; Treatment of inhalational anthrax and cutaneous anthrax; Malaria prophylaxis
Tetracycline actions Prevents introduction of new amino acids to the nascent peptide chain; Usually inhibitory and reversible upon withdrawal of the drug; Inhibits bacterial protein synthesis at the level of the 30S bacterial ribosome; Inhibits protein synthesis by blocking the attachment of charged aminoacyl-tRNA to the A site on the ribosome
Tetracycline therapeutic uses Bacteriostatic action against susceptible bacteria. Spectrum: Includes activity against some gram-positive pathogens: B. antbracis, C. perfringens, C. tetani, L. monocytogenes, Nocardia, P. acnes, A. israelii. Active against some gram-negative pathogens: H. influenza, L. pneumophila, Y. enterocolitica, Y. pestis, N. gonorrboeae, N. meningitides. Also active against several other pathogens, including Mycoplasma, T. pallidum, Chlamydia, Rickettsia, B. burgdorferi
Elimination/Excretion of Tetracylines 20-40 percent excreted unchanged by the urine; Some inactivation in the intestine and some enterohepatic circulation with excretion in bile and feces; Can differ with other tetracyclines
Adverse/Side effects of Tetracyclines Dizziness; Vestibular reactions; Hepatotoxicity, pseudomembranous colitis, diarrhea, nausea, vomiting; Drug rash with eosinophilia and systemic symptoms, erythema multiforme, stevens-johnson syndrome, toxic epidermal necrolysis, photosensitivity; Minocycline-thyroid disorders; Minocycline-lupus like syndrome; Doxycycline, minoclycline-phlebitis at IV site
Contraindications of Tetracyclines Hypersensitivity; Some products contain alcohol or bisulfites; avoid in patients with known hypersensitivity or intolerance; OB: risk of permanent staining of teeth in infant if used during last half of pregnancy; Lactation: lactation; OB, Lactation, Pedi: Can be used in children and pregnant and lactating women for the treatment of anthrax (doxycycline only)
Medication/Food interactions of Tetracyclines May increase effect of warfarin. May decrease effectiveness of estrogen-containing hormonal contraceptives. Antacids, calcium, iron, zinc, aluminum, and magnesium for insoluble compounds (chelates) and decrease absorption of tetracyclines. Sucralfate may bind to tetracycline and decrease its absorption from the GI tract; Cholestyramine or colestipol decrease oral absorption of tetracyclines. Adsorbent anti-diarrheals may decrease absorption of tetracyclines. Barbiturates, carbamazepine, or phenytoin may decrease activity of doxycycline. Calcium decreases absorption by forming insoluble compounds (chelates)
Medication Administration of Tetracyclines PO; IV
Nursing interventions of Tetracyclines Assess for infection at beginning of and throughout therapy; Obtain specimens for culture and sensitivity before therapy; Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly; Assess for rash periodically during therapy; May cause stevens-johnson syndrome or toxic epidermal necrolysis. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia; IV: assess IV site frequently; may cause thrombophlebitis; Lab test considerations: Monitor renal and hepatic function and CBC periodically during long term therapy
Patient/Family teaching of Tetracyclines Instruct patient to take med around the clock, and to finish the completely as directed; Advise patient to avoid milk or other dairy products, antacids, zinc, calcium, magnesium- or aluminum-containing meds, sodium bicarbonate, and iron supplements within 1-3 hour; Instruct patient to notify health care professional immediately if rash, diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with anti-diarrheals without consulting health care professional; Advise female to use non-hormonal contraceptive; Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions; Advise patient to report signs of superinfection; Instruct patient to notify health care professional if symptoms do not improve within a few days for systemic preparation; Caution to discard outdated or decomposed med; they may be toxic; Malaria Prophylaxis: Advise patient to avoid being bitten by mosquitoes by using protective measures, especially from dusk to dawn (e.g., staying in well screened areas, using mosquito nets, covering the body with clothing, and using an effective insect repellant)
Evaluation/Desired outcomes of Tetracyclines
Resolution of the signs and symptoms of infection Length of time for complete resolution depends on the organism and site of infection; Decrease in acne lesions; Treatment of inhalation anthrax (post exposure) or treatment of cutaneous anthrax (doxycycline); Prevention of malaria; Reduction in inflammatory lesions associated with rosacea
Potential nursing diagnoses of Tetracyclines Risk for infection (indications, side effects); Non-compliance (patient/family teaching)