Antibiotics: Exemplars

Terms in this set (40)

assess:
- possible contraindications of precautions: known allergy (obtain specific information about the nature and occurrence of allergic reactions); history of liver disease; history of renal disease; and current pregnancy or lactation status
- physical assessment baseline
- skin for rashes or lesions
- specimens for C&S testing from site of infection
- temperature
- orientation, affect, and reflexes
- liver and renal function test values
- baseline ECG

check C&S reports to ensure right drug is being used

monitor hepatic and renal fx tests before therapy to reduce dose as necessary

ensure pt receives full course of abx as prescribed to eradicate infection and prevent resistance

ensure pt swallows tablet whole - do not cut, crush, or chew - to ensure therapeutic dose

monitor site of infection and presenting s/sx (e.g., fever, lethargy, urinary tract s/sx) throughout tx as failure of these to resolve may indicate need for reculture

arrange to continue drug therapy for at least 2 days after all s/sx resolve to prevent resistance

provide small, frequent meals as tolerated to ensure adequate nutrition w/ GI upset

provide frequent mouth care and ice chips or sugarless candy for relief of discomfort if dry mouth is present

provide adequate fluids to replace fluid lost w/ diarrhea

ensure ready access to bathroom facilities in case of diarrhea

institute safety measures to protect from injury in case of CNS effects

arrange for appropriate tx of superinfections as needed

provide pt teaching:
- take safety precautions, including changing position slowly and avoiding driving and hazardous tasks, if CNS effects occur
- try to drink a lot of fluids and maintain nutrition (very important) even though N/V/D may occur
- report difficulty breathing, severe headache, severe diarrhea, severe skin rash, and mouth or vaginal sores

evaluate:
- pt response to drug (resolution of bacterial infection)
- adverse effects (orientation and affect, GI effects, superinfections)
- effectiveness of teach plan (pt can came drug, dosage, possible adverse effects to expect, and specific measures to help avoid adverse effects)
- effectiveness of comfort and safety measures and compliance w/ regimen
CHILDREN:

very sensitive to the GI and CNS effects w/ more severe reactions
- monitor the hydration and nutritional status closely w/ drug-induced diarrhea, anorexia, N/V
- monitor for superinfections such as thrush that make eating and drinking difficult

many abx do not have proven safety and efficacy in pediatric use and extreme caution should be used
- fluoroquinolones are damaging to developing cartilage
- tetracyclines have adverse effects on growing bones and teeth

pediatric dosages of antibiotics should be double-checked

abx tx of ear infections is controversial w/ current research suggesting use of decongestants and anti-inflammatories may be just as successful w/o the risk of developing resistant strains

parents, not wanting to see their child sick, may demand abx as a cure-all whenever their child is fussy or feverish so parent education is important


ADULTS

many believe abx are a cure-all so it is important to explain abx are only useful against specific bacteria and can cause problems when used unnecessarily for viral infections such as the common cold

need to be cautioned to take entire course of med as prescribed and not to store unused pills for future infections or share abx

pregnant or breastfeeding women should not take abx unless benefit clearly outweighs potential risk to fetus or infant
- tetracyclines cause pitting of enamel in developing teeth and calcium deposits in growing bones

many abx interfere w/ the effectiveness of hormonal contraceptives and women of childbearing age should be advised to use barrier contraceptives


OLDER ADULTS

often don't present w/ the same s/sx of infections so assessing problem and obtaining appropriate specimens is especially important

may be more susceptible to adverse effects from abx tx
- monitor hydration and nutritional status closely
- assess the need for safety precautions w/ CNS effects

if hepatic or renal dysfunction is expected (e.g., very old, alcohol dependency, taking hepatotoxic or nephrotoxic drugs) the dose may need to be lowered and the pt should be monitored more frequently

caution to complete the full course of drug therapy even when they feel better and not to save pills for self-medication in the future
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