The Nature Of Infection Refer to your textbook pg 188-190
Causes
Overgrowth of microorganisms when growth conditions are met
Suppressed immune system
Food source
Oxygen or lack of it
Moisture
Warm environment
pH of 5 to 8 (slightly alkaline)
Dark environment
Microorganisms
Bacteria
Aerobic-must have oxygen
Anaerobic bacteria-thrives in spaces without oxygen
Fungi
Protozoa
Rickettsia
Viruses
Watch this video of different microorganisms under a microscope. Click Here
Transmission of microorganisms
Body fluids
Touch
Contact with contaminated equipment
Inhalation
Control measures Refer to your textbook pg 204-206
Effective handwashing
Proper disposal of contaminated materials
Proper cleaning of equipment
Appropriate use of isolation precautions
Signs and symptoms-not as prominent in the elderly
Elderly are at increased risk because of: Refer to your textbook pg 190-192
Decline in function of body systems due to aging process
Less clear signs and symptoms of infections
Co-existing diseases
Urinary retention
Decline in subcutaneous tissue, less protection from injury
Environment--exposure to infections (nosocomial)
Exposure to other elderly residents and staff who may have infections
Signs and symptoms of localized infection:
Local redness
Pus formation
Warmth
Swelling
Pain
Limitation of movement
Signs and symptoms of infections (general):
General decline
Increasing weakness
Headache
Confusion
Temperature elevation (fever)
Nausea, vomiting and diarrhea
Chills and sweating
Systemic anti-infective agents
Bactericidal (kills most bacterial microorganisms)
Bacteriostatic (prevents bacterial microorganisms from multiplying so that the body's immune system can kill the microorganism)
Broad-spectrum (kills many different microorganisms)
Microbe-specific (narrow-spectrum, kills only a few different microorganisms)
Resistance (render anti-infective ineffective; caused by overuse of antibiotics, not taking medications as instructed)
Hypersensitivity/allergic-a reaction to the drug. Do not give a medication to a resident who is sensitive to the drug or drugs of similar class. Notify supervisor for instruction.
Mild-rash, nausea and vomiting. Document observations, notify licensed nurse supervisor.
Severe-anaphylactic shock and death. Emergency situation-notify licensed nurse supervisor immediately, provide respiratory and cardiac support as instructed, trained.
Antibiotics-Class of Medication Refer to your textbook pg 192
Note ways to increase effectiveness and avoid sensitivity reactions. Note interactions with food or other drugs, contraindications, and special nursing care.
Penicillins (bactericidal)-used in bacterial infections where microorganism is susceptible to being killed or reproduction limited/impaired by drug. Refer to your textbook pg 195
Drug-food. Food decreases absorption of penicillin. Ampicillin (give 1 hour before or 2 hours after a meal).
Drug-drug. Allopurinol increases incidence of rash.
Cephalosporins-related to penicillins (bactericidal)-used in bacterial infections when microorganism is susceptible to being killed or reproduction/limited/impaired by drug. Refer to your textbook pg 196
Cephalexin (Keflex)
Cefaclor (Ceclor)
Cefadroxil (Duricet)
Cefpodoxime (Vantin)
Cefprozil (Cefzil)
Cefuroxime (Ceftin)
cefdinir (Omnicef)
ceftriaxone (Rocephin)
Nursing care and side effects:
Dizziness, headache, fatigue, diarrhea
Resident with impaired kidney function may require lower doses to avoid toxicity because of the slowed "renal clearance”.
Superinfections (other microorganisms may overgrow) of microbes such as fungus and/or other bacteria.
Drug-drug.
Antacids may reduce serum levels (especially Cefaclor)
H₂ antagonist (Pepcid) may decrease serum level.
Loop diuretic (Lasix or Bumex) may increase risk of nephrotoxicity.
May create a false positive reaction for urine glucose.
Sulfonamides-bacteriostatic Refer to your textbook pg 198-199
Sulfisoxazole
Sulfamethoxazole (Gantanol)
Trimethoprim and Sulfamethoxazole (Bactria)
Nursing care and side effects:
Headache, tinnitus, vertigo
Nausea, diarrhea
Hypersensitivity-can appear as much as 7 days after course of therapy completed.
Should be administered by drinking 8 ounces of water.
Should maintain at least 1500 cc fluids/day.
Fluoroquinolones-broad-spectrum antibacterial
Ciprofloxacin (Cipro)
Norfloxacin (Noroxin)
Ofloxacin (Floxin)
levofloxacin (Levaquin)
Nursing care and side effects:
Resident should drink sufficient fluids to assure hydration, kidney function, and urinary output.
Resident may be sensitive to sunlight (photosensitive) during and several days following drug use.
Resident with renal function impairment may require a lower than usual dose to avoid toxicity because of the slowed renal clearance.
Superinfections (other microorganisms may overgrow) of microbes such as fungus and/or other bacteria.
Physical symptoms of side effects may be: headache and dizziness; nausea, vomiting and diarrhea; skin rash (may indicate allergy to medication).
Drug-drug.
Antacids bind with the drug.
Cimetidine (Tagamet) may interfere with the elimination of this class.
May affect digoxin levels.
May increase clot-forming time.
May slow the elimination of theophylline, making blood levels of theophylline higher.
Drug-food
Decreased absorption when given with food.
Dairy products bind with the drugs similar to antacids. Avoid co administration.
Give 2 hours before or 6 hours after antacids, sucralfate, and products containing iron or zinc.
Tetracyclines-bacteriostatic. Refer to your textbook pg 196-197
Tetracycline (Sumycin)
Doxycycline (Vibramycin)
Minocycline (Minocin)
Nursing care and side effects:
Resident may be sensitive to sunlight (photosensitivity).
Minocycline may cause dizziness.
Resident with renal function impairment may require a lower than usual dose to avoid toxicity because of the slowed renal clearance.
Superinfections (other microorganisms may overgrow) of microbes such as fungus and/or other bacteria.
Physical symptoms of side effects may include: nausea, vomiting, diarrhea.
DO NOT use if outdated.
Drug-drug interactions.
Antacids-decrease the absorption of the class
Anticoagulants-may increase clot-forming time
Cimetidine (Tagamet)-decreases absorption of tetracyclines
Digoxin-serum level of digoxin may be increased
Iron preparations decrease the absorption of tetracyclines
Drug-food interactions.
Dairy products may decrease (by 50%) the absorption of tetracyclines (not minocycline or doxycycline).
Must be given on empty-stomach-either one hour before, or, two hours after meals.
Aminoglycosides-bactericidal Refer to your textbook pg 198
Tobramycin (Nebcin) (IV)
Gentamicin (Garamycin) (IV)
Kanamycin (Kantrex) (oral)
Neomycin
Nursing care and side effects:
Resident with renal function impairment may require a lower than usual dose to avoid toxicity because of the slowed renal clearance. Keep resident well hydrated.
Ototoxic-increases with increase in dose.
Macrolides, lincomycin, and clindamycin-bacteriostatic or bactericidal, depending on drug concentration. Refer to your textbook pg 197
Clarithromycin (Biaxin)
Azithromycin (Zithromax)Erythromycin (E-Mycin, EES, Ery-Tab)
erythromycin (E-Mycin, EES, Ery-Tab
Nursing care and side effects:
Monitor for abdominal pain or discomfort (somewhat dose related in susceptible patients), nausea, vomiting, diarrhea, and headache.
Drug-food.
Food delays absorption of Clarithromycin.
Food increases absorption of Azithromycin.
Miscellaneous Antibiotics
Vancomycin-bactericidal against enterococci, microorganisms that are resistant to other antibiotics.
Nursing care and side effects:
Ototoxic-transient or permanent.
Resident with renal function impairment may require a lower than usual dose to avoid toxicity because of the slowed renal clearance. Should avoid giving multiple types of hepatotoxic drugs.
Superinfection
Metronidazole (Flagyl)-bactericidal (particularly with anaerobic infections, gynecologic infections), amebicide.
Protostat
Nursing care and side effects:
Can cause urine to darken.
GI symptoms (nausea, vomiting and diarrhea)
Headache, dizziness, in coordination
Alcohol can cause severe GI distress.
Antiviral Drug-work in different ways to intervene in the viral attachment to the host cell, inhibiting cellular receptor or factor required for replication, or blocking enzymes essential for viral replication. Refer to your textbook pg 201-203
Common adverse reactions, especially severe headache, nausea, insomnia, and myalgia.
Antifungal Agents-work to suppress fungal infections. Refer to your textbook pg 200-201
Amphotericin B
Ketoconazole (Nizoral)
Fluconazole (Diflucan)
Itraconazole
Nursing care and side effects:
Hepatotoxicity
Allergic or hypersensitivity reactions
May have significant interactions
Terbinafine HCL (Lamisil)
Pay close attention to your textbook pg 208-209 189-191 regarding Representative Antimicrobials
Also complete the Ch. 7 review on pg 213-217 193-196. You do not need to hand in your answer to your instructor. This is for your study purposes only.
Review the practice procedure in your textbook pg 210-211 191-192 on administering medications to an isolation patient.
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Please view the Powerpoint slide show on Antibiotics and Antifungals.
Don’t forget to participate in the discussion board topics 7-9 for Unit 3 if you have not yet done so.
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Unit 21
