Chapter 8

Vancomycin

An antibiotic that interferes with cell wall synthesis in susceptible bacteria. Indicated for: Used in patients who are intolerant to or allergic to penicillin and/or cephalosporins and in the treatment of patients with staphylococcal infections that no longer respond to penicillin or cephalosporins. Prophylaxis against bacterial endocarditis *Highly toxic - reserved for very special situations* Adverse Effects: Renal failure, ototoxicity, superinfections, "red man syndrome" (characterized by sudden and severe hypotension, fever, chills, paresthesias and erythema or redness of the neck and back) Available: IV, oral When it is the only antibiotic that is effective against a specific bacteria, however, the benefits outweigh the risks. *Page 91*

Bacitracin

An antibiotic that interferes with the cell wall synthesis of susceptible staphylococcal bacteria. Adverse Effects: Nephrotoxicity, and superinfection Indicated for: Respiratory infections in infants, eye infections, prevention of minor skin infections Available: IM, Ophthalmic, Topical *page 90*

Chloramphenicol

An older antibiotic prevents bacterial cell division in susceptible bacteria. *Because of the potential toxic effects of this drug its use is limited to serious infections for which no other antibiotic is effective* Adverse Effects: "gray syndrome" in neonates and premature babies (characterized by abdominal distention, pallid cyanosis, vasomotor collapse, irregular respirations, and even death), bone marrow depression, including aplasmic anemia that can result in death Seen with the use of ophthalmic and otic forms Available: IV *Page 94*

Polymyxin B

An older antibiotic that uses a surfactant-like reaction to enter the bacterial cell membrane and disrupt it, leading to cell death in susceptible gram-negative bacteria. Available: IM, IV, Intrathecal, Ophthalmic Adverse Reactions: nephrotoxicity, neurotoxicity (facial flushing, dizziness, ataxia, paresthesias, and drowsiness), drug fever and rashes

What would contribute to drug resistance?

Antibiotic prescription for viral illness *page 92*

A client comes to the clinic reporting mouth sores hat appear consistent with an oral yeast infection. The nurse should question the client about recent use of:

Antibiotics *page 95*

Broad-Spectrum

Antibiotics that are effective against a wide range of bacteria

Narrow-Spectrum

Antibiotics that are effective only against very selective bacteria

A client has been taking antibiotics at home for the treatment of a respiratory infection for the past 6 days, and there is no evident improvement in the infection. Which nursing assessment is most appropriate?

Assess the client's adherence to the medication regimen *page 92*

The nurse is preparing to administer a new anti-infective to a client. The nurse should prioritize what assessment?

Assessment for allergic reaction

Administration of what type of antibiotic by the nurse would be most likely to cause a superinfection?

Broad spectrum

A client is admitted to the hospital with elevated temperature, chills, cough, and fatigue. The health care provided orders a chest x-ray, which indicates pneumonia. The blood cultures also come back positive for a Gram-negative bacillus. The provider orders two antibiotics to be given to the client, one for Gram-negative organisms and one for Gram-positive organisms. Why does the provider not prescribe just one antibiotic for both types of bacteria?

Broad-spectrum antibiotics can cause antibiotic resistance. *page 91*

After teaching a group of students about adverse reactions to anti-infective agents, the instructor determines that the students need additional teaching when they identify what as a common adverse effect?

Cardiac toxicity *page 93-95*

The nurse is caring for a client who is immunocompromised following a kidney transplant and who has developed an infection. When planning this client's care, the nurse should prioritize what action?

Carefully maintaining the client's isolation precautions *page 91*

A client who has returned from traveling overseas is suspected of having a parasitic infection. What action should the nurse most likely perform?

Collect a stool sample

A nurse is instructing a client on the antibiotic regimen for the treatment of pneumonia. Which statement is most important to share with client?

Complete the entire prescription of medication *page 92*

A client with an upper respiratory tract infection was prescribed roxithromycin, an antibiotic. To what should the nurse tell the client that irregular administration of this medication could lead?

Development of drug resistance *page 91*

The nurse is administering an anti-infective to a pediatric client. What assessments related to adverse effects in this client should the nurse priortize?

Hydration and nutritional status (Antibiotics can cause nausea, vomiting, and diarrhea. Be careful the child doesn't lose too much weight)

A nurse collects a culture sample from a client's infected would bed. Laboratory testing of this sample will aloow the care team to:

Identify the specific organism causing the infection

Superinfection

Infections that occur when opportunistic pathogens that were kept in check by the "normal" bacteria have the opportunity to invade tissues and cause infections because the normal flora bacteria have been destroyed by antibiotic therapy

A client is to receive penicillin. The nurse understands that this drug achieves its effect by which action?

Interfering with the pathogen cell wall *page 89*

The nurse is preparing to administer a drug that is bactericidal. The nurse should explain what characteristic of this drug?

It will directly cause the death of pathogenic cells *page 92*

A client is diagnosed with strep throat. Which of the factor has contributed to the development of the illness?

Leukopenia *page 91*

The nursing instructor is talking with the students about anti-infective medication and explains that drugs that are very selective in their actions are said to be what?

Narrow spectrum

Which cells participate in this effort to control tissue injury associated with the second stage of the inflammation process?

Neutrophils

To ensure that the most appropriate drug is being used to treat a pathogen, which would need to be done first?

Obtaining sensitivity testing *page 93*

A client with burns has developed a wound infection. This client is experiencing what type of wound infection?

Opportunistic infection *page 95*

A group of nursing students are learning about the factors that underlie recent increases in the incidence and prevalence of antibiotic-resistant microorganisms. What factor is known to contribute to antibiotic resistance?

Overuse of antibiotics *page 91*

A client with acne has been receiving an anti-infective agent for a prolonged period. Initially, the drug was effective, but over time its effectiveness as decreased. What is the nurse's best action?

Refer the client to the health care provider because the client may be experiencing resistance. *page 91*

Clients receiving aminogylcosides should be monitored closely for which toxicities?

Renal *page 93-94*

A female client calls the pediatrician's office because her child reports a sore throat. The nurse anticipates the pediatrician will take what action?

Request a throat culture *page 95*

What would a nurse least expect as an adverse reaction to anti-infective agents?

Respiratory Toxicity *page 93*

The nurse administering an anti-infective agent recognizes that the drug will destroy some human cells as pathogens because of the absence of:

Selective toxicity *page 88*

People taking antimicrobial drugs should be instructed to report any problem that could indicate adverse drug effects, lack of therapeutic response, or emergence of another infection. One such problem is:

Skin Rash *page 94*

Bacitracin (Baciguent) interferes with the cell wall synthesis of which type of bacteria?

Staphylococcal *page 90*

Bactericidal

Substance that causes the death of bacteria, usually by interfering with cell membrane stability or with proteins or enzymes necessary to maintain the cellular integrity of the bacteria

What occurs when the normal flora is destroyed by the use of anti-infectives?

Superinfection *page 95*

Resistance

The ability of pathogens over time to adapt to an anti-infective to produce cells that are no longer affected by a particular drug

Selective Toxicity

The ability to affect certain proteins or enzyme systems that are used by the infecting organism but not by the human cells

A client is being treated for urosepsis with ceftriaxone IV. What assessment finding should prompt the nurse to contact the care provider immediately?

The client has a new onset of jaundice and edema *page 94*

When reviewing the medication orders, a nurse notes that combination therapy with two anti-infective agents has been ordered. What is the nurse's best interpretation of this order?

The client has an infection that may be caused by more then one organism. *page 93*

A 30-year-old female client received an insect bite that has progressed to cellulitis over the past several days. What client characteristics should the nurse prioritized when administering anti-infectives?

The client is in the second trimester of pregnancy.

A medical nurse on a night shift is reviewing a client's medication administration record for the following day. The nurse notes that a combination antimicrobial drug is prescribed. What is implied by the fact that the client has been prescribed a combination drug?

The client may have an infection caused by multiple microorganisms. *page 93*

When describing an anti-infective agent with a narrow spectrum of activity, what would the nurse include?

The drug is selective in its action on organisms *page 90*

Sensitivity Testing

The evaluation of pathogens obtained in a culture to determine the anti-infectives to which the organisms are sensitive and which agent would be appropriate for treatment of a particular infection

A critically ill client has developed a fever of 38.9 C, and blood cultures have been drawn and sent to the laboratory for culture and sensitivity testing. Determination of the culture will give the care team what information?

The exact identity of the infectious microorganism *page 93*

A client has been diagnosed with osteomyelitis and has been prescribed clindamycin, a narrow spectrum antibiotic. When planning this client's care, the nurse should understand that:

The microorganism causing the infection is likely known *page 90*

Spectrum

The range of bacteria against which an antibiotic is effective

A nurse has questioned why a client's health care provider has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug in the treatment of an infection. Which facts provide the best rationale for the use of narrow-spectrum antibiotics whenever possible?

The use of broad-spectrum antibiotic can create a risk for a superinfection. *page 90,95*

Culture and susceptibility tests are performed prior to the prescription of antimicrobial drugs. What is the specific purpose of the culture?

To identify the organism causing the infection *page 92-93*

Prophylaxis

Treatment to prevent an infection before it occurs, as in the use of antibiotics to prevent bacterial endocarditis in high-risk patients or antiprotozoals to prevent malaria

A premenopausal woman has been bothered with recurrent urinary tract infections. What antibiotic after sexual intercourse would assist in preventing the recurrence of infection?

Trimethoprim-sulfamethoxazole (Bactrim) *page 89*

A nurse is teaching a colleague about the factors that are known to contribute to antibiotic resistance. When phenomenon should the nurse describe?

Use of antibiotics for viral illnesses *page 89*

A nurse is asked to explain the difference between community-acquired infections and nosocomial infections. What response best describes the difference?

Usually, community-acquired infections are less severe and easier to treat since nosocomial infections often occur in people whose immunity is impaired

An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with

Vancomycin *page 91*

Aminogylcoside antibiotics tend to collect in the eighth cranial nerve. The nurse would anticipate that which clinical manifestation may occur from the cranial nerve involvement?

Vertigo *page 94*

Culture

a sample of bacteria (e.g., from sputum, cell scrapings, urine) to be grown in a laboratory to determine the species of bateria that is causing an infection

An adult client with an autoimmune disorder regularly takes oral corticosteroids. The nurse knows that corticosteroids can be used in the successful treatment of inflammation but they can also create a risk for:

infection *page 598*

What intervention is necessary for the nurse to perform prior to initiating prescribed antibiotic therapy?

obtaining a specimen for culture and sensitivity *page 89*

Meropenem

An antibiotic that inhibits the synthesis of bacterial cell walls in susceptible bacteria. Indicated for: Intra-abdominal infections, some cases of meningitis Adverse Reactions: GI effects (potentially fatal pseudomembranous colitis), headache, dizziness, rash, and superinfection *Because of toxic effects on GI cells, it is only used on infections with proven sensitivity to meropenem and reduced sensitivity to less toxic antibiotics Available: IV Not recommened for children under 3 mo

The nurse has provided drug teaching for a client who will be discharged to home on an anti-infective. What statement made by the client indicates the nurse needs to provide additional teaching concerning the use of anti-infectives?

"I will stop taking the antibiotic once my symptoms have resolved."

The client in the clinic receives a prescription for an anti-infective to treat a urinary tract infection. The client asks the nurse, "Would you ask the doctor to give me refills on this prescription? I get a urinary tract infection every few months, it seems, and I'd like to have a refill on hand for next time." What is the nurse's priority response?

"Saving antibiotics for another time and trying to diagnose your own health problem can lead to resistant organisms that no longer respond to drugs."

A nurse is caring for a client who is hospitalized for pneumonia. The nurse reviews the electronic health record and evaluates that the microbiology data does not support the use of the broad spectrum antibiotic. Which statement is the nurse's best response to the provider about the results?

"The microbiology data is identifying another antibiotic appropriate for the client." *page 105*

The nurse admits a client with septicemia (infection in the bloodstream). The client denies any allergies, and the doctor has ordered cefuroxime based on blood culture and sensitivity testing. The client states, "I'd prefer vancomycin because I've been reading about drug-resistant bacteria and I don't want to take any chances." What is the nurse's best response?

"Vancomycin is a powerful drug with many adverse effects, and it is generally reserved for when no other drug will work."

The nurse collects the past medical history of a client new to the clinic. The client reports an allergy to penicillin. What questions should the nurse include in follow-up assessment? (Select all that apply)

- "What signs and symptoms were displayed with the reaction?" -"How many doses were administered before the reaction occurred?" -"Had the medication ever been prescribed before the time when the reaction occurred?"

What are classified as anti-infectives? (Select all that apply)

- Antiprotozoals - Antihelmintics - Antifungals *page 95*

What situation is an indication for combination antimicrobial drug therapy? (Select all that apply)

- The infection is caused by several different organisms - There is a likely emergence of drug-resistant organisms if a singe drug is used - A fever is present in a client whose immune system is suppressed - The infection is considered nosocomial in its nature *page 91-92*

What interacts in the immune response? (Select all that apply)

-Lymphocytes -Leukocytes -Antibodies *page 91*

An adult client is experiencing pain and swelling in the ankle from a fall. Which medications are appropriate for the nurse to suggest to the presciber for symptom management? Select all that apply.

-non-steroidal anti-inflammatory (NSAID) -corticosteroid -aspirin *page 271*

For what client would a broad-spectrum antibiotic be most appropriate?

A client who has symptoms of infection but whose culture and sensitivity results are not yet available

What client is receiving prophylactic anti-infectives?

A client who is prescribed a 3-day course of antibiotics prior to dental surgery

The hospital nurse is caring for a group adult clients. For which client should the nurse most likely administer prophylactic anti-infectives?

A client with colorectal cancer who is pre-operative for a bowel resection *page 93*

The nurse is caring for several medical clients who have infections. For which client would the administration of a broad spectrum antibiotic be most appropriate?

A client with signs of infection who is awaiting the results of laboratory testing *page 90*

When caring for infants and the elderly who are in need of an antimicrobial agent, the nurse is aware that when compared with doses for young and middle-aged adults, these clients may require:

A lower dose *page 89*

For what client would the use of prophylactic anti-infective be most appropriate?

A pre-surgical client who has an artificial heart valve

Bacteriostatic

A substance that prevents the replication of bacteria, usually by interfering with proteins or enzyme systems necessary for reproduction of the bacteria