III (Infection, Inflammation, & Immunity)

(suffix -sone), Prednisone-decreases pain associated with inflammation/depresses inflammatory & decreases immune response & immunocompromised, decreases mineralocorticoids-body's natural steroids (side effects-worse with high-dose IV include hunger/weight gain, insomnia/jittery, moon face & buffalo hump), if holistic measures possible/changing things in diet that cause inflammation do that first, take full high-dose tapered down slowly for adrenal glands to make mineralocorticoids again, disrupts normal flora (thrush/candidiasis oral or vaginally-yeast)

Corticosteroids/Anti-inflammatories

As a clinic nurse, you are caring for a patient who has been prescribed an antibiotic for tonsilitis & has been instructed to take the antibiotic for 10 days. When you do a follow-up call with this patient, you are informed that the patient is feeling better and is stopping the medication after taking it for 4 days. What information should you provide to this patient?

Finish all the antibiotics to eliminate the organism completely

(Suffix-Floxacin, Cipro is most common, Levaquin-Levofloxacin for pneumonia), common in lung diseases, Candidiasis-thrush if in mouth or yeast infection common with antibiotics (take probiotic found in yogurt while taking antibiotics to help prevent GI upset & yeast infections), unique side effect-achilles tendon rupture (pain with walking in back of heel)-stop med & call doctor, push fluids, photosensitivity/phototoxicity-tetracyclines (wear sunscreen & hat when out as you burn easier)

Fluoroquinolones

Health care professionals are required to follow certain principles to ensure that nosocomial infections do not occur in the health care facility. What contributes to infections during health care?

Health professionals donning artificial nails

Recognize symptoms/labs indicating these responses (III)

Increased WBC count (CBC with differential-breakdown of white blood cells), fever, redness, swelling, purulent drainage (yellow/green) Culture to know what type of bacteria-gram positive vs. gram negative vs. Cocci vs. Staph vs. Strep (preliminary result at 24 hours & 48 hours, with final result at 72 hours)

(warfarin-Coumadin, blood thinner stopping clotting cascade & common with heart attack, DVT, PE, A-Fib), Interacts with foods that contain Vitamin K, alcohol, & a lot of other meds, check INR early, interacts with grapefruit juice, Azithromycin-less side effects & interacts, the later the generation of drug lessen side effects

Macrolides

Corticosteroids have what effect on wound healing?

Mask presence of infection

A postoperative patient, with an open abdominal wound is currently taking coticosteroids. The physician orders a wound culture of the abdominal wound even though there are no signs & symptoms of infection. What action by the nurse is appropriate?

Obtain the wound culture specimen

Certain antibiotics you can take with food (before meals)

Penicillin, Cephalosporins

(cephalosporins has cross-allergy to penicillins, but are cheap & have the least side effects & monitor for penicillin allergy-common), Penicillin allergy testing as intradermal introduction to penicillin (if penicillin allergy is documented & unsure of veracity), stop infusion if patient becomes SOB, dizzy, rash, urticaria (allergic reaction)

Penicillins

Nursing interventions/treatments; how do you teach your patient/coworkers to prevent infections?

Proper hand hygiene, don't share personal items, cover mouth/nose when coughing/sneezing, obtain immunizations PRN, contact precautions, aseptic technique

The nurse is caring for a client who had a bowel resection one week ago. What interventions are the most appropriate to promote wound healing & reduce risk of infection at the incision site?

Provide the client with ensure supplements, increase intake of protein & vitamin C in the diet, & teach the client to wash hands before touching the incision

-vir

Retroviral for HIV

An 87-year-old client was admitted to your hospital unit with an elevated leukocyte count & a fever accompanied by warm, flushed skin. What do her symptoms suggest?

She has an overwhelming bacterial infection

The nurse is caring for a client who had an open cholecystectomy 24 hours ago. The client's vital signs have been stable over the last 24 hours, with most recent temperature 98.6 degrees F (37 degrees C), blood pressure (BP) 118/76 mm Hg, respiratory rate (RR) 16 breaths/minute, and heart rate (HR) 78 bpm, but these signs are now changing. Which set of vital signs indicates that the nurse should contact the health care provider (HCP)?

Temperature above 101 degrees F, elevated BP & RR

An older adult has asthma & asks the nurse about taking the pneumonia vaccine. The nurse should tell the client:

"You should receive the vaccine."

Don't use med if possible, gentamicin common, monitor patient for hearing loss by observation & kidney damage (minimum urine output 30 mL's an hour), BUN, creatinine, GFR, if any med is unsafe draw trough levels-narrow therapeutic margin (too high it's toxic, too low it's ineffective) drawn 30 minutes before next scheduled dose & hold dose until trough level is back (consult with pharmacy prior to administering dose), not common & typically only given in hospital setting

Aminoglycoside

A patient in the emergency department is being treated for a wrist fracture. The patient asks why a splint is being applied instead of a cast. What is the best response by the nurse?

"A splint is applied when more swelling is expected at the site of injury."

When teaching unlicensed assistive personnel (UAP) about the importance of hand washing in preventing disease, the nurse should instruct the UAP that:

"Handwashing is the best method for preventing cross-contamination."

What is associated with impaired immunity in the aging patient?

Decreased renal function

Cef- or Ceph-

Antibiotic (Cephalosporin)

-floxacin

Antibiotic (Fluoroquinolones)

-mycin

Antibiotic (Macrolide)

-cillin

Antibiotic (Penicillans)

-Sulfa

Antibiotic (Sulfonamides)

-micin

Antibiotic (aminoglycoside)

-cycline

Antibiotic (tetracycline)

A 24-year-old client is being seen by the physician in the primary care group where you practice nursing. Over the past 2 months, the client has been receiving treatment for multiple ear infections & tonsillitis. She reports vaginal discharge & itching at this appointment. What would you expect to be the cause of her vaginitis?

Antibiotics

-azole

Antifungals

Treats Candidiasis (yeast or thrush), LTC-apply to skin folds (powdered-Nystatin most common), Flagyl common & given for GI infections (diverticulitis), hard on liver-AST & ALT liver enzymes

Antifungals

-clovir

Antiviral

most common is vaccines, (influenza, cold, COVID), influenza & COVID vaccines are killed viruses, shingles-attenuated/weakened live virus

Antivirals

Broad spectrum (prescribed until results of culture come in 72 hours & may switch to be more effective with narrow spectrum & take full course of antibiotics to prevent superinfection/antibiotic resistance (prefix CEF or CEPH)

Cephalosporins

Certain antibiotics you can't take with dairy products:

Cephalosporins, Tetracyclines

-solone or -sone

Corticosteroids

A nurse is taking care of a client with tuberculosis who has developed resistance to the ordered antibiotic. Which type of client is most likely at increased risk for infection?

Elderly

After the initial phase of the burn injury, the client's plan of care will focus primarily on:

Preventing infection

Certain antibiotics you can't take with food (empty stomach-1 hour before or 2 hours after meals)

Tetracyclines, Macrolides, Rifampin

What is an accurate rationale as to why older adults are more susceptible to serious infections?

They have less efficient defense mechanisms

Nursing students are reviewing information about infectious diseases & events associated with infection. Students demonstrate understanding of the information when they identify the incubation period as:

Time between exposure & onset of symptoms

In its own class, widely used for MRSA, not absorbed well via GI tract-mostly given IV, oral for C-Diff, very dangerous drug with similar toxicities to Gentamicin (draw peak & trough level), need central line-given through PICC as it is very hard on veins through peripheral line, on long-term course (6 weeks administered based on weight of patient & diluted in large volume 250 or 500 mL's given slowly 2-4 hours), side effect-Red Man's syndrome- massive vasodilation that can be fatal stopping heart (flushing, tachycardia-heart pounding, patient turns red from torso up, dizziness, lightheadedness)-slow dose & call provider, caustic to veins, check trough level-see if one is due & withhold med if patient is already toxic/overdosed

Vancomycin

Antibiotics side effect/cause

disrupt normal flora in GI system-N/V/D (GI upset common)