NR 293 Week 7 Concepts; Infection

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Robin Williams

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Nursing

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NR 293 Pharmacology

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Chamberlain

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68

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Please give a thumbs up on this and any of my other documents that you used :) Week 7 Concepts: Infection Antibiotics Prepare: Antibiotics Starting Antibiotics Which of the following actions is important before starting an antibiotic? Store the antibiotic in a safe place Monitor for side effects Verify patient does not have an allergy to an antibiotic Verify there is the correct amount of pills Beta-lactamase What is beta-lactamase? A biproduct of cellular metabolism A chemical that is combined with an antibiotic to assist with bacterial control An enzyme that destroys penicillin An enzyme that destroys the cell wall of a bacteria Broad Spectrum Which of the following accurately describes a broad spectrum antibiotic? An antibiotic fluoresces when exposed to an ultraviolet light source An antibiotic has a wide ranger of dosages available The antibiotic treats a wide variety of bacteria The antibiotic treats a specific bacteria Self Check: Starting Antibiotics An antibiotic is started based on which of the following factors? Select all that apply. What is available on the formulary Most likely causative bacteria Gram staining Price of the medication Culture grown from the source of the infection Self Check: Penicillin Resistance Which of the following causes penicillin resistance? The production of beta-lactamase by the bacterial cell The cell wall of a gram positive bacterial The presence of beta-lactam next to the bacterial cell wall An abnormally large dose of penicillin Self Check: Bacteriostatic When an antibiotic is bacteriostatic, it means which of the following? The antibiotic doesn’t work against the bacteria. The antibiotic destroys the bacteria. The antibiotic reduces the replication of the bacteria. The antibiotic prevents further replication of the bacteria. Self Check: Severe Diarrhea Lori is experiencing severe diarrhea for the last 2 weeks. She has been on an antibiotic for four weeks due to a severe kidney infection. The diarrhea is best described as which of the following? Side effect of the antibiotic Unrelated illness Complication of her kidney infection Superinfection related to antibiotic use Self Check: Dental Cleaning John is scheduled for a dental cleaning tomorrow. He has been diagnosed with a heart murmur in the past. His cardiologist prescribed azithromycin 500mg orally x 1 dose about 1 hour before his cleaning. Why is he being prescribed this antibiotic? Prophylactic treatment Treatment of a superinfection Treatment to reduce normal bacteria flora Empiric treatment Reflect: Antibiotics Potential Interactions Additive effects of antibiotic Penicillin and Non-steroidal Anti-inflammatories Could causing arrhythmia Azithromycin and sertraline Reduced antibiotic absorption Tetracycline and milk Reduced effectiveness of contraception Azithromycin and estradiol Increased anticoagulation Tetracycline with warfarin Match the potential interaction when giving an Antipsychotic drug with the following? Concerns While Taking Drugs Joy is taking the erythromycin 500mg three times daily for 10 days. Which of the following do you need to be concerned about while she takes this drug? Select all that apply. Nausea GI upset Vomiting Headache Allergy rash Treatment with Antibiotic Gloria is started on ciprofloxacin for symptoms of a urinary tract infection. She was seen by a telemedicine provider, and her urine was not collected. Which of the following is accurate about her treatment? She is being treated based on a positive culture for Escherichia coli The antibiotic is being used to decrease her normal bacterial flora She is being treated prophylactically with the antibiotic She is being treated empirically with the antibiotic Stopping Antibiotics Dora started an antibiotic yesterday. Which of the following assessment findings indicate an immediate need to stop her antibiotic? Nausea Vomiting Vertigo Rash Headache Preventative Action 47493209142Match the safety concern with the preventative action. Treating Infection Which of the following are ways that antibiotics treat infection? Increase natural flora in the GI tract Increase bacterial replication of deoxynucleic acid (DNA) Disrupt cell metabolism Stop bacterial cell wall creation Stop bacteria from producing proteins Medication Education Amanda was prescribed azithromycin 250mg daily for 5 days. She takes estradiol for birth control, and uses warfarin 5mg daily for chronic atrial fibrillation. Which of the following suggests further education is needed? “I should not use alcohol while taking this medication.” “My birth control will continue to be effective.” “I need to contact my cardiologist to help monitor my warfarin closely while on this antibiotic.” “I should take this medication as directed.” Antibiotic Classes Which antibiotic class inhibits protein synthesis of the bacteria by binding to 50s ribosomal subunits in the bacteria? Fluroquinolones Penicillin Macrolides Tetracyclines Sulfonamides Penicillin and Cephalosporins Prepare: Penicillin and Cephalosporins Common Side Effects What are common side effects of penicillin? Select all that apply. Diarrhea Anxiety Nausea Headache Vomiting Skin Infection Alice was prescribed cefalexin for a skin infection. When should she stop taking her antibiotic? One month In two days As long as it says to on the prescription When the infection goes away Penicillin Allergy If a patient has a penicillin allergy, what other antibiotic might they also react to? Aminoglycosides Cephalosporins Fluroquinolones Macrolides Self Check: Penicillin and Cephalosporins Cephalosporin Superiority Nancy was started on Cefepime, a 4th generation cephalosporin for urinary tract infection. Which of the following makes this superior to a first generation cephalosporin for her diagnosis? Penetration of the blood-brain barrier Broad spectrum activity Increased activity against beta-lactamase It is a newer antibiotic Cephalosporin Medications When giving cephalosporin medications, which of the following statements is accurate? These are primarily metabolized through the liver so they have a lot of drug interactions to review These are metabolized in the stomach, so there are no drug interaction They do interact with seizure drugs, so monitoring of drug levels may be necessary They are primarily metabolized through the kidney, so dosage reductions may be needed in renal insufficiency Cephalosporin Advantages In reviewing the advantages to a 4th generation cephalosporin, which of the following are accurate statements? They have a broader spectrum They are more susceptible to beta-lactamase They destroy less gram negative bacteria Less likey to cross the blood-brain barrier (to treat meningitis) Better penetration of gram negative bacterial cell walls Blurred Vision Since starting Amoxicillin, Doug is experiencing blurred vision? Which of the following is accurate? This is not a known side effect of the amoxicillin, and patient should stop the drug This is probably not related to the amoxicillin, and patient should continue the drug and notify their provider This is probably a side effect of amoxicillin, and patient should continue the drug This is a known side effect of amoxicillin, and patient should continue the drug Cephalexin Phillip started an antibiotic for a skin infection 2 days ago. The prescription says to take cephalexin 500mg every 6 hours for 10 days. His skin infection appears to be gone. Which of the following would be appropriate for him to do? Continue the antibiotics for the 7 days as instructed Stop the antibiotic and save the rest in case the infection returns Continue the antibiotic for 3 more days, then stop Stop the antibiotic and dispose of the pills that are left Reflect: Penicillin and Cephalosporins Metabolism of Antibiotics Boris will be given a dose of cefazolin prior to an abdominal surgery he is having. He has a history of liver failure. Based on knowledge of the metabolism of this antibiotic, which of the following is accurate? He should not receive this medication due to liver disease The dosage needs to be adjusted downward due to the liver failure The dosage can remain the same, this is primarily metabolized by the kidney The dosage needs to be increased as the antibiotic won’t be effective Complex Infections Alice is prescribed a cephalosporin antibiotic for a complex infection. After being on the antibiotic for a month, she states experiencing white oral plaques and a sore throat. This is likely caused by which of the following? Superinfection Empiric infection Strep throat Sub-therapeutic does of the antibiotic Strep Throat Julie has been given penicillin for strep throat. Which of the following statements is true when educating Julie about penicillin therapy? Julie needs to take the penicillin at evenly spaced intervals She is taking an oral contraceptive and must be cautioned to use an alternate form of birth control while being treated with penicillin If she has signs of an allergic reaction, continue the medication and notify her healthcare provider She should save whatever is leftover medication for anyone else in the household who gets strep throat Piggybacking Antibiotics Wally was ordered cefazolin 100mg diluted in 0.9% NaCL 100mL to run over 60 minutes. He currently has one intravenous site with 0.9% NaCL with Potassium Chloride 20 mEq running at 100mL/hr. Which of the following is most appropriate in delivering this piggyback antibiotic? (Hint: review your drug book about IV administration) Infuse the antibiotic through a Y site on the current intravenous line Stop the main infusion to give the antibiotic through separate IV tubing Skip the antibiotic until the current infusion is done Start a new intravenous site because these medications are incompatible Further Teaching Sandy is prescribed cephalexin 500mg every 6 hours for 7 days for a skin infection. Which of the following statements suggest that further teaching may be required? “Some nausea may be expected as it is a common side effect.” “I should call back in several days if the wound isn’t improving.” “I can stop this medication when my wound heals.” “I should not save any leftover medication.” Penicillin Allergy When assessing patient for a possible penicillin allergy, which of the following symptoms would be consistent with a hypersensitivity reaction? Select all that apply. Shortness of breath Wheezing Nausea Urticaria Rash Common Side Effects Larry has been started on cephalexin for a skin infection. In doing medication teaching, which of the following most common side effects could he expect? Select all that apply. Vomiting Diarrhea Hearing changes Nausea Double vision Constipation Antibiotic Generations 9524228170Drag and drop the items to complete the table below. 0-2216020Quinolones (Ciprofloxacin) Prepare: Quinolones (Ciprofloxacin) Stopping the Antibiotic Alice was prescribed ciprofloxacin 500mg q12 hours for 3 days for a urinary tract. When should she stop taking her antibiotic? In three days In two days One week Just after one dose Antibiotic Class If a patient has a ciprofloxacin allergy, what antibiotic class might they react to? Cephalosporins Fluroquinolones Aminoglycosides Macrolides Patient History Which patient history finding is important before administering ciprofloxacin? Diagnosis of chronic obstructive pulmonary disease History of alcohol use History of tendonitis Allergy to penicillin Self Check: Quinolones (Ciprofloxacin) Ciprofloxacin Nancy was started on ciprofloxacin for her complicated urinary tract infection? Which of the following makes this superior to other fluroquinolone antibiotics? Much less expensive Broad spectrum activity Strongest antibiotic in the class Better penetration of the genitourinary tract Abnormalities Ben has an automatic internal cardio-defibrillator (AICD) and is taking amiodarone for dysrhythmias. When started on ciprofloxacin, which of the following abnormalities puts him at higher risk for life threatening arrhythmia? Hypertension Atrial fibrillation Coronary artery disease Prolonged QT syndrome Why Was it Prescribed? Ciprofloxacin was selected to treat Elizabeth’s complicated urinary tract infection. This antibiotic was selected due to which of the following reasons: Low cost alternative Good penetration of the genitourinary tract Broad spectrum activity Strong effect against gram positive bacteria Elevated Temperature and Dysuria A patient with a complicated urinary tract infection has been taking ciprofloxacin for three days. The patient continues to have an elevated temperature and dysuria. Which of the following should the healthcare professional consider? Continue the medication, it takes time for it to fight infection Notifying the healthcare provider about the lack of improvement Encourage Tylenol for the fever Stop the medication Interactions When giving ciprofloxacin, which medications are known to interact with this medication? Select all that apply. Lisinopril Phenytoin Amlodipine Fluoxetine Warfarin Reflect: Quinolones (Ciprofloxacin) Possible Interactions When a client with chronic obstructive pulmonary disease is taking theophylline and also receives ciprofloxacin, which of the following interaction could occur? High level of ciprofloxacin Reduced levels of theophylline Increased levels of theophylline Lower levels of ciprofloxacin Expected Interactions Jose has a seizure disorder that is well controlled with phenytoin. He was recently prescribed ciprofloxacin for a urinary tract infection. What might the nurse expect when these two drugs are given together? Select all that apply. There is no known interaction between these drugs Jose may be at higher risk of seizures Jose’s infection will resolve quicker Jose will have higher anticoagulation levels Jose could become toxic from his phenytoin due to increased blood levels How It Works Belinda was prescribed ciprofloxacin for a complicated urinary tract infection. Fluroquinolones work by which of the following? Inhibit bacterial wall synthesis Inhibit DNA gyrase Inhibit floic acid production for bacterial replication Inhibit beta-lactamase Serious Interactions Rita was prescribed ciprofloxacin for her urinary tract infection. She is currently taking fluoxetine, ibuprofen, warfarin, and lisinopril. When giving intravenous quinolones, the nurse needs to keep in mind that these drugs may have serious interactions with which drugs? Antihypertensive Nonsteroidal anti-inflammatory drugs Selective serotonin reuptake inhibitor antidepressants Oral anticoagulants Intravenous Ciprofloxacin You are ordered to give ciprofloxacin intravenously through a piggyback. Currently you have another piggyback running through the same IV line. Which of the following would be incompatible in the IV line with ciprofloxacin? (Hint: refer to your drug reference guide.) Lidocaine Potassium chloride Magnesium sulfate Diltiazem Expected Actions Ciprofloxacin is ordered for a patient admitted with pyelonephritis. The allergy band says that the patient is allergic to all cephalosporins. The nurse verifies this. Which of the following expected actions will the nurse take next? Notify the provider about a possible allergy to ciprofloxacin Administer the medication as prescribed Take the allergy wristband off as this is incorrect information Hold the medication and request another antibiotic Prolonged QT Interval When giving ciprofloxacin, which medications are known to cause a prolonged QT interval with this medication? Fluoxetine Amlodipine Lisinopril Phenytoin Warfarin Generic Drugs Generic Half-Life Ciprofloxacin 4 hours Levofloxacin 8 hours Moxifloxacin 12 hours Gemifloxacin 7 hours Complete the following table by dragging and dropping the brand and half-life to the proper generic drug. Nursing Application - Antibiotics Prepare: Nursing Application - Antibiotics Antibiotic Therapy Doris presents to the urgent care with dysuria and insists that she has a urinary tract infection. The healthcare provider finds nothing to suggest this. During the discharge process, the patient tells the nurse that she is not leaving without a prescription for an antibiotic. Which of the following is true regarding antibiotic therapy? She still might have an infection and should get an antibiotic Over prescribing of antibiotics can lead to antibiotic resistance She could consider using antibiotics she has saved from a previous illness Antibiotics are under-prescribed and help to reduce infections everywhere Further Analysis The provider has prescribed amoxicillin 875mg one tablet twice daily for strep throat. Which of the following would require further analysis? The medication is not indicated for strep throat Amoxicillin doesn’t come as a tablet The patient has an allergy to penicillin The dosage of 875 mg is too high Teaching the Patient During discharge planning, the nurse prepares to teach the patient about their amoxicillin prescription. Which of the following indicates the patient may need more instruction? “If I get a rash, it should go away in a day or two.” “I should not drink alcohol while taking this medication.” “I will take the antibiotic for 7 days as prescribed.” “Taking it with food may help with some of the nausea.” Self Check: Assessment Gladys's Case Study Gladys is a 56 year old female who presented to the clinic with complaints of dysuria. A urinalysis revealed a urinary tract infection. Her urine was sent to the lab to obtain a culture and sensitivity, which should be available in about four days. The nurse is reviewing her current medication list for possible interactions using the Drug Interaction Checker in preparation for discharge teaching on Amoxicillin. 14210229185Which of the following information is the nurse concerned about? Gladys’s History After identifying Glady is allergic to amoxicillin, the primary health care provider gives her a prescription for ciprofloxacin 500mg twice daily for 5 days. The nurse reviews her history in preparation for discharge teaching. Which of the following would require further analysis and possible nursing action? Patient has an allergy to penicillin Antibiotics generally should be given for 10 to 12 days She has a history of Achilles tendonitis and still has problems with it She smoke 1 pack per day of cigarettes Self Check: Diagnosis and Assessment Gladys’s Discharge In doing Gladys’s discharge instructions, which of the following indicates she may need more information? Select all that apply. “I should take this as directed until I finish the five-day course.” “I’ll save any extra in case I get another infection.” “This should work, another provider gave me the same one about a month ago.” “I should avoid alcohol while taking this medication.” Gladys’s Discharge Continued As part of Gladys’s discharge instructions, which of the following would the nurse expect to include? Your symptoms should be gone tomorrow. Your symptoms may take a week to improve. Your symptoms will get worse before they get better. You may be on the wrong antibiotic if you are not better in a few days. A fever could be a side effect of the medication. Self Check: Implement and Evaluate Gladys’s Evaluation The nurse receives Gladys’s culture and sensitivity results from the lab. She has been on the ciprofloxacin for two days. She states her symptoms are unchanged. The report indicates the following: Amoxicillin = Susceptible Cefazolin = Susceptible Ceftriaxone = Susceptible Ciprofloxacin = Resistant Nitrofurantoin = Resistant Piperacillin/tazobactam = Susceptible In evaluating Gladys’s response to the antibiotic, which of the following do you consider? Repeat the urine culture and sensitivity Notify the healthcare provider to request a change in the antibiotic Notify the healthcare provider to extend her current antibiotic for 5 more days Notify the patient to continue her antibiotic Reflect: Nursing Application - Antibiotics Treating Pnemonia The nurse is reviewing the orders for a patient who has been admitted for treatment of pneumonia. The patient is being started on doxycycline 500mg every 12 hours for 10 days. The nurse notes patient’s allergy band says, “doxy”. Asking what happens when the patient took doxycycline in the past, the patient states that they had an upset stomach. What is the nurse’s first action at this time? Call the prescriber to clarify the order because of the patient’s allergy Hold the doxycycline Administer the drug as ordered and include a small snack ZZ Ask the pharmacy to order a different antibiotic George Answer the following questions about George based on the information provided in each question. Question 1 / 3 George is admitted to the hospital with pneumonia. His WBC count is elevated, he has a fever of 101.5, and he is short of breath. The provider immediately orders a sputum culture and sensitivity to determine which bacteria might be causing the pneumonia. The results will not be back for 3 days. Levofloxacin 750mg IV is ordered to start now. The nurse knows that the rationale for this antibiotic order is which of these? To treat for a superinfection To provide empiric therapy To treat staphylococcus aureus To provide prophylactic therapy Question 2 / 3 George is discharged from the hospital and is prescribed tetracycline 500mg four times daily for continued treatment of his pneumonia. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey? The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity. The teeth should be observed closely for signs of mottling or other color changes. When he stops coughing, the medication may be discontinued. This medication needs to be taken with antacids to reduce GI upset. Question 3 / 3 George develops a cellulitis from a previous intravenous site he had during hospitalization. A second-generation cephalosporin is ordered for a new skin infection. A day after starting, the patient develops a rash. Which nursing action is appropriate? Ask the pharmacy to change the order to a first-generation cephalosporin. Notify the prescriber about the rash and a possible change in antibiotics. Continue the medication, and monitor for adverse effects. Administer the drug with a nonsteroidal anti-inflammatory drug to reduce adverse effects. History of Heart Problems While assessing a woman who is receiving levofloxacin for pneumonia, the nurse notices that the patient has a history of heart problems. The nurse will monitor for which potential cardiac effect of fluroquinolone therapy? Prolonged QT interval Dysrhythmias Bradycardia Tachycardia Linda Answer the following questions about Linda based on the information provided in each question. Question 1 / 2 Linda is prescribed erythromycin for a urinary tract infection. During patient education regarding this oral macrolide, the nurse will include which information? Select all that apply. The patient may take the drug with a small snack to reduce GI irritation. Use another form of birth control if the patient is taking oral contraceptives. If GI upset occurs, the drug will have to be stopped. The drug needs to be taken with an antacid to avoid GI problems. The patient needs to take each dose with a sip of water. Question 2 / 2 Linda has been on erythromycin for almost the entire course, but calls the nurse practitioner to complain of severe vaginal itching. She has also noticed a thick, whitish vaginal discharge. The nurse practitioner suspects which of these? The UTI has become worse instead of better A superinfection has developed The UTI is resistant to the antibiotic This is an expected response to antibiotic therapy Bacteriostatic The nurse is reviewing the orders for a bacteriostatic antibiotic. Which statements best describes a bacteriostatic compound? Bactericidal antibiotics are stronger than bacteriostatic antibiotics Bacteriostatic antibiotics prevent bacteria from multiplying Bacteriostatic antibiotics destroy bacteria Bacteriostatic antibiotics cause bacterial growth to increase Antivirals: Non-HIV Prepare: Antivirals - Non-HIV Goals of Non-HIV Antiviral Therapy How does taking medications to treat a viral illness promote healing of the indi

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