Nursing Process Focus: Patients Receiving Penicillin G (Pentids)

Transcription

1 Prior to administration Assess for presence or history of local or systemic infection. Patients Receiving Penicillin G (Pentids) Risk for Infection, related to weakened immune state or contact with pathogen action and therapy treatment and prevention measures Risk for Injury (anaphylaxis), related to adverse effects of drug Remain free from signs of allergic reaction to drug therapy. Demonstrate knowledge of drug action and side effects. Demonstrate resolution to incidence of infection. *Monitor for evidence of allergic reaction to drug. (Allergic reaction may occur immediately or delayed beyond 72 hours.) *Monitor intake and output especially quantity and consistency of bowel movements. (Severe diarrhea may occur due to the possible adverse effect from pseudomembranous colitis.) *Evaluate patient s understanding of drug therapy and administration. *Give medication on empty stomach to reduce destruction by gastric acid and enhanced absorption. *Evaluate patient for evidence of resolution of infectious process. (If the prescribed antibacterial is not effective another medication or different dosage may be required.) *Observe for superinfection, especially in susceptible patients including elderly, debilitated, or immunosuppressed patient. (There is a high risk for superinfections due to of signs of allergic reaction including itching, rash, respiratory distress. to immediately contact the health care provider if allergic reaction occurs. *Advise patient to consult health care provider before taking antidiarrheal medication. These medications may worsen or prolong diarrhea. to take medication one hour before or two hours after a meal. To take medication with glass of water. To take all of medication unless instructed to discontinue by the health care provider. *Instruct patient to notify the health care provider if symptoms persist or worsen. *Instruct patient to report signs and symptoms of superinfection. Symptoms may include: fever, black hairy tongue, stomatitis, loose, foul-smelling stools, vaginal discharge, or cough. normal flora reduced or eliminated.) outcomes are met (see Planning ).

2 Prior to administration Assess for presence of local or systemic infection. Obtain history of drug allergies. Patients Receiving Cefotaxime (Claforan) Risk for Injury (allergic reaction), related to adverse reaction to drug Risk for Infection (superinfection), related to effects of drug therapy Risk for Deficient Fluid Volume, related to effects of drug on GI system Diarrhea, related to side effects of drug Remain free of symptoms of allergic reaction. Maintain adequate fluid balance. Demonstrate absence of superinfetion. Maintain formed stool consistency. *Monitor for severe diarrhea caused by the disruption of normal bowel flora. (May cause fluid electrolyte imbalance and superinfection of antibiotic-associated pseudomembranous colitis.) *Cultured dairy products with live active cultures, such as kefir or yogurt may be used to help maintain normal intestinal flora. Supplements containing beneficial bacteria, such as acidophilus, are also available OTC. *Monitor for rash, pruritus, or fever (indicative of an allergic reaction to the medications.) *Monitor intake and output carefully in patients with compromised renal function or if receiving aminoglycoside. *Monitor renal function with lab studies periodically during and after therapy. (Toxicity could occur from drug toxins that are unable to be excreted.) to report loose stools or diarrhea. to avoid treating diarrhea with antidiarrheals as this can impede the process of eliminating bad bacteria". to check with health care provider before taking any probiotic products. *Instruct patient to report adverse reactions promptly. *Explain to patient purpose of required laboratory tests and schedule follow-up with health care provider. *Monitor for superinfection, especially with *Instruct patient to report symptoms, prolonged therapy. especially in debilitated or chronically ill patient.

3 Patients Receiving Tetracycline HCl (Achromycin and others) Assessment Prior to administration Assess for presence/history of: Lyme disease, pneumonia, acne vulgaris, Typhus, Cholera, Rocky Mountain spotted fever, Chlamydia, sexually transmitted diseases, bladder infections, Helicobacter Pylori ulcers. Disturbed Body Image, related to change in appearance Noncompliance, related to prolonged therapy Ineffective Therapeutic Regimen Management, related to prolonged course of treatment action and side effects Remain free of symptoms caused by the diagnosed infection. Maintain positive body image. Demonstrate knowledge of drug therapy and side effects. Demonstrate compliance with drug regimen. *Monitor dental status when administered to children under age 8. (Drug may cause permanent discoloration of teeth, enamel defects, and bone growth retardation.) *Administer with caution to patients with impaired kidney or liver function. (Could result in impaired metabolism and excretion.) *Evaluate use of OTC products such as antacids, calcium supplements, iron products, and laxatives containing magnesium. (These products interfere with drug absorption.) *Instruct patient and caregivers to report evidence of tooth discoloration or dental abnormalities to health care provider. to report changes in urinary output. to report for follow up care and lab tests of kidney and liver function and serum tetracycline levels. *Instruct patient to consult with health care provider before taking over the counter drugs. *Evaluate patient understanding of drug therapy and administration. (Drug may cause to avoid direct exposure to sunlight photosensitivity and increase risk of sunburn. during and after therapy. Wear protective Tetracyclines can increase patient s sensitivity clothing, sunglasses and sunscreen. of the skin to ultraviolet light.) to use an alternate form of birth control until all the medication is completed. to avoid taking drug with food, especially dairy products. that contact of topical agent may cause irritation to eyes, nose, mouth, or allergic reaction. to report worsening of infection and burning sensation to health care provider. outcomes are met (see Planning ).

4 Patients Receiving Erythromycin (E-mycin, Erythrocin) Assessment Obtain complete health history including allergies, drug history and possible drug Assess for presence/history of local or systemic infection. Obtain history of allergic reaction to drugs. Deficient Knowledge, related to disease process and drug therapy Risk for Infection, related to superinfection Risk for Deficient Fluid Volume, related to effects of drug on GI system Diarrhea, related to effect of drug therapy Risk for Injury (anaphylaxis), related to adverse reaction to drug Demonstrate knowledge or drug therapy and treatment regimen. Remain free of drug induced diarrhea. Maintain adequate fluid balance. Maintain absence of allergic reaction to drug. *Contraindicated in patients with hepatic disease. (Because the metabolism of erythromycin ethylsuccinate (EES) is mainly by the liver, it increases the patient s risk for toxicity.) *Monitor WBC, temperature, cultures, and perform infection-focused physical examination. (To determine effectiveness of drug therapy.) *Evaluate patient understanding of treatment regimen. (Patient must complete full course of therapy to prevent bacterial resistance.) *Monitor for evidence of G.I. distress. (May require alternate form of medication.) *Monitor for ototoxicity in patients receiving high dose; older adults, female and history of kidney or liver dysfunction. *Observe for signs and symptoms of superinfection by overgrowth of nonsusceptible bacteria or fungi. *Instruct patient to report history of medical problems to health care provider. Instruct patient to: report fever and worsening symptoms of infection. report for follow-up examinations. Instruct patient to: complete full prescription even if feeling better or symptom free. take with full glass of water, on an empty stomach one-hour before or two hours after meals. avoid taking with or just after acidic fruit juices or carbonated drinks. *Instruct patient to report past history of GI problems to health care provider. *Instruct patient to immediately report dizziness, vertigo, nausea, tinnitus, roaring noises, or hearing impairment to the health care provider. *Instruct patient to report diarrhea, abdominal pain, vaginal discharge, or fever.

5 Assess for presence/history of local or systemic infection. Obtain history of drug allergies. Patients Receiving Gentamicin (Garamycin) Risk for Injury, related to renal insufficiency related to aminoglycoside therapy Risk for Injury, related to disturbances of balance and impaired ability to detect environmental hazards therapy and side effects Maintain normal renal function throughout drug therapy. Demonstrate knowledge of drug therapy and side effects. Remain free of physical injury. *Use with caution with impaired renal function or neuromuscular disorders. (Renal impairment can increase the risk of toxicity with this drug. Patients with neuromuscular disorders may experience greater muscular weakness due to possible neuromuscular blockade with the drug s action.) *Monitor for signs of renal toxicity including unusual appearance of urine (dark, cloudy) intake and output ratio, and the presence of edema. *Monitor for evidence of ototoxicity, including headache, dizziness or vertigo, nausea or vomiting with motion, ataxia, nystagmus, tinnitus, roaring noises, sensation of fullness of ears, and hearing impairment. *Monitor peak and trough drug levels. (Aminoglycosides have a narrow therapeutic range.) *Observe for symptoms of neurotoxicity or neuromuscular blockade. *Observe for signs and symptoms of bacterial overgrowth due to drug s effect to kill all bacteria, even normal flora that can lead to superinfection. *Instruct patient to provide thorough history of medical conditions and treatment to health care provider. Instruct patient : to increase fluid intake to 2000 ml per day. to report evidence of decreased urinary output to the health care provider. *Instruct patient to notify health care provider if changes in hearing occur. *Explain to patient that frequent serum drug therapy levels are necessary to prevent and monitor for complications. *Instruct patient to immediately report muscle twitching, numbness, seizures, weakness, or difficulty breathing to the health care provider. *Instruct patient to report diarrhea, anogenital itching, vaginal discharge, stomatitis, or glossitis.

6 Assess for presence or history of local or systemic infections. Obtain history of drug allergies. Patients Receiving Ciprofloxin (Cipro) Deficient Knowledge, related to antibacterial drug therapy Risk for Deficient Fluid Volume, related to GI side effects from drug therapy Diarrhea, related to effects of drug therapy Demonstrate understanding of drug therapy. Demonstrate evidence of resolution of diagnosed infection after drug therapy is completed. Maintain adequate fluid and electrolyte balance. *Safety for use by children under 18 not established, due to possible action of Cipro on the cartilage, usually the Achilles tendon: tendon rupture. (May interfere with bone development in children less than 18 years of age.) *Antacids, dairy products, sucralfate or vitamin or mineral supplements that contain calcium, iron or zinc can decrease effects of medication. *Administer with water and maintain adequate fluid intake to avoid crystalluria. *Monitor intake and output. *Monitor urine ph. (The drug alters urinary ph and causes crystals to form in urine.) *Monitor use of caffeine during drug therapy. (Absorption of Cipro is decreased by caffeine.) *Monitor plasma theophylline concentrations for patients prescribed these drugs. (The drug affects half-life of theophylline preparations.) *Instruct patient to contact health care provider at the first signs of tendon pain or inflammation. *Instruct patient to administer these substances and medications 2 hours after ciprofloxacin. *Take each dose with a glass of water and drink several extra glasses of fluid daily to prevent formation of ciprofloxacin crystals in the urine. *Instruct patient to avoid caffeine intake during drug therapy. *Inform patient that serum levels will need to be monitored. *Monitor patient for symptoms of dizziness or *Advise patient to use caution when driving, lightheadedness. (These may occur due to the operating machinery, or performing other action of ciprofloxacin on the central nervous hazardous activities until effect of drug is system (CNS).) known.

7 Patients Receiving Trimethoprim (Bactrim, Septra) Risk for Infection, related to contact with contagious agents (nosocomial or community-acquired) Risk for Infection, related to increased vulnerability secondary to diminished immune response therapy and side effects Assessment Assess for presence or history of systemic, respiratory or urinary tract infection. Assess intake and output. Demonstrate reduction in symptoms related to the diagnosed infection. Demonstrate understanding of drug therapy and side effects. Remain free of symptoms of side effects of drug therapy. *Monitor renal function including BUN and creatinine values, and intake and output. (Drug can cause hematological toxic effects, which are increased with kidney disease and also the elderly population.) *Evaluate complaints of painful urination, flank pain, and fever. (Drug can change the urine ph and could increase the patient s risk for formation of renal calculi.) *Monitor baseline and follow-up urinalysis, CBC, platelet count, BUN and creatinine clearance with long-term therapy. (To evaluate effectiveness of drug therapy.) *Observe for symptoms of adverse reactions. (Evidenced in hematology and blood coagulation studies and by skin manifestations.) *Monitor skin integrity. (This drug can also increase patient s sensitivity on the skin to ultraviolet lights.) *Monitor compliance with treatment regimen. (Full course of therapy is required. If patient stops medication before prescription is complete, symptoms may reoccur and this may increase resistance to further antibiotics.) Inform patient: that creatinine clearance tests and BUN may need to be monitored. to report changes in urinary elimination to the health care provider. Advise patient: to drink liters of fluid daily. to report painful urination, flank pain or fever to the health care provider. *Instruct patient to continue medical follow-up and laboratory test appointments when receiving drug for extended period of time. *Instruct patient to report skin rash, sore throat, fever, mouth sores, or unusual bleeding or bruising. *Instruct patient to avoid exposure to direct sunlight and sunlamps. *Instruct patient to take drug as directed and to complete full prescription.

8 Assess for presence or history of infections resistant to other antibiotics. Obtain history of hearing loss, impaired renal function. Obtain history of cardiovascular disease. Obtain history of hearing loss. Patients Receiving Vancomycin (Vancocin) Disturbed Sensory Perception, related to ototoxicity Risk for Injury (deep vein thrombosis), related to chemical irritation of vein therapy and side effects Demonstrate therapeutic response to drug therapy. Remain free of phlebitis. Maintain normal hearing acuity. *Evaluate hearing acuity. (Contraindicated with previous hearing loss due to drug s ototoxic effects.) *Monitor peak and trough vancomycin levels to ensure safe and effective dosage. *Monitor renal status. (Dosage is adjusted with renal insufficiency.) *Monitor IV site carefully. (Drug is irritating to tissues and causes necrosis and severe pain with extravasations.) Inform patient: that audiometry tests will be done to prevent complications from possible ototoxicity. to report symptoms of hearing loss, buzzing in ears. *Inform patient about purpose of laboratory studies. *Advise patient of importance of laboratory studies to establish baseline renal function and to monitor function during and after treatment. *Instruct patient to report pain or other symptoms of discomfort immediately during intravenous infusion. *Monitor for proper use of medication. Patient must take medication as prescribed and complete full course of treatment. Do not take other antidiarrheal preparations.

9 Obtain complete health history including Assess for presence/history of positive tuberculin skin test, positive sputum culture or smear, close contact with person recently infected with tuberculosis, AIDS, receiving immunosuppressant drugs, alcohol abuse, liver or kidney disease. Patients Receiving Isoniazid (INH) Disturbed Sensory Perception, related to peripheral neuritis and optic neuritis therapy and side effects Ineffective Therapeutic Regimen Management, related to long term therapy Demonstrate adherence to extended drug therapy. Demonstrate negative sputum cultures indicating effective drug therapy. Demonstrate understanding of drug therapy. *Monitor liver function. (Contraindicated in patients with acute liver disease or history of isoniazid-related liver damage.) *Monitor for negative sputum cultures. Change noted within 2-3 weeks. (To evaluate effectiveness of drug therapy.) *Monitor for presence of peripheral neuritis related to pyroxidine deficiency. (Pyrodoxidine (vitamin B6) deficiency causes neurotoxic effects.) *Evaluate diet for ingestion of foods containing tyramine. (Ingestion of tyraminecontaining foods may cause palpitation, flushing and BP elevation, and histaminecontaining foods may cause exaggerated drug response with headache, palpitation, sweating, flushing, itching, or diarrhea.) to provide accurate and complete medical, medication and treatment history. to avoid alcohol intake during drug therapy. to report signs of liver impairment to health care provider, including jaundice, itching, fatigue. *Instruct patient to follow through on prescribed lab tests. to take pyrodoxine supplement to reduce risk of side effects. to report symptoms of numbness, tingling, or burning of feet to the health care provider. *Advise patient to avoid foods such as aged cheeses, smoked fish, tuna, sauerkraut juice, and yeast extracts.