Nursing Process Focus:
Patients Receiving Ciprofloxin (Cipro)
Assessment
Potential Nursing Diagnoses
Prior to administration:
 Deficient Knowledge related to
antibacterial drug therapy
 Obtain complete health history including
allergies, drug history and possible drug
 Risk for fluid volume deficit related to GI
interactions
side effects from drug therapy
 Assess for presence or history of local or
 Diarrhea, related to effects of drug therapy
systemic infections
 Obtain vital signs
 Obtain history of drug allergies
Planning: Patient Goals and Expected Outcomes
The patient will:
 Demonstrate understanding of drug therapy
 Demonstrate evidence of resolution of diagnosed infection after drug therapy is completed
 Maintain adequate fluid and electrolyte balance
Implementation
Interventions and (Rationales)
Patient Education/Discharge Planning
 Safety for use by children under 18 not
 Instruct patient to contact health care
established, due to possible action of Cipro
provider at the first signs of tendon pain
on the cartilage, usually the Achilles
or inflammation.
tendon: tendon rupture. (May interfere with
bone development in children less than 18
years of age.)
 Avoid administering medications or foods
 Instruct patient to administer these
that contain _______________________,
substances and medications _______
______________________________, or
hours after ciprofloxacin.
_________________ such as antacids,
dairy products, sucralfate or vitamin or
mineral supplements, within ________
hours.
 Administer with water and maintain
 Take each dose with a glass of water
adequate fluid intake to avoid crystalluria.
and drink several extra glasses of fluid
daily to prevent formation of
 Monitor ____________ and __________
ciprofloxacin crystals in the urine.
and urine pH. (The drug alters urinary pH
and causes crystals to form in urine.)
 Monitor use of caffeine during drug
 Instruct patient to avoid caffeine intake
therapy. (Absorption of Cipro is
during drug therapy.
____________________ by caffeine.)

Monitor plasma theophylline
concentrations for patients prescribed these
drugs. (The drug affects half-life of
theophylline preparations.)

Inform patient that serum levels will
need to be monitored.

Monitor patient for symptom of
 Advise patient to use caution when
__________________________________.
driving, operating machinery, or
(This may occur due to the action of
performing other hazardous activities
ciprofloxacin on the central nervous system
until effect of drug is known.
(CNS).)
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes have been met (see “Planning”).
Patients Receiving Trimethoprim (Bactrim, Septra)
Assessment
Potential Nursing Diagnoses
Prior to administration:
 Infection, Risk related to contact with
contagious agents (nosocomial or
 Obtain complete health history including
allergies, drug history and possible drug
community acquired)
interactions
 Infection, Risk related to increased
vulnerability secondary to diminished
 Assess for presence or history of systemic,
respiratory or urinary tract infection
immune response
 Assess intake and output
 Knowledge, Deficient, related to drug
therapy and side effects
Planning: Patient Goals and Expected Outcomes
The patient will:
 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
Implementation
Interventions and (Rationales)
Patient Education/Discharge Planning
Inform patient:
 Monitor __________________ function
including these labs: ______________
 That _________________ tests and
and _____________values, and intake and
____________ may need to be monitored
output.(Drug can cause hematological
 To report changes in urinary elimination to
toxic effects, which are increased with
the health care provider
kidney disease and also the elderly
population.)
Advise patient to:
 Evaluate complaints of painful urination,
flank pain, and fever. (Drug can change
 Drink 2.5-3 liters of fluid daily.
the urine pH and could increase the
 Report painful _______________, flank
patient’s risk for formation of renal
pain or fever to the health care provider
calculi.)
 Monitor baseline and follow-up urinalysis,  Instruct patient to continue medical
CBC, platelet count, BUN and creatinine
follow-up and laboratory test appointments
clearance with long-term therapy. (To
when receiving drug for extended period
evaluate effectiveness of drug therapy.)
of time.

Observe for symptoms of adverse
reactions. (Evidenced in hematology and
blood coagulation studies and by skin
manifestations.)

Instruct patient to report skin rash, sore
throat, fever, mouth sores, or unusual
bleeding or bruising.

Monitor _______________ integrity.
(This drug can also increase patient’s
sensitivity on the skin to ultraviolet
lights.)

Instruct patient to avoid exposure to direct
_______________________.

Monitor
 Instruct patient to take drug as directed and
________________________with
to
treatment regimen. (Full course of therapy
__________________________________.
is required. If patient stops medication
before prescription is complete, symptoms
may reoccur and this may increase
_____________________to further
antibiotics.)
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes have been met (see “Planning”).
Nursing Process Focus:
Patients Receiving Penicillin G (Pentids)
Assessment
Potential Nursing Diagnoses
Prior to administration
 Infection, Risk for, related to weakened
immune state or contact with pathogen
 Obtain complete health history including
allergies, drug history and possible drug
 Knowledge deficient related to drug action
interactions.
and therapy treatment and prevention
measures
 Assess for presence or history of local or
systemic ________________________.
 Injury, Risk (anaphylaxis) for related to
 Obtain vital signs
adverse effects of drug
Planning: Patient Goals and Expected Outcomes
The patient will:
 Remain free of signs of allergic reaction to drug therapy
 Demonstrate knowledge of drug action and side effects
 Demonstrate resolution to incidence of infection
Implementation
Interventions and (Rationales)
Patient Education/Discharge Planning
 Monitor for evidence of _____________ Instruct patient:
__________________________ to drug.
 Signs of allergic reaction including
(_______________________ may occur
_______________, ______________,
immediately or delayed beyond 72
_____________________________.
hours.)
 To immediately contact the health care
provider if __________________
reaction occurs.

Monitor intake and output especially
quantity and consistency of __________
________________________________.
(Severe diarrhea may occur due to the
possible adverse effect from
Pseudomembranous colitis.)

Evaluate patient’s understanding of drug
therapy and administration.
Give medication ________________
____________________________ 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.)

Advise patient to consult health care
provider before taking antidiarrheal
medication. These medications may
worsen or prolong diarrhea.
Instruct patient to:
 Take medication _______ hour before or
____________ hours _________ a meal.
 Take medication with glass of water
 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.

Observe for ______________________,
especially in susceptible patients
including elderly, debilitated, or
immunosuppressed patient. (There is a
high risk for superinfections due to
normal flora reduced or eliminated.)

Instruct patient to report signs and
symptoms of superinfection. Symptoms
may include: __________________,
____________________, stomatitis,
___________________ stools, vaginal
_________________________, or
___________________.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes are met (see “Planning”).
Nursing Process Focus:
Patients Receiving Cefotaxime (Claforan)
Assessment
Potential Nursing Diagnoses
Prior to administration
 Injury, Risk for ___________________
related to adverse reaction to drug
 Obtain complete health history including
allergies, drug history and possible drug
 Infection, Risk for superinfection related to
interactions
effects of drug therapy
 Assess for presence of local or systemic
 Fluid volume, Risk for deficit, related to
infection
effects of drug on GI system
 Obtain vital signs
 Diarrhea, Risk for related to side effects of
drug
 Obtain history of drug allergies
Planning: Patient Goals and Expected Outcomes
The patient will:
 Remain free of symptoms of allergic reaction
 Maintain adequate fluid balance
 Demonstrate absence of superinfection
 Maintain formed stool consistency
Implementation
Interventions and (Rationales)
Patient Education/Discharge Planning
Instruct patient to:
 Monitor for severe ____________
________________________ caused
 Report loose stools or diarrhea.
by the disruption of normal bowel flora.
 Avoid treating diarrhea with
(May cause fluid _________________
antidiarrheals as this can impede the
imbalance and superinfection of
process of eliminating “bad bacteria"
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
bacterial, such as acidophilus, are also
available OTC).


Monitor for _____________, pruritus,
or _________________ (indicative of
an ___________________ reaction to
the medications).
Monitor _______________ and
____________________ carefully in
patients with compromised
______________ function or if
receiving aminoglycoside.

Instruct patient to report adverse
reactions promptly.

Explain to patient purpose of required
laboratory tests and schedule follow-up
with health care provider.


Monitor renal function with lab studies
periodically during and after therapy.
(Toxicity could occur from drug toxins
that are unable to be excreted.)
Monitor for ___________________,
especially with prolonged therapy.

Instruct patient to report symptoms,
especially in debilitated or chronically ill
patient.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes have been met (see”Planning”).
Nursing Process Focus:
Patients Receiving Tetracycline HCl (Achromycin and others)
Assessment
Potential Nursing Diagnoses
Prior to administration
 Body image, disturbed related to change in
appearance
 Obtain complete health history including
allergies, drug history and possible drug
 Noncompliance related to prolonged
interactions.
therapy
 Assess for presence/history of: Lyme
 Therapeutic regimen management,
disease, pneumonia, acne vulgaris,
Ineffective related to prolonged course of
Typhus, Cholera, Rocky Mountain
treatment
spotted fever, Chlamydia, sexually
 Knowledge, Deficient, related to drug
transmitted diseases, bladder infections,
action and side effects
Helicobacter Pylori ulcers
Planning: Patient Goals and Expected Outcomes
The patient will:
 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
Implementation
Interventions and (Rationales)
Patient Education/Discharge Planning
 Monitor ______________status when
 Instruct patient and caregivers to report
administered to children under age 8.
evidence of tooth discoloration or dental
(Drug may cause permanent discoloration
abnormalities to health care provider.
of teeth, enamel defects, and bone growth
retardation.)
Instruct patient to:
 Administer with caution to patients with
impaired _____________________or
 Report changes in ___________ output
_________________ function. (Could
 Report for follow up care and lab tests of
result in impaired metabolism and
___________________ and ___________
excretion.)
function and serum tetracycline levels.

Evaluate use of OTC products such as
__________________,
__________________ supplements,
______________________, and laxatives
containing ______________. (These
products interfere with drug absorption).

Instruct patient to consult with health care
provider before taking over the counter
drugs.

Instruct patient to:
 Avoid direct exposure to _____________
during and after therapy. Wear protective
clothing, and ______________________.
 Use an alternate form of birth control
until all the medication is completed.
 Avoid taking drug with ______________,
especially ________________ products.
 Report adverse effects 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.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes are met (see “Planning”).
Evaluate patient understanding of drug
therapy and administration. (Drug may
cause _________________________ and
increase risk of
_____________________. Tetracyclines
can increase patient’s sensitivity of the
skin to __________________________.)
Nursing Process Focus:
Patients Receiving Erythromycin (E-mycin, Erythrocin)
Assessment
Potential Nursing Diagnoses
Prior to administration:
 Knowledge, Deficient related to disease
process and drug therapy
 Obtain complete health history
including allergies, drug history and
 Infection, Risk for related to superinfection
possible drug interations.
 Fluid volume, Risk for Deficit related to
 Assess for presence/history of local or
effects of drug on GI system
systemic ________________________  Diarrhea, Risk forrelated to effect of drug
 Obtain vital signs
therapy
 Obtain history of _________________  Injury, Risk for (anaphylaxis) , related to
reaction to drugs
adverse reaction to drug
Planning: Patient Goals and Expected Outcomes
The patient will:
 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
Implementation
Interventions and (Rationales)
Patient Education/Discharge Planning
 Contraindicated in patients with
 Instruct patient to report history of medical
_______________________disease.
problems to health care provider.
(Because the metabolism of erythromycin
ethylsuccinate (EES) is mainly by the
__________________, it increases the
patient’s risk for toxicity.)

Monitor this lab: _________,
temperature, cultures, and perform
infection-focused physical examination.
(To determine effectiveness of drug
therapy.)
Evaluate patient understanding of
treatment regimen. (Patient must
complete the full course of therapy to
prevent _________________________


_________________________.)

Monitor for evidence of G.I. distress.
(May require alternate form of
medication.)
Instruct patient:
 To report ____________and worsening
symptoms of ____________________.
 To 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 _______-hour before or _______
hours after meals.
 Avoid taking with or just after ______
fruit juices or carbonated drinks.
 Instruct patient to report past history of GI
problems to health care provider.


Monitor for ____________________ in
patients receiving high dose, older
adults, female and history of kidney or
liver dysfunction.

Instruct patient to immediately report
__________________________________
__________________________________
__________________________________
to the health care provider.
Observe for signs and symptoms of
 Instruct patient to report diarrhea,
___________________________ by
abdominal pain, vaginal _____________,
overgrowth of non-susceptible bacteria
or fever.
or fungi.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes have been met (see “Planning”).
Nursing Process Focus:
Patients Receiving Gentamicin (Garamycin)
Assessment
Potential Nursing Diagnoses
Prior to administration:
 Injury, Risk for related to renal
insufficiency related to aminoglycoside
 Obtain complete health history including
allergies, drug history and possible drug
therapy
interactions
 Injury, Risk for related to disturbances of
balance and impaired ability to detect
 Assess for presence/history of local or
systemic infection
environmental hazards
 Obtain vital signs
 Knowledge, Deficient related to drug
therapy and side effects
 Obtain history of drug allergies
Planning: Patient Goals and Expected Outcomes
The patient will:
 Maintain normal renal function throughout drug therapy.
 Demonstrate knowledge of drug therapy and side effects
 Remain free of physical injury
Implementation
Interventions and (Rationales)
Patient Education/Discharge Planning
Instruct patient to provide thorough history of
 Use with caution with impaired
__________________________function medical conditions and treatment to health care
or neuromuscular disorders. (_________ provider.
impairment can increase the risk of
toxicity with this drug. Patients with
neuromuscular disorders may experience
greater ________________ weakness
due to possible neuromuscular blockade
with the drug’s action.)

Monitor for signs of __________toxicity
including unusual appearance of urine
(dark, cloudy) intake and output ratio,
and the presence of edema. Report
immediately
Instruct patient to:
 Increase fluid intake of 2000 ml per day.
 Report evidence of decreased
_______________output to the health care
provider

Monitor for evidence of
________________________including
_______________________,
_____________ or vertigo,
_____________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
__________________therapeutic range.)

Instruct patient to notify health care
provider if changes in
__________________________ occur.

Explain to patient that frequent serum drug
therapy levels are necessary to prevent and
monitor for complications.



Observe for symptoms of neurotoxicity
or neuromuscular blockade.

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.
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.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes have been met (see “Planning”).
Nursing Process Focus:
Patients Receiving Vancomycin (Vancocin)
Assessment
Potential Nursing Diagnoses
Prior to administration:
 Sensory perception, Disturbed related to
ototoxicity
 Obtain complete health history including
allergies, drug history and possible drug
 Injury, Risk for deep vein thrombosis
interactions
related to chemical irritation of vein
 Assess for presence or history of infections  Knowledge, Deficient, related to drug
resistant to other antibiotics
therapy and side effects
 Obtain history of hearing loss, impaired
renal function
 Obtain history of cardiovascular disease
 Obtain history of hearing loss
Planning: Patient Goals and Expected Outcomes
The patient will:
 Demonstrate therapeutic response to drug therapy
 Remain free of phlebitis
 Maintain normal hearing acuity
Implementation
Interventions and (Rationales)
Patient Education/Discharge Planning
Inform patient:
 Evaluate ____________________.
(Contraindicated with previous hearing loss  That audiometry tests maybe done to
due to drug’s ototoxic effects.)
prevent complications from possible
ototoxicity.
 To report symptoms of ______________,
buzzing in ears

Monitor peak and trough
____________________________levels to
ensure safe and effective dosage.

Inform patient about purpose of laboratory
studies.

Monitor ________________ status.
(Dosage is adjusted with ____________
insufficiency.)

Advise patient of importance of laboratory
studies to establish baseline ___________
function and to monitor function during
and after treatment.

Monitor IV site carefully. (Drug is
irritating to tissues and causes necrosis and
severe pain with extravasations.)

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 _____________________ of
treatment. Do not take other antidiarrheal
preparations.
Nursing Process Focus:
Patients Receiving Isoniazid (INH)
Assessment
Potential Nursing Diagnoses
Prior to administration:
 Sensory perception, Disturbed related to
peripheral neuritis and optic neuritis
 Obtain complete health history including
allergies, drug history and possible drug
 Knowledge, Deficient, related to drug
interactions
therapy and side effects
 Assess for presence/history of Positive
 Therapeutic regimen management,
tuberculin skin test, positive sputum culture
Ineffective related to long term therapy
or smear, close contact with person
recently infected with tuberculosis, AIDS,
receiving immunosuppressant drugs,
alcohol abuse, liver or kidney disease
Planning: Patient Goals and Expected Outcomes
The patient will:
 Demonstrate adherence to extended drug therapy
 Demonstrate negative sputum cultures indicating effective drug therapy
 Demonstrate understanding of drug therapy
Implementation
Interventions and (Rationales)
Patient Education/Discharge Planning
Instruct patient to:
 Monitor ________________function.
(Contraindicated in patients with
 Provide accurate and complete medical,
________________________________.)
medication and treatment history.
 Avoid ________________ intake during
drug therapy
 Report signs of _____________
impairment to health care provider,
including jaundice, itching, fatigue
 Monitor for negative sputum cultures.
 Instruct patient to follow through on
Change noted within 2-3 weeks. (To
prescribed lab tests.
evaluate effectiveness of drug therapy.)
Instruct patient to:
 Monitor for presence of peripheral neuritis
related to pyroxidine deficiency.
 Take pyrodoxine supplement to reduce
(Pyrodoxidine (vitamin __________)
risk of side effects.
deficiency causes neurotoxic effects.)
 Report symptoms of numbness, tingling,
or burning of feet to the health care
provider
 Evaluate diet for ingestion of foods
 Advise patient to avoid foods such as
containing tyramine. (Ingestion of
______________________,
tyramine-containing foods may cause
______________, ________________
palpitation, flushing and BP elevation, and
and yeast extracts.
histamine-containing foods may cause
exaggerated drug response with headache,
palpitation, sweating, flushing, itching, or
diarrhea.)