Metropolitan Community College
Nursing Program
Nancy Pares, RN, MSN
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Before Antibiotics
◦ Infections treated topically with ‘poultice’ or
surgically removed
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1936…Sulfonamide discovered
◦ Beginning of understanding of microbes
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1941…Penicillin introduced
◦ WWII had great results with high volume data
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Present ….
◦ Man vs. microbe= resistant pathogens
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Peak effect
◦ 15-30 min after infusion has begun
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Trough effect
◦ Lowest point of medication effect
◦ Draw blood just before the next scheduled dose
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Barriers/prevention
◦ Intact skin, adequate nutrition, respiratory cilia,
immune system
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Seek and Destroy
◦ WBC, adequate blood supply, intestinal flora,
vaginal flora, stomach acids
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Virulence of the pathogen
Number of pathogens
Chronic illness
Poor nutrition
Diseases/drugs that decrease the immune
system
Entry point
Super infections
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Status of immune system
◦ May need prophylactic therapy
Location of the infection
◦ Many drugs do not cross blood brain barrier
Extent of inflammation
◦ Decrease circulation of drug
Age: metabolization of drug
Pregnancy: risks to fetus vs. benefit of drug
Genetics: enzyme deficiencies do not allow antibiotics to
clear system
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Should be done before antibiotic initiated
Microscopic examination
◦ Urine, stool, blood, spinal fluid, sputum, purulent
drainage
◦ Identify the organism and test with antibiotics
 Culture and sensitivity testing
 Preliminary results within 24 hours
 Final results in 2-3 days
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Covered in objective 2
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Passive immunity
◦ A person has been given vaccine
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Active immunity
◦ Has had the disease
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Acquired resistance
◦ Bacteria have randomly mutated and can transmit
mutated bacteria to others
◦ Healthcare practitioners role
 Use antibiotics when indicated
 Prophylaxis: deep tissue injury, prosthetic heart
valves
Antibiotics
do not
create mutations
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Narrow
◦ Effective on limited number of organisms
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Broad
◦ Effective on many organisms; often used first
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Bacteriocidal
◦ Kills
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Bacteriostatic
◦ Prevents growth and reproduction
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Hypersensitivity
◦ Can result in anaphylactic shock/death
 15% of penicillin users
 Treat with Benedryl, corticosteroids, epinephrine
◦ Cross sensitivity
 When antibiotics are closely related chemically
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Organ toxicity
◦ Liver, kidneys, CNS, GI is most common
◦ Vancomycin highly nephrotoxic
◦ Gentamycin highly ototoxic
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Hematotoxicity
◦ Chloramphenicol
 Causes aplastic anemia
 Bone marrow cannot make red blood cells
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Action/use
◦ Kill bacteria by disrupting cell wall; chemical make
up responsible is beta lactam ring—
 some bacteria secrete enzyme that splits the beta
lactam ring allowing the bacteria to become resistant
◦ Chemical modifications
 Penicilinase resistant, broad spectrum, extended
spectrum
◦ Treatment of pneumonia, skin, bone and joint
infections, blood infections, gangrene, meningitis
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Routes
◦ PO, IM, IV
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Adverse effects
◦ Hypersensitivity most common
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Nursing considerations
◦ VS, assess previous reactions, lab (electrolytes,
renal function, ECG, Observe for IV reaction within
30 min; client teaching; decrease effects of
contraceptives; take on empty stomach
◦ Pen G Procaine—not given IV= lethal
◦ Prototype: Pen G Potassium
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Action/Use
◦ Bacteriocidal by attaching to penicillin binding
proteins to inhibit cell wall synthesis
◦ Gram negative infections and when less expensive
penicillins are not tolerated; 5-10% of people
allergic to penicillin are also allergic to
cephalosporins
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Adverse reactions
◦ Hypersensitivity; kidney toxicity
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Prototype—Cefotaxime (Claforan)
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First generation
◦ Most effective against gram neg; beta lactamase
producing organisms usually resistant
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Second generation
◦ More potent, broader spectrum, moderately
resistant to beta lactamase organisms
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Third generation
◦ Longer duration of action, resistant to b-lactamase
◦ Drugs of choice for pseudomonas, klebsiella,
neisseria, salmonella and H. influenza
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Fourth generation-treat CNS infections
◦ Use: gram + cocci; gram - bacilli
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Nursing considerations
◦ Assess for bleeding disorders-check PT levels
 Interferes with Vit K metabolism
◦ Assess kidney and liver function labs
 Important in Vit K production
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Assess concurrent meds: (NSAIDS)
Monitor I&O
Assess GI symptoms
Client teaching
 Cultured dairy (superinfection prevention); avoid
alcohol use, complete full RX; IM inj. painful
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Action/Use
◦ Bacteriostatic; inhibits protein synthesis to slow
microbial growth
◦ Rocky Mtn Spotted fever, typhus, cholera, Lyme
disease, peptic ulcers (caused by H. pylori),
chlamydial infections
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S/E
◦ n/v, diarrhea, photosensitivity, permanent
discoloration of teeth <8 yo
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Nursing considerations
◦ Avoid use <8 yo, avoid sunlight/UV exposure;
monitor labs (CBC, liver function, kidney function)
◦ Teach importance of oral and perineal hygiene
due to super infections
◦ Do not take with milk products, iron supplements,
or antacids; wait 1-3 hrs before taking antacids;
wait 2 hrs before and after taking lipid lowering
drugs (Ca+ and iron bind with tetracycline)
◦ Decreases effectiveness of oral contraception
◦ Prototype: tetracycline
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Action/use
◦ Bacteriocidal; inhibits protein synthesis
◦ Aerobic gram neg bacteria (e. coli, seratia,
proteus, klebsiella, pseudomanas); administered
with other antibiotic for entercocci infections.
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S/E
◦ Irreversible ototoxicity, nephrotoxicity, respiratory
paralysis
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Prototype: Gentamycin (Garamycin)
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Nursing considerations
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Monitor for ototoxicity (How?)
Monitor for nephrotoxicity (How?)
Provide optimal oral hygiene
IV administration should be done slowly
Poorly absorbed via GI—only route is IV
Monitor peak and trough levels for toxicity
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Quinolones/fluoroquinolones
◦ First introduced in 1962
◦ Currently four generations
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Macrolides
◦ Low doses-bacteriostatic
◦ High doses-bacteriocidal
◦ Prototype: e mycin
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Action/Use
◦ Bacteriocidal;inhibit enzymes (DNA gyrase and
topoisomerase) to affect DNA synthesis;gram
neg microbes
◦ Respiratory, GI, GU tracts; skin and soft tissue;
newer agents very effective against anerobes
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S/E/route
◦ n/v; ADVERSE: dysrhythmias,liver failure and
CNS changes; not used in pregnancy; caution in
children; oral BID
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Prototype:Ciprofloxicin (Cipro)
Most common= levaquin
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Nursing considerations:
◦ Assess hypersensititivity; report neurologic
effects
◦ Phototoxicitity
◦ Don’t take with vitamins/mineral supplements (or
wait 2 hrs before and after
◦ Monitor labs
◦I&O
◦ Take all the prescription
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Action/Use
◦ Binds to bacterial ribosome to inhibit synthesis
(act inside cell); bacteriostatic; effective against
gram + and -;treats whooping cough,
◦ Legionaire’s disease, H. influenza and
Mycoplasma pneumoniae
◦ Newer drugs synthesized from erythromycin—
less GI disturbance
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S/E—very few
Prototype: erythromycin (E-Mycin)
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Nursing considerations
Do not use in pregnancy
Assess history of hypersensititivity
Monitor labs (liver and kidney, INR)
Macrolides decrease warfarin metablism and
excretion
◦ Photosensitivity
◦ Complete the course of treatment
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Clindamycin (Cleocin)
◦ Grm + and – effectiveness
◦ Use: oral infections
◦ Contraindication: hypersensitivity
 Limited use due to association w pseudomenbranous
colitis
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Sulfonamides
◦ Action:bacteriostatic, broad spectrum, used for
UTI
◦ Classified by route of administration
 Systemic and topical
◦ Systemic
 Sulfisoxazole (Gantrisin)
◦ topical
 Sulfadoxine (Fansidar)- not 1st choice drug
◦ Contraindicated in pregnancy and infants < 2
years (promotes jaundice);low soluability causes
crystals in urine
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Vancomycin ( Vancocin)
◦ Reserved for severe infections; most effective with
MSRA; need peak and trough labs
◦ Sensititivity reaction: hypotension and rash with
rapid IV infusion (Red Man Syndrome)
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Imipenim (primaxin)—carbapenem category
◦ Bacteriocidal; preparation specific for IV vs IM
◦ Stable for 4 hrs; synergistic effects with
aminoglycosides
◦ Use; septicemia/bacterial meningitis
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Ketolides
◦ Use: respiratory infections
◦ Low incidence of adverse effects
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Glycylcyclines
◦ Use: complicated skin infections; MSRA
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Nursing Dx
Pain related to infection
Infection
Hyperthermia
Risk for injury related to adverse drug effects
Deficient knowledge related to drug therapy
Risk for deficient fluid volume r/t fever, diarrhea
from adverse drug effect
◦ Risk for non compliance r/t deficient knowledge,
cost of drug, drug effects
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Client will
◦ Report diminished signs and symptoms of infection;
decreased fever and fatigue; increased appetite
◦ Be free from or experience minimal adverse effects
◦ Verbalize understanding of the drugs use, adverse
effects and required precautions
◦ Demonstrate proper self administration
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Monitor vs and symptoms of infections
Monitor hypersensitivity reaction
Monitor for severe diarrhea
Admin drug as ordered
Monitor for superinfection
Precaution regarding OTC
Monitor for photosensitivity
Determine food and drug interactions
Monitor IV site
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Patient
◦ reports diminished signs and symptoms of
infection, decreased fever
◦ Is free from or experiences minimal adverse effects
◦ Verbalizes and understanding of the drugs use,
effects and precautions
◦ Demonstrates proper self admin.
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Tuberculosis:
◦ Cause:
 Mycobacterium tuberculosis
◦ Incidence:
◦ Treatment: prolonged due to cell wall resistance
to penetration by anti infective drugs
 Multiple drug concurrently
 Rifampin: used for H influenza
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Isoniazid (INH)
◦ Action:
 Inhibits synthesis of cell wall
◦ Use:
 tuberculosis
◦ S/E
 Numbness of hands, feet; rash; fever
 Contraindicated: hepatic disease; do not take with
antacids
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General Action:
◦ Inhibit ergosteral synthesis
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Amphoericin B (Fungizone)
◦ Systemic
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New class: echinocandins
◦ Used for systemic mycoses
◦ Caspofungin: treats aspergilosis
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Azoles
◦ Fluconazole (Diflucan)
 Action/use
 Penetrates most body membranes; interferes with
synthesis of ergosterol
◦ Nystatin (Mycostatin)
 Superficial antifungal
 Swish and swallow
 Glycemic control changes occur
 Do not use intravaginally with pregnancy or lactating
moms
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Nonnucleoside reverse transcriptase
inhibitors (NRTI)
◦ Action: binds to viral transcript and dis allows the
DNA action
◦ Prototype: efavirenz (Sustiva)
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Nucleoside and nucleotide reverse
transcriptase inhibitors (NNRTI)
◦ Action: creates a defective DNA by replacing one
of the nucleotides
◦ Prototype: Zidovudine (AZT)
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Protease inhibitors
◦ Lopinavir (Kalentra)
 Combination drug of lopinavir and ritonavir
 Action: inhibits hepatic breakdown of lopinavir
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Fusion inhibitor:
◦ Action: blocks fusion of HIV viron to DC4
receptor
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Assessment
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Infection RT
Risk of transmission of infection RT
Risk for infection RT
Risk for injury RT
Deficient knowledge RT
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To prevent…
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To alleviate..
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To improve…
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Client teaching