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1、NURS 1950 Antibiotics and other Agents,Metropolitan Community College Nursing Program Nancy Pares, RN, MSN,In the beginning.,Before Antibiotics Infections treated topically with poultice or surgically removed 1936Sulfonamide discovered Beginning of understanding of microbes 1941Penicillin introduced
2、 WWII had great results with high volume data Present . Man vs. microbe= resistant pathogens,Chain of infection.recall,Objective 1: Identify the bodys natural defenses against infections,Barriers/prevention Intact skin, adequate nutrition, respiratory cilia, immune systemSeek and Destroy WBC, adequa
3、te blood supply, intestinal flora, vaginal flora, stomach acids,Objective 2: Describe factors that increase the susceptibility of the body to infection,Virulence of the pathogen Number of pathogens Chronic illness Poor nutrition Diseases/drugs that decrease the immune system Entry point Super infect
4、ions,Host Factors,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
5、 not allow antibiotics to clear system,Obj. 3: Name the lab tests done to identify the invading pathogen,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 sensiti
6、vity testing Preliminary results within 24 hours Final results in 2-3 days,Obj. 4: Identify factors utilized to select an appropriate antibiotic,Covered in objective 2,Obj. 5 Explain what resistance means and the various types of resistance,Passive immunity A person has been given vaccine Active imm
7、unity Has had the disease 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,Obj. 6: Define narrow spectrum and broad spectrum,Narrow Effe
8、ctive on limited number of organisms Broad Effective on many organisms; often used first Bacteriocidal Kills Bacteriostatic Prevents growth and reproduction,Obj. 7: Describe adverse reactions to antibiotics,Hypersensitivity Can result in anaphylactic shock/death 15% of penicillin users Treat with Be
9、nedryl, corticosteroids, epinephrine Cross sensitivity When antibiotics are closely related chemically Organ toxicity Liver, kidneys, CNS, GI is most common Vancomycin highly nephrotoxic Gentamycin highly ototoxic,Adverse reactions cont,Hematotoxicity Chloramphenicol Causes aplastic anemia Bone marr
10、ow cannot make red blood cells,Obj. 8 Discuss the penicillins and identify specific penicillin preparations,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
11、 resistant Chemical modifications Penicilinase resistant, broad spectrum, extended spectrum Treatment of pneumonia, skin, bone and joint infections, blood infections, gangrene, meningitis,Penicillins cont,Routes PO, IM, IV Adverse effects Hypersensitivity most common Nursing considerations VS, asses
12、s previous reactions, lab (electrolytes, renal function, ECG, Observe for IV reaction within 30 min; client teaching Prototype: Pen G Potassium,Obj.9 Discuss various cephalosporin preparations,Action/Use Bacteriocidal by attaching to penicillin binding proteins to inhibit cell wall synthesis Gram ne
13、gative infections and when less expensive penicillins are not tolerated; 5-10% of people allergic to penicillin are also allergic to cephalosporins Adverse reactions Hypersensitivity; kidney toxicity PrototypeCefotaxime (Claforan),Cephalosporin classifications,First generation Most effective against
14、 gram +; beta lactamase producing organisms usually resistant Second generation More potent, broader spectrum, moderately resistant to beta lactamase organisms Third generation Longer duration of action, resistant to b-lactamase Drugs of choice for pseudomonas, klebsiella, neisseria, salmonella and
15、H. influenza Fourth generation-treat CNS infections,Cephalosporins,Nursing considerations Assess for bleeding disorders-check PT levels Assess kidney and liver function labs Assess concurrent meds: (NSAIDS) Monitor I IM inj. painful,Obj. 10 Discuss tetracycline , including nursing implications,Actio
16、n/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 S/E n/v, diarrhea, photosensitivity, permanent discoloration of teeth 8 yo,Tetracycline cont,Nursing considerat
17、ions 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),
