Podcast
Questions and Answers
A client presents with a fever, chills, and an elevated WBC count. What is the most appropriate initial nursing action?
A client presents with a fever, chills, and an elevated WBC count. What is the most appropriate initial nursing action?
A client is prescribed gentamicin. Which assessment finding would be of most concern?
A client is prescribed gentamicin. Which assessment finding would be of most concern?
Which of the following is the most important reason for completing a culture and sensitivity test before starting antimicrobial treatment?
Which of the following is the most important reason for completing a culture and sensitivity test before starting antimicrobial treatment?
A client who takes a carbapenem reports a rash to the nurse. Which information would be most important for the nurse to assess regarding the client's medical history?
A client who takes a carbapenem reports a rash to the nurse. Which information would be most important for the nurse to assess regarding the client's medical history?
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What is the primary reason for using antimicrobial dressings?
What is the primary reason for using antimicrobial dressings?
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When administering an aminoglycoside, the nurse should prioritize monitoring for which adverse effects?
When administering an aminoglycoside, the nurse should prioritize monitoring for which adverse effects?
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A client on antimicrobial therapy is demonstrating nonadherence. Which intervention should the nurse prioritize?
A client on antimicrobial therapy is demonstrating nonadherence. Which intervention should the nurse prioritize?
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A client is administered a skeletal muscle relaxant while on gentamicin. Which adverse effect requires vigilant monitoring by the nurse?
A client is administered a skeletal muscle relaxant while on gentamicin. Which adverse effect requires vigilant monitoring by the nurse?
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Which generation of cephalosporins is known for having the strongest gram-negative activity?
Which generation of cephalosporins is known for having the strongest gram-negative activity?
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A patient taking linezolid should be closely monitored for which of the following adverse effects?
A patient taking linezolid should be closely monitored for which of the following adverse effects?
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Which medication requires monitoring of peak and trough levels due to potential adverse effects?
Which medication requires monitoring of peak and trough levels due to potential adverse effects?
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A patient prescribed a quinolone should be advised regarding which specific adverse effect?
A patient prescribed a quinolone should be advised regarding which specific adverse effect?
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Which of the following is a critical teaching point for a patient taking sulfonamides?
Which of the following is a critical teaching point for a patient taking sulfonamides?
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What is the recommended time frame for initiating oseltamivir (Tamiflu) treatment after the onset of flu symptoms in order to ensure efficacy?
What is the recommended time frame for initiating oseltamivir (Tamiflu) treatment after the onset of flu symptoms in order to ensure efficacy?
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Which antibiotic class is contraindicated in pregnancy and in children under 8 due to the risk of tooth discoloration?
Which antibiotic class is contraindicated in pregnancy and in children under 8 due to the risk of tooth discoloration?
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Which of the following strategies is NOT directly aimed at fighting antibiotic resistance?
Which of the following strategies is NOT directly aimed at fighting antibiotic resistance?
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Study Notes
Antimicrobial Therapy: Key Points
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Infection Recognition: Pathogens cause disease; common signs include fever, chills, redness, swelling, pain, fatigue, and elevated white blood cell count.
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Treatment Approach: Treatment uses antimicrobial medications tailored to the pathogen.
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Pre-treatment Considerations: Determine if the disease is contagious (isolate if so) and perform culture and sensitivity tests on the pathogen to identify the appropriate drug or utilize broad spectrum antibiotics if needed. Check for allergies, especially penicillin allergies and identify possible nonadherence.
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Nonadherence Management: Consider medication reminders, simplified regimens, and patient education to improve compliance; nonadherence can lead to treatment failure and resistance development.
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Collaboration: Work with providers, pharmacists, and infection control specialists to develop individualized treatment plans.
Antimicrobial Medications and Classes
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Antimicrobial Dressings: These utilize agents like honey, Hydrofera Blue, mupirocin, or silver for wounds with foul odors or partial/full-thickness wounds (consult with a skin/wound care team).
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Aminoglycosides: Inhibit protein synthesis targeting gram-negative microbes including Gentamicin, neomycin, streptomycin, and tobramycin. Adverse effects include ototoxicity (tinnitus, hearing loss, vertigo) and nephrotoxicity (monitor BUN/creatinine). Avoid mixing in the same syringe and use cautiously with skeletal muscle relaxants.
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Carbapenems: Potent broad-spectrum antibiotics including Ertapenem, Imipenem-cilastatin, and Meropenem. Adverse effects include penicillin cross-hypersensitivity, pseudomembranous colitis, and seizures (risk heightened with renal impairment or existing seizure disorders).
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Cephalosporins: Similar to penicillins, with generations based on broadened gram-negative coverage: 1st gen (gram-positive), 2nd gen (increased gram-negative), 3rd gen (strong gram-negative), and 4th gen (broad spectrum). Monitor for IV site inflammation (phlebitis/thrombophlebitis).
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Macrolides: Inhibit protein synthesis, commonly used in respiratory, GI, skin, and STI infections. Examples include Azithromycin, clarithromycin, and erythromycin. May interact with oral contraceptives; ensure patient understands administration instructions (with or without food).
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Linezolid (Zyvox): Used for serious or life-threatening infections. Adverse effects include bone marrow suppression (monitor for sore throat, fatigue, fever, petechiae), and visual changes (especially with prolonged use). Avoid MAOIs, dopamine, epinephrine, pseudoephedrine, and certain antidepressants.
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Penicillins: Disrupt bacterial cell walls; examples include Penicillin G and piperacillin. Used in pneumonia, syphilis, gonorrhea, and bacterial endocarditis prophylaxis. High electrolyte content (need to monitor with renal issues) and nephrotoxicity are potential adverse effects.
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Quinolones: Examples include Ciprofloxacin and levofloxacin for UTIs, sinusitis, and anthrax. Adverse effects include photosensitivity, dizziness, nausea and tendon rupture specifically with corticosteroid users or CKD.
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Sulfonamides: Examples include Sulfasalazine and co-trimoxazole, commonly used for UTIs, otitis media, and strep infections. Ensure patients drink plenty of water, and avoid sun exposure.
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Tetracyclines: Examples include Doxycycline and tetracycline, used in UTIs, respiratory infections, and acne. Adverse effects include photosensitivity, and should be avoided in pregnancy, or children under 8 to avoid tooth discoloration.
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Vancomycin: Effective against gram-positive bacteria. Adverse effects include Red Man Syndrome (infusion reaction), ototoxicity, and nephrotoxicity. Monitor peak and trough levels.
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Antifungals (Amphotericin B): Used for life-threatening fungal infections. Premedicate to reduce side effects like fever and chills. Monitor for hypokalemia and nephrotoxicity.
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Antivirals: Examples include acyclovir (herpes; slow IV infusion), oseltamivir (flu, start treatment within 48 hours), and tenofovir (HIV/Hep B).
Discharge Instructions & Resistance Prevention
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Discharge Teaching: Take medications as prescribed; use backup contraception if applicable; report side effects; and avoid alcohol with certain medications.
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Resistance Mitigation: Prevention through hand hygiene, vaccinations, aseptic techniques; data collection (CDC) improves prevention strategies; avoid antibiotic overuse; active research for new antibiotics.
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Description
This quiz covers essential aspects of antimicrobial therapy, including recognition of infections, treatment approaches, and pre-treatment considerations. It also explores the importance of managing nonadherence and the role of collaboration among healthcare providers in developing effective treatment plans.
