IV therapy integumentary

Integumentary Drugs and Antibiotics

• Integumentary drugs and antibiotics are used to treat various infections.

Classification of Antimicrobial Medications

• Narrow-spectrum: Medications effective against a limited range of microorganisms.
• Broad-spectrum: Medications effective against a wider range of microorganisms.
• Bactericidal medications: Kill bacteria.
• Bacteriostatic medications: Inhibit bacterial growth.

Identification of Causative Agent

• Laboratory testing is essential to identify the causative microorganism.
• Gram stain: A quick method to identify the type of microorganism.
• Culture: A method to grow the microorganism for identification when gram stain is inconclusive.
• Nurses must collect specimens carefully to prevent contamination before antibiotics are administered.

Host Factors

• Immune system: The body's defense mechanisms against infection.
• Site of infection: Location where the infection is present.
• Age: The age of the patient can impact the immune response, and some infections respond differently in varying age groups.
• Blood-brain barrier: A barrier that protects the brain from harmful substances in the bloodstream.
• Endocarditis: Inflammation of the lining of the heart chambers and valves.
• Purulent abscesses: Pus-filled infections with poor blood supply leading to slower response to antibiotics.
• Surgical removal of drainage: This process can potentiate the effect of antibiotics.
• Phagocytes: Cells that engulf and destroy foreign invaders.
• Pregnancy: Affects the immune response.
• Presence of a previous allergic reaction: Indicates the potential for an allergic reaction to a drug.

Combination Therapy

• Used to treat severe infections due to multiple bacteria.
• Prevents bacterial resistance.
• Reduces dosage, decreasing risk of toxicity/side effects.
• More effective treatment.
• Increased resistance may occur if not followed properly.
• Increased cost of treatment.
• More adverse and toxic reactions.
• Antagonistic effects may occur among antibiotics.
• Increases risk of superinfection.

Prophylaxis Treatment

• Prevents infections in clients undergoing specific surgeries, procedures, or exposures.
• Prevents conversion to infection.
• Utilized for clients with prosthetic heart valves undergoing dental procedures.
• Used for recurring UTIs.

Preventative Measures

• Hand hygiene: Critical before and after patient contact.
• Recognize invasive procedures: Identify procedures increasing infection risk.
• Encourage immunizations: Up-to-date immunizations reduce infections.
• Full course of medication: Completing the full course of medication to prevent resistance/recurrence.
• Aseptic technique: Proper technique to prevent contamination.
• Careful assignment of rooms: Reduces risk of cross-contamination.
• Monitor effectiveness of treatment: Assessing efficacy is crucial to monitor the status.
• Post-treatment cultures: Confirm adequate treatment.
• Monitor clients for improvement: Crucial factor to monitor.

Resistance to Drugs

• Drug resistance arises when antibiotics are regularly used by patients or when multiple individuals are in close proximity.
• Bacteria develop natural resistance.
• Bacteria can acquire resistance.
• New resistance develops, associated with bacteria with both natural and acquired resistance ability.

US Food and Drug Administration Pregnancy Risk Classifications

• Category A: No risk of fetal harm.
• Category B: No risk in humans, possibly risk in humans.
• Category C: Risk cannot be ruled out in either species and/or both animal and human studies.
• Category D: Positive evidence of risk in humans, but use may be justified in some situations.
• Category X: Contraindicated in pregnancy due to evidence of possible fetal harm.

Sulfonamide

• Effective antibiotic against various infections.
• Uses: UTI, Otitis Media, Changoird, Pertussis, Shigellosis, and Pneumocystis Pneumonia, Treating Burns
• Adverse reactions: Anorexia, nausea, vomiting, diarrhea, abdominal pain, chills, fever, stomatitis, hyperkalemia, kernicterus, orange-yellow urine and skin, crystalluria, photosensitivity, hypersensitivity reactions, generalized skin reactions, toxic epidermal necrolysis, and hematologic changes.
• Contraindications/Precautions: Hypersensitivity to sulfonamides, during lactation/pregnancy/children under 2, infections caused by group A beta-hemolytic streptococci.
• Drug interactions: Oral anticoagulants and hydantoins.
• Monitoring: Diabetes, hypoglycemic reactions, Cranberry juice, and antibiotic interaction.
• Dosage, administration, and implementation: Empty stomach 1 hour before or 2 hours after meals with 8 oz of water. Drink at least 8 large glasses of water daily.
• Burn injury treatment: Clean, remove debris, sterile gloved hand application, 1/16 inch thick application and caution for pain.

Penicillins

• Actions: Weakens and lyses bacterial cell walls.
• Used against: Meningitis, Syphilis, and many other infectious diseases.
• Extended spectrum: Treating difficult bacteria.
• Prophylaxis: Bacterial endocarditis and other conditions.
• Adverse reactions: Gastrointestinal, hypersensitivity, and anaphylactic shock. Cross-sensitivity/allergy with other drugs. Superinfections: Bacterial, fungal. Hematopoietic changes.
• Precautions/Contraindications: Hypersensitivity to penicillin, cephalosporins, and imipenum. Use cautiously: Renal disease, asthma, bleeding disorders, GI issues, pregnancy, or lactation.
• Drug interactions: Birth control pills, tetracyclines, anticoagulants, beta-adrenergic blocking drugs.
• Administration and dosage: With meals, unless otherwise indicated. Ac and PC Meals, with 8oz of water.

Cephalosporins

• Broad-spectrum bactericidal antibiotics.
• Generations: Divided into first, second, third, and fourth generations, each with varying effectiveness against gram negative organisms.
• Penetration into cerebrospinal fluid (CSF) increases with each generation.
• Uses: Respiratory Infections, Ear Infections, Bone/Joint Infections, Genitourinary Tract Infections, Postoperative Infections, and Meningitis. Prophylaxis following sexual assault.
• Adverse reactions: Gastrointestinal such as nausea, vomiting, and diarrhea; possible superinfection. Intramuscular and intravenous administration may cause pain, tenderness and inflammation. Intravenous infusion reactions may cause thrombophlebitis. Adverse effects: Headache, dizziness, malaise, heartburn, fever, nephrotoxicity, hypersensitivity, aplastic anemia, and toxic epidermal necrolysis. Allergy to penicillin may cross to some cephalosporins.
• Precautions/Contraindications: Hypersensitivity to cephalosporins or penicillins. Use cautiously with bleeding disorders or anticoagulants: need to monitor bleeding times. Monitor vitamin K supply. Use cautiously in renal, hepatic disease and pregnancy/known penicillin allergy.
• Drug interactions: Aminoglycosides and oral anticoagulants.
• Nursing alert: Disulfiram-like reaction with alcohol within 72 hours of treatment.
• Administration and Dosage: Administered with food. Shake oral suspensions, store in refrigerator.

Tetracyclines

• Broad-spectrum antibiotics
• Uses: Rickettsiae, intestinal amebiasis, skin and soft tissue infections, uncomplicated urethral, endocervical, or rectal infections, Acne, Mycoplasmal pneumonia, lyme disease, adjunctive treatment: Helicobacter pylori, Anthrax.
• Adverse reactions: Gastrointestinal (N/V/D), epigastric distress, stomatitis, sore throat, skin rashes, hepatotoxic, superinfections such as C diff. Photosensitivity. Monitor for photosensitivity reactions. (sun, tanning beds).
• Precautions/Contraindications: Hypersensitivity, use in pregnancy (Category D), children younger than 8-9 (due to teeth staining.) Use cautiously in renal or liver impairment.
• Drug interactions: Antacids, oral anticoagulants, oral contraceptives, digoxin, and calcium-rich foods.
• Administration and dosage: Empty stomach with full glass of water (exceptions Minocin and Terramycin), Avoid dairy/antacids simultaneously.

Macrolides

• Prophylaxis: Used before dental or other procedures in patients allergic to penicillin to prevent rheumatic fever and bacterial endocarditis.
• Treatment: Legionnaires' disease, pertussis, acute diphtheria, Chlamydial infections, Mycoplasmal pneumonia, and streptococcal infections.
• Adverse reactions: Gastrointestinal (N/V/D), abdominal pain/cramping, pseudomembranous colitis, visual disturbances, ototoxicity, thrombophlebitis, prolonged QT interval, which can lead to dysrhythmias and sudden cardiac death.
• Contraindications/Precautions: Hypersensitivity to macrolides, preexisting liver disease, prolonged QT interval, use cautiously in patients with liver dysfunction, myasthenia gravis, during pregnancy (Cats B and C) and lactation.
• Drug interactions: Antacids, Digoxin, Anticoagulants, Clindamycin, Lincomycin, Chloramphenicol, and Theophylline.
• Implementation: Administer on empty stomach with 8 oz water (except azithromycin, dirithromycin, erythromycin). Monitor PT/INR if on Coumadin, and greater than 2 weeks of liver function. Avoid concurrent administration with diltiazem/verapamil.

Lincosamides

• Used to treat serious infections where penicillin or erythromycin aren't effective.
• Used in conjunction with other antibiotics.
• Effective against a range of gram-negative and gram-positive microorganisms.
• Adverse reactions: Gastrointestinal/other body reactions such as abdominal pain, esophagitis, nausea, vomiting, diarrhea, skin rash, and blood dyscrasias.
• Contraindications/Precautions: Hypersensitivity to lincosamides, minor bacterial/viral infections. Use cautiously with history of GI disorders, renal disease, liver impairment, myasthenia gravis.
• Implementation: Food impairs absorption, patient should not eat anything by mouth for 1-2 hours before/after administration. Usually given with food or a full glass of water.

Fluoroquinolones

• Broad-spectrum bactericidal antibiotics.
• Uses: Lower respiratory tract/GI infections; Bone and joint infections; Urinary tract infections and skin infections.
• Adverse reactions: Common: Nausea, diarrhea, headache, abdominal pain, dizziness. Serious: Achilles tendon rupture, photosensitivity, hypersensitivity, bacterial/fungal superinfections such as colitis, yeast, thrush.
• Contraindications/Precautions: Hypersensitivity; children under 18; pregnancy. Use cautiously with renal impairment, history of seizures, geriatric patients, on dialysis.
• Drug interactions: Theophylline, cimetidine, oral anticoagulants, antacids, iron salts/zinc, dairy products.
• Implementation: Increase fluid intake; administer ciprofloxacin and moxifloxacin 2-4 hours before or 6-8 after antacids.

Aminoglycosides

• Primarily used to treat infections caused by gram-negative microorganisms.
• Used to reduce bacteria in the bowel (for patients with abdominal surgery or hepatic coma), and to treat tuberculosis (TB), when used in conjunction with other medications.
• Adverse reactions: Hypersensitivity, photosensitivity, nephrotoxicity (proteinuria, hematuria, BUN and creatinine increases), ototoxicity (tinnitus, dizziness, roaring in ears), neurotoxicity, and changes in consciousness leading to difficulty swallowing and risk of aspiration.
• Contraindications/Precautions: History of hypersensitivity, pre-existing hearing loss, myasthenia gravis, pregnancy, Parkinsonism, and during lactation. Use cautiously in older adults, renal failure, and neuromuscular disorders.
• Interactions: Cephalosporins and loop diuretics.
• Implementation: Check peak and trough levels, inspect needle site, rate of infusion, and vein.

Linezolid (Zyvox)

• Bacteriostatic and bactericidal antibiotic used in treatment of vancomycin-resistant enterococcus (VRE) and health care- and community-acquired pneumonias and skin infections.
• Adverse reactions: Common and less common: Nausea, vomiting, diarrhea, headache, dizziness, insomnia, rash, fatigue, depression, nervousness, photosensitivity. Serious: Pseudomembranous colitis, thrombocytopenia.
• Contraindications/Precautions: Hypersensitivity to the drug, pregnancy (Category C), lactation, and phenylketonuria. Use cautiously in bone marrow depression, hepatic dysfunction, renal impairment, hypertension, and hyperthyroidism.
• Drug interactions: Antiplatelet drugs, MAOIs, large amounts of food containing tyramine.

Vancomycin (Vancocin)

• Inhibits bacterial cell wall synthesis and increases cell wall permeability
• Used for treating infections caused by susceptible gram-positive bacteria, such as MRSA and infections associated with Clostridium difficile.
• Adverse reactions: Nephrotoxicity, ototoxicity, Red man syndrome (at the IM/IV site). Infusion reaction: Nausea, chills, fever, urticaria, sudden drop in blood pressure with parenteral administration, and skin rashes.
• Contraindications/Precautions: Hypersensitivity to vancomycin, allergy to corn/corn products, cautious use with renal/hearing impairment, and pregnancy and lactation.
• Interactions: Other ototoxic or nephrotoxic drugs. Additive effects may occur.

Quinopristin/Dalfopristin (Synercid)

• Bacteriostatic/bactericidal agent
• Used to treat vancomycin-resistant Enterococcus faecium (VREF)
• Adverse reactions: Irritation at the vein infusion site, incompatibility with saline or heparin flush solutions, nausea, vomiting, and diarrhea.
• Contraindications/Precautions: Known hypersensitivity, pregnancy, and lactation.
• Interactions: Serum levels of some drugs may increase, including antiretrovirals, antineoplastics and immunosuppressants, calcium channel blockers, and benzodiazepines.

Antivirals

• Shorten the length of viral outbreaks, but do not prevent spread of disease.
• Effective against Herpes simplex virus 1 and 2, Herpes zoster, HIV, CMV retinitis. (with ganciclovir- prophylaxis), Hepatitis (with Interferon alfa), Influenza (with Oseltamivir), and RSV (with Ribavirin).
• Adverse reactions: Systemic (oral or IV): crystalluria (with rapid IV), nephrotoxicity (with acyclovir), bone marrow suppression (with ganciclovir), GI disturbances (N/V/D), headache, rash, fever, insomnia, and topical burning, stinging, pruritus.
• Contraindications/Precautions: Hypersensitivity, unstable cardiac disease, pregnancy (cat C) and lactation (especially for Ribavirin). Careful use with renal impairment, low blood cell counts, epilepsy, and respiratory issues.
• Drug interactions include Probenecid (increases acyclovir levels), cimetidine (increases valacyclovir levels), theophylline (increased acyclovir levels).
• Implementation: Small, frequent, soft, non-irritating meals may be useful if nausea is mild.. Use gloves with topical application. Administer topical without regard to food, unless GI distress.

Antifungals

• Fungicidal: Kills fungi.
• Fungistatics: Inhibits fungal growth.
• Superficial and deep fungal infections
• Systemic infections such as candidiasis and cryptococcal meningitis
• Superficial infections of nailbeds, oral, anal, and vaginal areas
• Ringworm infections: Keep towels/washcloths separate.
• General adverse reactions: Infusion reactions (fever, chills, rigors, headache, 1-3 hours post-IV), topical reactions (irritation, burning, redness, thrombophlebitis), nephrotoxicity, bone marrow suppression, and electrolyte imbalance (especially potassium). Ketoconazole can cause hepatitis.
• Contraindications/Precautions: Pregnancy, lactation, and renal impairment. Use cautiously with renal dysfunction, bone marrow suppression, or anemia.
• Patient management issues: Superficial and deep fungal infections may respond slowly; check I&Os, creatinine, and BUN, especially with nephrotoxic drugs; and complete therapy even if the infection improves, as complete therapy will help prevent recurrence. High doses of fluconazole for pregnancy.
• Topical antifungals: Used for athletes foot, jock itch , ringworm, and yeast infections. Clotrimazole, Gentian Violet, Miconazole, and Tolnaftate. Nsg interventions: Do not chew/swallow troches. Clean applicators after use; clean site prior to application; clean old cream/lotion off. Swish and swallow if indicated.
• Systemic antifungal examples: Amphotericin B, Fluconazole, Griseofulvin, Ketoconazole, Nystatin, and Terbinafine.

Topical Antipsoriatics

• Used to remove lesions associated with psoriasis.
• Examples: Anthralin and calcipotriene.
• Contraindicated in patients with known hypersensitivity.
• Used cautiously during pregnancy and lactation.

Keratolytics

• Remove excess epidermis growth in conditions such as warts, calluses, corns, and seborrheic keratoses.
• Contraindicated in patients with hypersensitivity to drugs.
• For use on moles, birthmarks, warts with hair, on genital or facial warts, warts on mucous membranes, and infected skin.
• Use cautiously during pregnancy and lactation.

Miscellaneous Medications

• Mafenide (Sulfamylon): Penetrates thick eschar.
• Silver sulfadiazine (Silvadene): Broad-spectrum topical anti-infective.
• Silver nitrate: Topical anti-infective, astringent.
• Aluminum acetate: Burrow's solution, astringent.
• Calamine lotion: Astringent.

Topical Drugs Used in Skin Disorders

• Specific drugs to address skin issues such as rashes, eczema, psoriasis, and others.
• Nursing process implementation includes monitoring and managing patient needs and addressing impairments in skin integrity. Carefully assess pain, infection risks, and other needs. Use cool, wet compresses for itching relief whenever indicated.

Topical Antiseptics and Germicides

• Chlorhexidine (Hibiclens): Affects a wide range of microorganisms, including gram-positive and gram-negative bacteria.
• Iodine: Anti-infective agent against bacteria, fungi, viruses, yeasts, and protozoa (Povidone-iodine- Betadine).
• Uses: Reduce bacteria, surgical scrubs, pre-operative skin cleanser, and home skin cleansing to prevent infection.

Topical Corticosteroids

• Localized anti-inflammatory activity. Reduce itching, redness, swelling when applied to inflamed skin. Used to treat skin disorders, psoriasis, dermatitis, rashes, eczema, insect bites, and first- and second-degree burns, including sunburns.
• Apply sparingly in a thin film, rub in gently.
• Do not apply bandages, dressings, cosmetics, etc over the treated area unless otherwise directed.
• Contraindications: Known drug or component hypersensitivity. Careful use during pregnancy and lactation.

Topical Enzymes

• Remove necrotic tissue from chronic dermal ulcers and severely burned areas.
• Hasten reduction of proteins into simpler substances.
• Contraindicated in patients with known hypersensitivity; wounds in contact with body cavities or exposed nerves.
• Used cautiously during pregnancy and lactation.

Topical Local Anesthetics

• Temporarily inhibits sensory nerve impulse conduction.
• Use as directed by a primary health care provider. Clean and dry the area before application.
• Remove previous residue. Instruct the patient not to eat for an hour following application.
• Used for the relief of itching and pain due to minor burns, fungal infections, insect bites, rashes, sunburn, and plant poisoning.
• Contraindicated in patients with known hypersensitivity to the local anesthetic or any component of its preparation.
• Use cautiously in patients also taking Class 1 antiarrhythmic drugs.