PCN and Cephalosporins NUR 210 Unit 10 (2023) Galen PPP.pptx

Antibiotics Overview & Penicillin and Cephalosporins NUR 210 Unit 10   Antibacterial Inhibit bacterial growth or kill bacteria and other microorganisms...

Antibiotics Overview & Penicillin and Cephalosporins NUR 210 Unit 10   Antibacterial Inhibit bacterial growth or kill bacteria and other microorganisms  Antibiotics Antibacterial/Antibiotics Inhibit bacterial growth or kill bacteria  Bacteriostatic drugs Inhibit growth of bacteria  Bactericidal drugs Kill bacteria  Overview of mechanism of action Inhibition of bacterial cell wall synthesis Alteration of membrane permeability Antibacterial Inhibition of protein synthesis Inhibition of synthesis of bacterial RNA and DNA Interference with metabolism within the cell  Resistance to antibacterial Pathogen continues to grow after antibacterial administration Resistance to Inherent resistance Antibiotics Acquired resistance Health care acquired infections MRSA VREF VRSA  Antibiotic misuse Taken for viral infections Taken when no bacterial infection Antibiotic Misuse present and Resistance Taking antibiotics incorrectly (skipping 1 doses) Misuse increases antibiotic resistance Cross-resistance Can occur between antibacterial drugs with similar actions  Used to detect the infective microorganism present in a sample (e.g., blood, sputum, Culture and swab) and what drug can kill it. The Sensitivity (C & S) organism causing the infection is determined by culture, and the antibiotics the organism is sensitive to are determined by sensitivity. If ordered, done prior to starting antibiotic  Culture and Sensitivity (C & S)  General adverse reactions Allergic reaction Hypersensitivity, rash, pruritus, hives, anaphylactic shock Superinfection Secondary infection when normal flora killed ◦ Candidiasis Antibacterial ◦ C diff Usual sites ◦ Mouth, skin, respiratory tract ◦ Genitourinary tract, intestines Organ toxicity Ear, liver, kidney Stevens-Johnson syndrome Adverse Reactions Stevens-Johnson’s Syndrome Superinfections  Spectrum Narrow spectrum ◦ Primarily effective against one bacteria type Antibacterial Broad spectrum Effective against gram-positive and gram- negative Examples: tetracycline, cephalosporins Frequently used when offending microorganism has not been identified by C&S  Amoxicillin Action Inhibit bacterial cell wall synthesis Penicillin Some are broad-spectrum Some are narrow-spectrum Resistance is a problem  Side Tongue discoloration, stomatitis, glossitis Effects/Adverse GI distress Reactions - Penicillin Clostridium difficile-associated diarrhea Hypersensitivity, anaphylaxis Superinfection Bleeding (interferes with clotting) SJS  Allergy to other PCN or cephalosporin Colon issues that causes diarrhea Contraindications & Caution with renal impairment and liver Interactions – impairment Penicillin Decrease effect with acidic fruits/juices – (citrus juice) Decreases effectiveness of oral birth control Anticoagulants  Generations of cephalosporins (ceph or cef in name) Groups First, second, third, fourth, and fifth Cephalosporins generation 1 Each generation is effective against a broader spectrum of bacteria Use Bacterial infections  Side effects/Adverse reactions The “ceph-” or “cef-” Gi upset Dizziness/vertigo, headache drugs Cephalosporins 1 Superinfection Bleeding Allergic reaction/anaphylactic reaction Nephrotoxic SJS  Interactions Bleeding disorder or warfarin Decreases effect of oral birth control Cephalosporins 1 Contraindication Severe kidney disease Penicillin or cephalosporin allergy  Nursing Process: Assessment Antibiotics – PCN Assess for allergies and Cephalosporins Assess renal and liver function Review lab results Review I & O Vital signs  Nursing interventions Obtain C&S before giving first dose. Monitor for superinfection. Monitor for signs and symptoms of allergic Antibiotics Penicillin reaction & Ceftriaxone Monitor Vital signs Increase fluids – monitor I & O Take on empty stomach best but with food is ok Consider safety issues. Administer IV over 30 minutes. For IM mix with sufficient solution to give IM  Take the entire prescribed dose Teach to the side effects to expect and adverse reactions to report (yeast infection) Teach to use buttermilk, yogurt, Teaching acidophilus milk, or probiotics to maintain GI flora Teach signs and symptoms of allergy For children’s doses chew tablets, shake suspension, refrigerated, use a measuring device Decreases effect of oral birth control Evaluation Did it work? How can we tell if it worked?  Which nursing intervention has the highest priority for the patient who is taking a cephalosporin? A. Wait until culture results are received Practice Question #1 before initiating antibiotic. B. Monitor the patient for signs and symptoms of a superinfection. C. Administer IV over 2 hours to prevent phlebitis. D. Instruct the patient to take the drug for 5 days only.  Answer: B Rationale: Superinfection is a common adverse effect of antibiotics. The nurse should culture the infected area before Practice Question #1 initiating antibiotics and may begin drug therapy before culture results are received. IV cephalosporins should be administered over 30 to 45 minutes, not 2 hours. Cephalosporins are usually given 10 days for a full regimen.  A patient enters the emergency department with a draining wound. Once the patient is admitted and assessed, the priority nursing intervention is to Practice Question #2 A. administer the ordered antibiotics. B. teach the patient about the ordered antibiotics. C. culture the wound. D. enforce droplet isolation precautions.  Answer: C Rationale: The priority nursing Practice Question #2 intervention is to obtain a culture and antibiotic sensitivity testing of infective organism (C&S).  Which statement will the nurse include when teaching a patient about cephalosporin therapy? A. “Avoid ingesting buttermilk or yogurt when taking this medication.” Practice Question #3 B. “Stop taking the medication when you feel better.” C. “Immediately stop taking the medication if you develop nausea.” D. “Inform your health care provider if you develop mouth ulcers.”  Answer: D Rationale: The patient should be instructed to report signs of superinfection, such as mouth ulcers Practice Question #3 or discharge from the anal or genital area. Ingestion of buttermilk or yogurt may prevent superinfection of the intestinal flora; the entire course of the medication should be taken; and the medication should be taken with food if nausea develops.