WHICH OF YOUR PATIENTS HAVE RISK FACTORS

WHICH OF YOUR PATIENTS HAVE RISK FACTORS FOR INFECTIOUS DISEASES? TRANSMISSION-BASED PRECAUTIONS: Name some behaviors that are part of Standard Precautions? Imagine you are going into the following rooms below – walk yourself through the PPE/Precautions your need to follow: Patient with C. diff colitis Patient with Influenza A Patient with herpes zoster and open, weeping lesions Patient with active tuberculosis infection Patient with latent tuberculosis infection NOTE: for the antibiotics and S/A/E that I list below, I’m not listing ALL of the S/A/E you need to know – I’m just jotting some down as a proposed order to study these in – you don’t have to take my advice, just trying to provide you a path forward so the antibiotics are less overwhelming. ANTIBIOTICS SIDE AND ADVERSE EFFECTS and NURSING CONSIDERATIONS – START WITH COMMONALITIES ACROSS CLASSES – Start with knowing the S/A/E and nursing considerations that apply to ALL antibiotics: Commonalities across antibiotics: GI upset Allergic reactions Superinfections – Fungal example? GI infection example? Concurrent use of oral contraceptives Warfarin? Not true for EVERY antibiotic, but many of them don’t combine well with warfarin (increased risk for bleeding when warfarin and antibiotic taken together in many instances) For each of these think: “what would I be watching out for?” or “what education should I provide to my patient?” ANTIBIOTICS SIDE AND ADVERSE EFFECTS and NURSING CONSIDERATIONS – then I move onto the ones that have the SHORTER lists of S/A/E and nursing considerations – that’s where I start my studying: Penicillins and Cephalosporins – pretty simply S/A/E, well-tolerated by patients, I work on these first – they are also both beta-lactams in terms of molecular structure Then, a move onto drugs that I know treat certain BACTERIA: drugs used to treat C. diff, Vancomycin and Metronidazole – these drugs don’t JUST treat C. diff, but when used for C. diff, what are the different routes of administration related to each? Then I go to treating tuberculosis Linezolid, Rifampin, Ethambutol, Pyrazanimide Then, I go for the drugs that cause memorable reactions: Tetracycline cause teeth to turn BROWN, don’t take with antacids Vancomycin causes red man syndrome (that one is above already) Metronidazole can cause Stevens-Johnson Syndrome (SJS) and you can’t take it with alcohol (above already) Macrolides – causing QT PROLONGATION leading to cardiac dysrhythmias like torsades Fluoroquinolones – can cause tendon rupture and RHABDOMYOLYSIS Then I go to the others I might have missed, but are still important: Aminoglycosides (I have a memory aide for this one in the slides, which helps) IF A PATIENT IS TAKING LINEZOLID, AND YOU FIND YOU THEY ARE ALSO ON AN SSRI, WHAT’S THE PROBLEM WITH THIS? WHAT DO YOU HAVE TO WATCH OUT FOR THAT ARE S/S OF THIS CONDITION? RECOGNIZING AND ADDRESSING ADVERSE ANTIBIOTIC DRUG REACTIONS: be able to recognize (what are s/s?) and then what are we going to do about these? Allergic or anaphylaxis (we already discussed how to address in previous ppts so test yourself) Stevens-Johnson Syndrome Red Man Syndrome Superinfections WALK YOURSELF THROUGH CARING FOR THESE POKEMON PATIENTS: Mr. Koffing presents to the emergency department, reporting shortness of breath. He recently moved in with a family member who has been living abroad and tested positive for tuberculosis. Suspicious of Mr. Koffing recent TB exposure, what other signs and symptoms of TB might he present with if he has an active infection? What testing/diagnostics will help us determine if this is active TB? Mr. Koffing’s diagnostic test result indicate he has an active TB infection What drug or drugs will he receive? There is a first-line drug but there are other options…test yourself! Run through each of the TB meds and what the S/A/E are because patient will need education on when to call the provider, what effects are minor side effects. Mrs. Wheezing presents to high primary care provider. Mrs. Wheezing works as a prison guard at a local facility. She is reporting for her employer-mandated annual TB skin test. You are the RN performing the test – walk Mrs. Wheezing through what you are going to do, what the follow-up is, what you will be looking for. Mrs. Wheezing returns for her TB skin test to be read, and you note a 20 mm raised wheal on her arm at the site of PPD intradermal injection. Mrs. Wheezing is asymptomatic for active TB. What is the mostly likely plan of care for her now? What do you want to explain to her about latent TB infections (in other words, what’s the risk for her)? PATIENT WITH C. DIFF COLITIS… What s/s should you watch out for? What imbalances will the patient present with? Take this opportunity to review normal lab ranges relevant to C. diff. What are you going to do to address those imbalances? EXPLAIN TO A PATIENT WHY THEY NEED TO FINISH TAKING ALL OF THEIR ANTIBIOTICS PRESCRIBED. EXPLAIN THE ROLE OF SPONTANEOUS MUTATIONS IN THE DEVELOPMENT OF ANTIBIOTIC-RESISTENCE INFECTIONS. WALK YOURSELF THROUGH CARE OF A SEPTIC PATIENT… Mrs. Wheezing from above comes to the ED a few weeks later with shortness of breath, and productive, purulent sputum. BP: 88/40, HR: 120, RR: 34, SPO2: 92%, Rectal temp: 94.5F. WBC count is 34,000. What’s going on (what do you suspect is happening and what are your cues?) Prioritize concerns according to body systems (come up with your own list before you look below) sounds like sepsis (we have a suspected infection in her lungs given productive sputum and respiratory s/s and vital signs AND she had a positive TB skin test recently) Breathing – short of breath, respiratory rate is up, pulse ox is not the best What are your interventions? Circulation/Hemodynamics How do you determine if she has good or poor circulation? What are you looking at? What is a really simple intervention you can do RIGHT AWAY to improve her hemodynamics? What is your FIRST-LINE drug intervention? What if you try the above intervention and it does not improve your hemodynamics/circulation? Next intervention? Infection diagnostics and source control What other testing/diagnostics do you want run and what drug therapy does she need? Is there any order or interventions that you need to pay attention to – meaning, a certain sequence of interventions, like one needs to be done before another? Any other labs related to sepsis that you want? Anything else? Assuming sepsis, anything else you have to check or keep in mind that she is at risk for? this is a study guide not I homework. so please help me, it is not something to turn in.

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