McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 9  Antibiotics

■ ■ Monitor renal function tests before and periodically during therapy to arrange for dose reduction as needed. ■ ■ Ensure that the person receives the full course of the penicillin as prescribed, in doses around the clock, to increase effectiveness. ■ ■ Explain storage requirements for suspensions and the importance of completing the prescribed therapeutic course even if signs and symptoms have disappeared, to increase the effectiveness of the drug and decrease the risk of developing resistant strains. ■ ■ Monitor the site of infection and presenting signs and symptoms (e.g. fever, lethargy) throughout the course of drug therapy. Failure of these signs and symptoms to resolve may indicate the need to reculture the site. Arrange to continue drug therapy for at least 2 days after the resolution of all signs and symptoms to reduce the risk of development of resistant strains. ■ ■ Provide small, frequent meals as tolerated, ensure frequent mouth care and offer ice chips or sugarless lollies to suck if stomatitis and sore mouth are problems to relieve discomfort and ensure nutrition. ■ ■ Provide adequate fluids to replace fluid lost with diarrhoea. ■ ■ Monitor the person for any signs of superinfection to arrange for treatment if superinfections occur. ■ ■ Monitor injection sites regularly, and provide warm compresses and gentle massage to injection sites if they are painful or swollen. If signs of phlebitis occur, remove the IV line and reinsert it in a different vein to continue the drug regimen. ■ ■ Instruct the person regarding the appropriate dosage regimen and possible adverse effects to enhance knowledge about drug therapy and promote compliance. –– Try to drink a lot of fluids and to maintain nutrition (very important) even though nausea, vomiting and diarrhoea may occur. –– Report difficulty breathing, severe headache, severe diarrhoea, dizziness, weakness, mouth sores and vaginal itching or sores to a healthcare provider. Box 9.5 contains a teaching checklist for penicillins. ■ ■ Provide the following teaching:

■ ■ Evaluate the effectiveness of the teaching plan (person can name the drug, dosage, possible adverse effects to expect and specific measures to help avoid adverse effects). ■ ■ Monitor the effectiveness of comfort and safety measures and compliance with the therapeutic regimen.

KEY POINTS

KEY POINTS

■■ The penicillins are one of the oldest classes of antibiotics, and many resistant strains have

developed. The penicillinase-resistant antibiotics were created to combat bacteria that produce an enzyme to destroy the penicillin. Penicillins are used to treat a broad spectrum of infections, including respiratory tract infections and UTIs.

■■ Monitor the person on penicillin for nausea, vomiting, diarrhoea, superinfections and the possibility of hypersensitivity reactions.

Individual and family teaching

BOX 9.5

Penicillins • The penicillins are used to help destroy specific bacteria that are causing infections in the body.They are effective against only certain bacteria; they are not effective against viruses (such as cold germs) or other bacteria.To clear up a bacterial infection, the penicillins must act on the bacteria over a period of time, so it is very important to complete the full course to avoid recurrence of the infection. • The drug should be taken on an empty stomach with a full 150-mL glass of water—1 hour before meals or 2 to 3 hours after meals is best. Do not use fruit juice, soft drinks or milk to take your drug, because these foods may interfere with its effectiveness. (This does not apply to amoxyicillin or penicillin V.) • Common effects of these drugs include stomach upset, diarrhoea, changes in taste and change in the colour of the tongue. Small, frequent meals may help. It is important to try to maintain good nutrition.These effects should go away when the drug is stopped. • Report any of the following to your healthcare provider: hives, rash, fever, difficulty breathing, severe diarrhoea. • Tell any doctor, nurse, or other healthcare provider that you are taking this drug. • Keep this drug and all medications out of the reach of children and pets. • Do not share this drug with other people and do not use this medication to self-treat other infections. • It is very important that you complete the full course of your prescription, even if you feel better before you finish it.

Evaluation

■ ■ Monitor person’s response to the drug (resolution of bacterial infection). ■ ■ Monitor for adverse effects (GI effects; local irritation, phlebitis at injection and IV sites; superinfections).