Ppt chapter008

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Ppt chapter008

  1. 1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction to Clinical Pharmacology Chapter 08- Cephalosporins
  2. 2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction to Cephalosporins • Effective in the treatment of all strains of bacteria affected by penicillins and some strains resistant to penicillins • Classification: Divided into first, second, third and fourth-generation drugs • Uses: Treat urinary tract; skin infections; hospital acquired pneumonias
  3. 3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cephalosporins: Actions • Exert bactericidal effect: – Have a beta-lactam ring •Targets the bacterial cell wall, making it defective and unstable
  4. 4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cephalosporins: Uses • Used to treat infections caused by bacteria: – Respiratory – Ear – Bone/joint – Genitourinary tract infections • Culture and sensitivity tests: Help determine best antibiotic to control an infection • Used throughout perioperative period
  5. 5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cephalosporins: Adverse Reactions • Gastrointestinal reactions: – Nausea; vomiting; diarrhea • Administration route reactions: – Intramuscularly and Intravenously
  6. 6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins • Other body system reactions: – Headache; dizziness; malaise; heartburn; fever; nephrotoxicity; hypersensitivity; aplastic anemia; toxic epidermal necrolysis – Nursing alert: •Allergy: Approximately 10% of people allergic to penicillin are also allergic to cephalosporins Cephalosporins: Adverse Reactions (cont’d)
  7. 7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cephalosporins: Contraindications and Precautions • Contraindicated in patients: – Allergic to cephalosporins or penicillins • Used cautiously in patients with: – Renal disease; hepatic impairment; bleeding disorder; pregnancy; known penicillin allergy
  8. 8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cephalosporins: Interactions Drug Common use Effect of interaction Aminoglycosides Anti-infective Increased risk for nephrotoxicity Oral anticoagulants Blood thinner Increased risk for bleeding
  9. 9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cephalosporins: Interactions (cont’d) • Nursing alert: – Disulfiram-like reaction: If alcohol consumed within 72 hours – Symptoms: Flushing; throbbing; respiratory problems; vomiting; sweating; chest pain; hypotension – Severe reaction: Arrhythmias and unconsciousness
  10. 10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment • Preadministration assessment: – Obtain general health history before first dose – Check for need of cultures and sensitivity tests
  11. 11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment (cont’d) • Ongoing assessment: – Evaluate response to therapy – If infection worsens then notify primary health care provider – Check for signs and symptoms of infection
  12. 12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Nursing Diagnoses • Risk for impaired skin integrity • Risk for impaired comfort • Impaired urinary elimination • Diarrhea
  13. 13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Planning • The expected outcome includes an optimal response to therapy: – Management of adverse drug reactions – Understanding of and compliance with the prescribed treatment regimen
  14. 14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy: – Oral administration: Question patient regarding allergy to cephalosporins or penicillins; shake oral suspensions – Administer around the clock – Administer orally at least one hour before or two hours after meals – If patient experiences GI upset: Administer with food
  15. 15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d): – Parenteral administration: •Read the manufacturer’s instructions - injection; storage; life; methods; precautions – Methods of infusing cephalosporin: Direct; intermittent; or continuous IV infusion
  16. 16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins • Promoting an optimal response to therapy (cont’d): – Nursing alert: •Inspect the needle insertion site for signs of extravasation or infiltration •Inspect several times a day for signs of redness - phlebitis or thrombophlebitis Nursing Process: Implementation
  17. 17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins • Promoting an optimal response to therapy (cont’d): – Gerontologic alert: •When given IM - inject the drug into a large muscle mass •Assess muscle for atrophy in nonambulatory or if paralysis is present •Warn patient about stinging or burning sensation at site Nursing Process: Implementation
  18. 18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins • Promoting an optimal response to therapy (cont’d): – Chronic care alert: •People with phenylketonuria need to be aware that the oral suspension cefprozil contains phenylalanine •Interferes with urine test results - diabetic patients Nursing Process: Implementation
  19. 19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient needs: – Impaired skin integrity: •Inspect skin every 4 hours for redness, rash, or lesions; report; emollients, or antipyretic creams may be prescribed; avoid harsh soaps and perfumed lotions; avoid rubbing the area; warn about wearing rough or irritating clothing
  20. 20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins • Monitoring and managing patient needs (cont’d): – Impaired comfort: •Increased fever; take vital signs every 4 hours; administer an antipyretic drug or change drug or dosage as prescribed Nursing Process: Implementation
  21. 21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins • Monitoring and managing patient needs (cont’d): – Impaired urinary elimination: •Nephrotoxicity may occur; measure and record the fluid intake and output; Report changes Nursing Process: Implementation
  22. 22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins • Monitoring and managing patient needs (cont’d): – Impaired urinary elimination: Gerontologic alert: •Nephrotoxic effects / renal impairment: Monitor blood creatinine levels •Diarrhea: Check the patient’s stools and reports any presence of blood and mucus immediately Nursing Process: Implementation
  23. 23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins • Educating the patient and family: – Review dosage regimen with the patient and family – Advise to complete full therapy and adhere to timing – Explain to shake and keep oral suspensions refrigerated – Advise to avoid alcohol and take with food if GI upset Nursing Process: Implementation
  24. 24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Evaluation • Therapeutic effect achieved • Urine output at least 500mL daily; diarrhea - not experienced • Patient and family demonstrate understanding of drug regimen • Patient verbalizes importance of compliance with prescribed therapeutic regimen • Skin - free of inflammation, irritation or ulcerations
  25. 25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation

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