Nursing Process Focus:

Patients Receiving Ciprofloxin (Cipro)

Assessment
Prior to administration:
·  Obtain complete health history including allergies, drug history and possible drug interactions
·  Assess for presence or history of local or systemic infections
·  Obtain vital signs
·  Obtain history of drug allergies / Potential Nursing Diagnoses
·  Deficient Knowledge related to antibacterial drug therapy
·  Risk for fluid volume deficit related to GI side effects from drug therapy
·  Diarrhea, related to effects of drug therapy
Planning: Patient Goals and Expected Outcomes
The patient will:
·  Demonstrate understanding of drug therapy
·  Demonstrate evidence of resolution of diagnosed infection after drug therapy is completed
·  Maintain adequate fluid and electrolyte balance
Implementation

Interventions and (Rationales)

/

Patient Education/Discharge Planning

·  Safety for use by children under 18 not established, due to possible action of Cipro on the cartilage, usually the Achilles tendon: tendon rupture. (May interfere with bone development in children less than 18 years of age.) / ·  Instruct patient to contact health care provider at the first signs of tendon pain or inflammation.
·  Avoid administering medications or foods that contain ______, ______, or ______such as antacids, dairy products, sucralfate or vitamin or mineral supplements, within ______hours. / ·  Instruct patient to administer these substances and medications ______hours after ciprofloxacin.
·  Administer with water and maintain adequate fluid intake to avoid crystalluria.
·  Monitor ______and ______and urine pH. (The drug alters urinary pH and causes crystals to form in urine.) / ·  Take each dose with a glass of water and drink several extra glasses of fluid daily to prevent formation of ciprofloxacin crystals in the urine.
·  Monitor use of caffeine during drug therapy. (Absorption of Cipro is ______by caffeine.) / ·  Instruct patient to avoid caffeine intake during drug therapy.
·  Monitor plasma theophylline concentrations for patients prescribed these drugs. (The drug affects half-life of theophylline preparations.) / ·  Inform patient that serum levels will need to be monitored.
·  Monitor patient for symptom of ______. (This may occur due to the action of ciprofloxacin on the central nervous system (CNS).) / ·  Advise patient to use caution when driving, operating machinery, or performing other hazardous activities until effect of drug is known.

Evaluation of Outcome Criteria

Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”).


Patients Receiving Trimethoprim (Bactrim, Septra)

Assessment
Prior to administration:
·  Obtain complete health history including allergies, drug history and possible drug interactions
·  Assess for presence or history of systemic, respiratory or urinary tract infection
·  Assess intake and output / Potential Nursing Diagnoses
·  Infection, Risk related to contact with contagious agents (nosocomial or community acquired)
·  Infection, Risk related to increased vulnerability secondary to diminished immune response
·  Knowledge, Deficient, related to drug therapy and side effects
Planning: Patient Goals and Expected Outcomes
The patient will:
·  Demonstrate reduction in symptoms related to the diagnosed infection
·  Demonstrate understanding of drug therapy and side effects
·  Remain free of symptoms of side effects of drug therapy
Implementation

Interventions and (Rationales)

/

Patient Education/Discharge Planning

·  Monitor ______function including these labs: ______and ______values, and intake and output.(Drug can cause hematological toxic effects, which are increased with kidney disease and also the elderly population.) / Inform patient:
·  That ______tests and ______may need to be monitored
·  To report changes in urinary elimination to the health care provider
·  Evaluate complaints of painful urination, flank pain, and fever. (Drug can change the urine pH and could increase the patient’s risk for formation of renal calculi.) / Advise patient to:
·  Drink 2.5-3 liters of fluid daily.
·  Report painful ______, flank pain or fever to the health care provider
·  Monitor baseline and follow-up urinalysis, CBC, platelet count, BUN and creatinine clearance with long-term therapy. (To evaluate effectiveness of drug therapy.) / ·  Instruct patient to continue medical follow-up and laboratory test appointments when receiving drug for extended period of time.
·  Observe for symptoms of adverse reactions. (Evidenced in hematology and blood coagulation studies and by skin manifestations.) / ·  Instruct patient to report skin rash, sore throat, fever, mouth sores, or unusual bleeding or bruising.
·  Monitor ______integrity. (This drug can also increase patient’s sensitivity on the skin to ultraviolet lights.) / ·  Instruct patient to avoid exposure to direct ______.
·  Monitor ______with treatment regimen. (Full course of therapy is required. If patient stops medication before prescription is complete, symptoms may reoccur and this may increase ______to further antibiotics.) / ·  Instruct patient to take drug as directed and to ______.

Evaluation of Outcome Criteria

Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see “Planning”).


Nursing Process Focus:

Patients Receiving Penicillin G (Pentids)

Assessment
Prior to administration
·  Obtain complete health history including allergies, drug history and possible drug interactions.
·  Assess for presence or history of local or systemic ______.
·  Obtain vital signs / Potential Nursing Diagnoses
·  Infection, Risk for, related to weakened immune state or contact with pathogen
·  Knowledge deficient related to drug action and therapy treatment and prevention measures
·  Injury, Risk (anaphylaxis) for related to adverse effects of drug
Planning: Patient Goals and Expected Outcomes
The patient will:
·  Remain free of signs of allergic reaction to drug therapy
·  Demonstrate knowledge of drug action and side effects
·  Demonstrate resolution to incidence of infection
Implementation

Interventions and (Rationales)

/

Patient Education/Discharge Planning

·  Monitor for evidence of ______to drug. (______may occur immediately or delayed beyond 72 hours.) / Instruct patient:
·  Signs of allergic reaction including ______, ______, ______.
·  To immediately contact the health care provider if ______reaction occurs.
·  Monitor intake and output especially quantity and consistency of ______. (Severe diarrhea may occur due to the possible adverse effect from Pseudomembranous colitis.) / ·  Advise patient to consult health care provider before taking antidiarrheal medication. These medications may worsen or prolong diarrhea.
·  Evaluate patient’s understanding of drug therapy and administration.
·  Give medication ______to reduce destruction by gastric acid and enhanced absorption. / Instruct patient to:
·  Take medication ______hour before or ______hours ______a meal.
·  Take medication with glass of water
·  Take all of medication unless instructed to discontinue by the health care provider
·  Evaluate patient for evidence of resolution of infectious process. (If the prescribed antibacterial is not effective another medication or different dosage may be required.) / ·  Instruct patient to notify the health care provider if symptoms persist or worsen.
·  Observe for ______, especially in susceptible patients including elderly, debilitated, or immunosuppressed patient. (There is a high risk for superinfections due to normal flora reduced or eliminated.) / ·  Instruct patient to report signs and symptoms of superinfection. Symptoms may include: ______, ______, stomatitis, ______stools, vaginal ______, or ______.

Evaluation of Outcome Criteria

Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes are met (see “Planning”).

Nursing Process Focus:

Patients Receiving Cefotaxime (Claforan)

Assessment
Prior to administration
·  Obtain complete health history including allergies, drug history and possible drug interactions
·  Assess for presence of local or systemic infection
·  Obtain vital signs
·  Obtain history of drug allergies / Potential Nursing Diagnoses
·  Injury, Risk for ______related to adverse reaction to drug
·  Infection, Risk for superinfection related to effects of drug therapy
·  Fluid volume, Risk for deficit, related to effects of drug on GI system
·  Diarrhea, Risk for related to side effects of drug
Planning: Patient Goals and Expected Outcomes
The patient will:
·  Remain free of symptoms of allergic reaction
·  Maintain adequate fluid balance
·  Demonstrate absence of superinfection
·  Maintain formed stool consistency
Implementation

Interventions and (Rationales)

/

Patient Education/Discharge Planning

·  Monitor for severe ______caused by the disruption of normal bowel flora. (May cause fluid ______imbalance and superinfection of antibiotic-associated pseudomembranous Colitis. Cultured dairy products with live active cultures, such as kefir or yogurt may be used to help maintain normal intestinal flora. Supplements containing beneficial bacterial, such as acidophilus, are also available OTC). / Instruct patient to:
·  Report loose stools or diarrhea.
·  Avoid treating diarrhea with antidiarrheals as this can impede the process of eliminating “bad bacteria"
·  Monitor for ______, pruritus, or ______(indicative of an ______reaction to the medications). / ·  Instruct patient to report adverse reactions promptly.
·  Monitor ______and ______carefully in patients with compromised ______function or if receiving aminoglycoside.
·  Monitor renal function with lab studies periodically during and after therapy. (Toxicity could occur from drug toxins that are unable to be excreted.) / ·  Explain to patient purpose of required laboratory tests and schedule follow-up with health care provider.
·  Monitor for ______, especially with prolonged therapy. / ·  Instruct patient to report symptoms, especially in debilitated or chronically ill patient.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see”Planning”).


Nursing Process Focus:

Patients Receiving Tetracycline HCl (Achromycin and others)

Assessment
Prior to administration
·  Obtain complete health history including allergies, drug history and possible drug interactions.
·  Assess for presence/history of: Lyme disease, pneumonia, acne vulgaris, Typhus, Cholera, Rocky Mountain spotted fever, Chlamydia, sexually transmitted diseases, bladder infections, Helicobacter Pylori ulcers / Potential Nursing Diagnoses
·  Body image, disturbed related to change in appearance
·  Noncompliance related to prolonged therapy
·  Therapeutic regimen management, Ineffective related to prolonged course of treatment
·  Knowledge, Deficient, related to drug action and side effects
Planning: Patient Goals and Expected Outcomes
The patient will:
·  Remain free of symptoms caused by the diagnosed infection.
·  Maintain positive body image
·  Demonstrate knowledge of drug therapy and side effects
·  Demonstrate compliance with drug regimen
Implementation

Interventions and (Rationales)

/

Patient Education/Discharge Planning

·  Monitor ______status when administered to children under age 8. (Drug may cause permanent discoloration of teeth, enamel defects, and bone growth retardation.) / ·  Instruct patient and caregivers to report evidence of tooth discoloration or dental abnormalities to health care provider.
·  Administer with caution to patients with impaired ______or ______function. (Could result in impaired metabolism and excretion.) / Instruct patient to:
·  Report changes in ______output
·  Report for follow up care and lab tests of ______and ______function and serum tetracycline levels.
·  Evaluate use of OTC products such as ______, ______supplements, ______, and laxatives containing ______. (These products interfere with drug absorption). / ·  Instruct patient to consult with health care provider before taking over the counter drugs.
·  Evaluate patient understanding of drug therapy and administration. (Drug may cause ______and increase risk of ______. Tetracyclines can increase patient’s sensitivity of the skin to ______.) / Instruct patient to:
·  Avoid direct exposure to ______during and after therapy. Wear protective clothing, and ______.
·  Use an alternate form of birth control until all the medication is completed.
·  Avoid taking drug with ______, especially ______products.
·  Report adverse effects of topical agent may cause irritation to eyes, nose, mouth, or allergic reaction.
·  To report worsening of infection and burning sensation to health care provider.

Evaluation of Outcome Criteria

Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes are met (see “Planning”).

Nursing Process Focus:

Patients Receiving Erythromycin (E-mycin, Erythrocin)

Assessment
Prior to administration:
·  Obtain complete health history including allergies, drug history and possible drug interations.
·  Assess for presence/history of local or systemic ______
·  Obtain vital signs
·  Obtain history of ______reaction to drugs / Potential Nursing Diagnoses
·  Knowledge, Deficient related to disease process and drug therapy
·  Infection, Risk for related to superinfection
·  Fluid volume, Risk for Deficit related to effects of drug on GI system
·  Diarrhea, Risk forrelated to effect of drug therapy
·  Injury, Risk for (anaphylaxis) , related to adverse reaction to drug
Planning: Patient Goals and Expected Outcomes
The patient will:
·  Demonstrate knowledge or drug therapy and treatment regimen
·  Remain free of drug induced diarrhea
·  Maintain adequate fluid balance
·  Maintain absence of allergic reaction to drug
Implementation
Interventions and (Rationales) / Patient Education/Discharge Planning
·  Contraindicated in patients with ______disease. (Because the metabolism of erythromycin ethylsuccinate (EES) is mainly by the ______, it increases the patient’s risk for toxicity.) / ·  Instruct patient to report history of medical problems to health care provider.
·  Monitor this lab: ______, temperature, cultures, and perform infection-focused physical examination. (To determine effectiveness of drug therapy.) / Instruct patient:
·  To report ______and worsening symptoms of ______.
·  To report for follow-up examinations.
·  Evaluate patient understanding of treatment regimen. (Patient must complete the full course of therapy to prevent ______
·  ______.) / Instruct patient:
·  To complete full prescription even if feeling better or symptom free.
·  Take with full glass of water, on an empty stomach ______-hour before or ______hours after meals.
·  Avoid taking with or just after ______fruit juices or carbonated drinks.
·  Monitor for evidence of G.I. distress. (May require alternate form of medication.) / ·  Instruct patient to report past history of GI problems to health care provider.
·  Monitor for ______in patients receiving high dose, older adults, female and history of kidney or liver dysfunction. / ·  Instruct patient to immediately report ______to the health care provider.
·  Observe for signs and symptoms of ______by overgrowth of non-susceptible bacteria or fungi. / ·  Instruct patient to report diarrhea, abdominal pain, vaginal ______, or fever.

Evaluation of Outcome Criteria