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NUR 242 Clinical Skills Assessment Susan AkersSusan Akers is a 40 year old female who has presented to the Emergency Department this morning with a dull pain in her upper abdomen that gets worse when she eats fatty food, she has nausea and sometimes vomiting alongside the pain.She is diagnosed with cholelithiasis and underwent an open lap cholecystectomy 1/7 ago. The surgeon has prescribed the following antibiotic: Amoxicillin 1 gram and to be given twice daily.Please document the mechanism of action of the antibiotic (100 words) According to MIMS Australia (2020), Amoxicillin is original from group of penicillin, classed as a beta- lactam antibiotic. Amoxicillin targets bacterial cell wall biosynthesis, then prevents the development or destroys bacteria (Akhavan & Praveen Vijhani, 2019; Bryant et al., 2019). Amoxicillin binds to penicillin-binding proteins located in the bacterial cell wall, and interrupt the biosynthesis of the peptidoglycan layer (Akhavan & Praveen Vijhani, 2019; Evans et al., 2020). Then, some autolytic enzymes in the wall will be activated and lysis the bacterial cell wall (Akhavan & Praveen Vijhani, 2019). As the result, the bacteria will be destroyed. Please reference your evidence within last 5 years and APA styleIdentify the indications for this antibiotic (200 words)Please reference your evidence within last 5 years and APA styleAmoxicillin is a commonly used antibiotic that could cover a wide range of both gram-positive and gram-negative bacteria:?Streptococcus, Listeria monocytogenes,?Enterococcus, Haemophilus influenza, some?Escherichia coli,?Actinomyces,?Clostridial?species,?Salmonella,?Shigella, and?Corynebacteria?(Akhavan & Praveen Vijhani, 2019). The antibiotic therapy should be guided under the sensitivity test and patient response in the case of AMOX-resistant (Grayson et al., 2017).Amoxicillin is capable of preventing and treating the following conditions:Group A Streptococcal pharyngitis: After excluding infectious mononucleosis, Amoxicillin efficiently treat group A streptococcal pharyngitis (Grayson et al., 2017; Nakao et al., 2019)Otitis media and sinusitis: according to Frost et al. (2019), oral Amoxicillin is prescribed for middle ear infection and acute sinusitis associated with pneumococci and/or H. influenza in both adult and child.??Uncomplicated urinary tract infections: the drug effectively treats uncomplicated urinary tract infections caused by E.coli (Grayson et al., 2017).Respiratory tract infections: pharyngitis, tonsillitis caused by Streptococcus pyogenes, acute bacterial sinusitis, uncomplicated mild community –acquired pneumonia, acute lower respiratory tract infections. Infective endocarditisNeonatal septicemiaDental infections, intraoral infectionGroup B streptococcal infections during pregnancyTyphoid fever and other Salmonella infectionsGonorrhoeaHelicobacter pylori infection:?Lyme disease and Borrelia miyamotoi diseaseWhat are the contraindications of this antibiotic? (200 words)Please reference your evidence within last 5 years and APA styleAccording to?MIMS Australia?(2020), patients with previous hypersensitivity to beta-lactam antibiotics such as penicillin antibiotics or cephalosporin are significantly contraindicated to amoxicillin. National Prescribing Service (NPS) (2019) stated a cross-reactivity??In addition, amoxicillin is also contraindicated to people with atopic allergies (e.g., asthma, atopic dermatitis or eczema, allergic rhinitis), because they are more likely to experience anaphylaxis or develop Stevens-Johnson syndrome (Okubo et al., 2020).?Moreover, amoxicillin should not be given to patients with mononucleosis because the drug could increase the risk of a rash (Evans et al., 2020).?Besides that, using amoxicillin should be precautious in following conditions:?Diabetics: Amoxicillin can cause a false-positive reaction to sugar (glucose) present in the urine.?Patients with kidney disease or impaired renal function: Amoxicillin is excreted in urine(Grayson et al., 2017). Patients with renal impairment should be indicated amoxicillin with caution; adjusted dose intervals should be taken into consideration (Grayson et al., 2017;?MIMS Australia, 2020).?Elderly: renal function decrease in geriatric patients (O’Sullivan et al., 2016). Amoxicillin should be used associated with a renal monitoring function.Identify any adverse effects associated with this antibiotic (200 words)Please reference your evidence within last 5 years and APA styleAmoxicillin could cause some adverse effects as below:Hypersensitivity reactions:?Skin rash, itching, urticaria have been reported to the use of Amoxicillin from time to time (Grayson et al., 2017). Erythema multiforme and Stevens-Johnson syndrome, toxic skin necrosis, bullous, exfoliative dermatitis, and acute generalised exanthematous pustulosis (AGEP) are reported less commonly (Akhavan & Praveen Vijhani, 2019,?MIMS Australia, 2020, Grayson et al., 2017). Amoxicillin could also cause severe adverse effects such as angioedema (Quincke's edema), anaphylactic reactions, hypersensitivity vasculitis, and vasculitis interstitial nephritis (Akhavan & Praveen Vijhani, 2019,?MIMS Australia, 2020, Grayson et al., 2017). If one of the above disorders occurs, treatment should not be continued.Reactions in the gastrointestinal tract:??oral Amoxicillin could cause nausea, vomiting, and diarrhea (Grayson et al., 2017). Rarely, pseudomembranous colitis and hemorrhagic colitis associated to fatality have been reported.?Effects on the liver: There may be cholestatic hepatitis and jaundice (MIMS Australia, 2020).Effects on the kidneys: Crystalluria.Effects on hematology: Transient leukopenia, transient thrombocytopenia, and hemolytic anemia, have been reported (MIMS Australia, 2020). Prolonging bleeding time and prothrombin time could happen rarely. Central Nervous System Effects: Hyperactivity, dizziness, and convulsions could happen rarely. Seizures can occur in patients with kidney failure or who take high doses of the drug (MIMS Australia, 2020).?Using the latest available evidence, justify why this antibiotic or another should be prescribed for the patient in this scenario (300 words)Provide evidence from a minimum of 2 peer reviewed journals within last 5 years and APA style2016 WSES guidelines on acute calculous cholecystitis mentioned that Gallstones have opportunities to present as acute calculus cholecystitis in 20% symptomatic patient as Susan. Another paper by Matyjas et al. (2017) studied a bacterial culture in 92 patients that showed 46 patients accounted for 50% sample with a positive bacterial test. The bacteria presented were Enterococcus spp., Escherichia coli, Klebsiella spp., Candidiasis, Clostridium spp.Ierano et al. (2018) discussed a recommendation to use 1st Gen Cephalosporin single dose in open cholecystectomy for surgical prophylaxis. Department for Health and Wellbeing Government of South Australia (2020) also notice postoperative prophylaxis antibiotic is?only?given when the patient has a risk factor for infection after open cholecystectomy or laparoscopic surgery such as age greater than 70, diabetes, obstructive jaundice, common bile duct stones, acute cholecystitis, nonfunctioning gallbladder. In this case, recommendation prophylaxis antibiotic is cefazolin 2g IV, and add vancomycin 1g IV infusion to patient weight <80kg and high risk of Methicillin-resistant Staphylococcus aureu. To a patient with a high risk of Penicillin / Cephalosporin allergy, the use of gentamicin and vancomycin is an alternative. Noticeably, in statement 3.1of 2016 WSES guidelines, patients with uncomplicated cholecystitis, after the operation, a treatment without antibiotic can be applied when the focus of infection was managed by cholecystectomy. Statement 3.2 recommended using antimicrobial agents based on the pathogen and risk factor of resistance patterns. In this case, the common antibiotics used are Amoxicillin/clavulanate or Ampicillin/sulbactam in patients with a high bacterial concentration.?Back to Susan Akers’s case, the given information did not mention any symptom or test for a presence of cholecystitis or risk for postoperative infection. Even though the info said she visited the ED, her operation did not refer to an emergency one. According to the guidelines have been mentioned above, if she does not present a risk factor for infection after operating, she does not need a prophylaxis post-op.?Reference:Akhavan, B. J., & Praveen Vijhani. (2019, March 7).?Amoxicillin. ; StatPearls Publishing. , B. J., Knights, K. M., Darroch, S., & Rowland, A. (2019).?Pharmacology for health professionals. Elsevier.Devchand, M., & Trubiano, J. A. (2019). Penicillin allergy: a practical approach to assessment and prescribing.?Australian Prescriber,?42(6), 192–199. Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. (2016).?Journal of Hepatology,?65(1), 146–181. , J., Hannoodee, M., & Wittler, M. (2020).?Amoxicillin Clavulanate. PubMed; StatPearls Publishing. , H. M., Gerber, J. S., & Hersh, A. L. (2019). Antibiotic Recommendations for Acute Otitis Media and Acute Bacterial Sinusitis.?The Pediatric Infectious Disease Journal,?38(2), 217. , M. L., Cosgrove, S. E., Crowe, S., Hope, W., McCarthy, J. S., Mills, J., Mouton, J. W., & Paterson, D. L. (2017). Kucers’ The Use of Antibiotics: A Clinical Review of Antibacterial, Antifungal, Antiparasitic, and Antiviral Drugs, Seventh Edition - Three Volume Set. In?Google Books. CRC Press. , C., Peel, T., Ayton, D., Rajkhowa, A., Marshall, C., & Thursky, K. (2018). Surgical antibiotic prophylaxis – The evidence and understanding its impact on consensus guidelines.?Infection, Disease & Health,?23(3), 179–188. , T., Kaczka, K., Witas, H., P?oszaj, T., Matyjas, K., & Pomorski, L. (2017). Cholelithiasis - always infected??Polski Przeglad Chirurgiczny,?89(3), 23–26. Australia. (2020). .Au. , A., Hisata, K., Fujimori, M., Matsunaga, N., Komatsu, M., & Shimizu, T. (2019). Amoxicillin effect on bacterial load in group A streptococcal pharyngitis: comparison of single and multiple daily dosage regimens.?BMC Pediatrics,?19(1). , K., Kurono, Y., Ichimura, K., Enomoto, T., Okamoto, Y., Kawauchi, H., Suzaki, H., Fujieda, S., & Masuyama, K. (2020). Japanese guidelines for allergic rhinitis 2020.?Allergology International,?69(3), 331–345. ’Sullivan, E. D., Hughes, J., & Ferenbach, D. A. (2016). Renal Aging: Causes and Consequences.?Journal of the American Society of Nephrology,?28(2), 407–420. ? ................
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