PROTOTYPE DRUG: Penicillin G Potassium (Pentids)



Nursing Process Focus:

Patients Receiving Ciprofloxin (Cipro)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Deficient Knowledge related to antibacterial drug therapy |

|Obtain complete health history including allergies, drug history and |Risk for fluid volume deficit related to GI side effects from drug |

|possible drug interactions |therapy |

|Assess for presence or history of local or systemic infections |Diarrhea, related to effects of drug therapy |

|Obtain vital signs | |

|Obtain history of drug allergies | |

|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 |Instruct patient to contact health care provider at the first signs of|

|action of Cipro on the cartilage, usually the Achilles tendon: tendon |tendon pain or inflammation. |

|rupture. (May interfere with bone development in children less than 18| |

|years of age.) | |

|Avoid administering medications or foods that contain calcium, iron, |Instruct patient to administer these substances and medications 2 |

|or zinc such as antacids, dairy products, sucralfate or vitamin or |hours after ciprofloxacin. |

|mineral supplements, within 2 hours.. | |

|Administer with water and maintain adequate fluid intake to avoid |Take each dose with a glass of water and drink several extra glasses |

|crystalluria. |of fluid daily to prevent formation of ciprofloxacin crystals in the |

|Monitor intake and output and urine pH. (The drug alters urinary pH |urine. |

|and causes crystals to form in urine.) | |

|Monitor use of caffeine during drug therapy. (Absorption of Cipro is |Instruct patient to avoid caffeine intake during drug therapy. |

|decreased by caffeine.) | |

|Monitor plasma theophylline concentrations for patients prescribed |Inform patient that serum levels will need to be monitored. |

|these drugs. (The drug affects half-life of theophylline | |

|preparations.) | |

|Monitor patient for symptom of dizziness or lightheadedness. (This may|Advise patient to use caution when driving, operating machinery, or |

|occur due to the action of ciprofloxacin on the central nervous system|performing other hazardous activities until effect of drug is known. |

|(CNS).) | |

|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 |Potential Nursing Diagnoses |

|Prior to administration: |Infection, Risk related to contact with contagious agents (nosocomial |

|Obtain complete health history including allergies, drug history and |or community acquired) |

|possible drug interactions |Infection, Risk related to increased vulnerability secondary to |

|Assess for presence or history of systemic, respiratory or urinary |diminished immune response |

|tract infection |Knowledge, Deficient, related to drug therapy and side effects |

|Assess intake and output | |

|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 renal function including BUN and creatinine values, and intake|Inform patient: |

|and output.(Drug can cause hematological toxic effects, which are |That creatinine clearance tests and BUN may need to be monitored |

|increased with kidney disease and also the elderly population.) |To report changes in urinary elimination to the health care provider |

|Evaluate complaints of painful urination, flank pain, and fever. (Drug|Advise patient to: |

|can change the urine pH and could increase the patient’s risk for |Drink 2.5-3 liters of fluid daily. |

|formation of renal calculi.) |Report painful urination, flank pain or fever to the health care |

| |provider |

|Monitor baseline and follow-up urinalysis, CBC, platelet count, BUN |Instruct patient to continue medical follow-up and laboratory test |

|and creatinine clearance with long-term therapy. (To evaluate |appointments when receiving drug for extended period of time. |

|effectiveness of drug therapy.) | |

|Observe for symptoms of adverse reactions. (Evidenced in hematology |Instruct patient to report skin rash, sore throat, fever, mouth sores,|

|and blood coagulation studies and by skin manifestations.) |or unusual bleeding or bruising. |

|Monitor skin integrity. (This drug can also increase patient’s |Instruct patient to avoid exposure to direct sunlight and sunlamps. |

|sensitivity on the skin to ultraviolet lights.) | |

|Monitor compliance with treatment regimen. (Full course of therapy is |Instruct patient to take drug as directed and to complete full |

|required. If patient stops medication before prescription is complete,|prescription. |

|symptoms may reoccur and this may increase resistance to further | |

|antibiotics.) | |

|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 |Potential Nursing Diagnoses |

|Prior to administration |Infection, Risk for, related to weakened immune state or contact with |

|Obtain complete health history including allergies, drug history and |pathogen |

|possible drug interactions. |Knowledge deficient related to drug action and therapy treatment and |

|Assess for presence or history of local or systemic infection. |prevention measures |

|Obtain vital signs |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 allergic reaction to drug. (Allergic reaction |Instruct patient: |

|may occur immediately or delayed beyond 72 hours.) |Signs of allergic reaction including itching, rash, respiratory |

| |distress |

| |To immediately contact the health care provider if allergic reaction |

| |occurs |

|Monitor intake and output especially quantity and consistency of bowel|Advise patient to consult health care provider before taking |

|movements. (Severe diarrhea may occur due to the possible adverse |antidiarrheal medication. These medications may worsen or prolong |

|effect from Pseudomembranous colitis.) |diarrhea. |

|Evaluate patient’s understanding of drug therapy and administration. |Instruct patient to: |

|Give medication on empty stomach to reduce destruction by gastric acid|Take medication one hour before or two hours after a meal. |

|and enhanced absorption. |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|Instruct patient to notify the health care provider if symptoms |

|the prescribed antibacterial is not effective another medication or |persist or worsen. |

|different dosage may be required.) | |

|Observe for superinfection, especially in susceptible patients |Instruct patient to report signs and symptoms of superinfection. |

|including elderly, debilitated, or immunosuppressed patient. (There |Symptoms may include: fever, black hairy tongue, stomatitis, loose, |

|is a high risk for superinfections due to normal flora reduced or |foul-smelling stools, vaginal discharge, or cough. |

|eliminated.) | |

|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 |Potential Nursing Diagnoses |

|Prior to administration |Injury, Risk for (Allergic reaction) related to adverse reaction to |

|Obtain complete health history including allergies, drug history and |drug |

|possible drug interactions |Infection, Risk for superinfection related to effects of drug therapy |

|Assess for presence of local or systemic infection | |

|Obtain vital signs |Fluid volume, Risk for deficit, related to effects of drug on GI |

|Obtain history of drug allergies |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 diarrhea caused by the disruption of normal bowel |Instruct patient to: |

|flora. (May cause fluid electrolyte imbalance and superinfection of |Report loose stools or diarrhea. |

|antibiotic-associated pseudomembranous Colitis. Cultured dairy |Avoid treating diarrhea with antidiarrheals as this can impede the |

|products with live active cultures, such as kefir or yogurt may be |process of eliminating “bad bacteria" |

|used to help maintain normal intestinal flora. Supplements containing |Check with health care provider before taking any probiotic products. |

|beneficial bacterial, such as acidophilus, are also available OTC). | |

|Monitor for rash, pruritus, or fever (indicative of an allergic |Instruct patient to report adverse reactions promptly. |

|reaction to the medications). | |

|Monitor intake and output carefully in patients with compromised renal|Explain to patient purpose of required laboratory tests and schedule |

|function or if receiving aminoglycoside. |follow-up with health care provider. |

|Monitor renal function with lab studies periodically during and after | |

|therapy. (Toxicity could occur from drug toxins that are unable to be | |

|excreted.) | |

|Monitor for superinfection, 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 |Potential Nursing Diagnoses |

|Prior to administration |Body image, disturbed related to change in appearance |

|Obtain complete health history including allergies, drug history and |Noncompliance related to prolonged therapy |

|possible drug interactions. |Therapeutic regimen management, Ineffective related to prolonged |

|Assess for presence/history of: Lyme disease, pneumonia, acne |course of treatment |

|vulgaris, Typhus, Cholera, Rocky Mountain spotted fever, Chlamydia, |Knowledge, Deficient, related to drug action and side effects |

|sexually transmitted diseases, bladder infections, Helicobacter Pylori| |

|ulcers | |

|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 dental status when administered to children under age 8. |Instruct patient and caregivers to report evidence of tooth |

|(Drug may cause permanent discoloration of teeth, enamel defects, and |discoloration or dental abnormalities to health care provider. |

|bone growth retardation.) | |

|Administer with caution to patients with impaired kidney or liver |Instruct patient to: |

|function. (Could result in impaired metabolism and excretion.) |Report changes in urinary output |

| |Report for follow up care and lab tests of kidney and liver function |

| |and serum tetracycline levels. |

|Evaluate use of OTC products such as antacids, calcium supplements, |Instruct patient to consult with health care provider before taking |

|iron products, and laxatives containing magnesium. (These products |over the counter drugs. |

|interfere with drug absorption). | |

|Evaluate patient understanding of drug therapy and administration. |Instruct patient to: |

|(Drug may cause photosensitivity and increase risk of sunburn. |Avoid direct exposure to sunlight during and after therapy. Wear |

|Tetracyclines can increase patient’s sensitivity of the skin to |protective clothing, sunglasses and sunscreen. |

|ultraviolet light.) |Use an alternate form of birth control until all the medication is |

| |completed. |

| |Avoid taking drug with food, especially dairy 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 |Potential Nursing Diagnoses |

|Prior to administration: |Knowledge, Deficient related to disease process and drug therapy |

|Obtain complete health history including allergies, drug history and |Infection, Risk for related to superinfection |

|possible drug interations. |Fluid volume, Risk for Deficit related to effects of drug on GI system|

|Assess for presence/history of local or systemic infection |Diarrhea, Risk forrelated to effect of drug therapy |

|Obtain vital signs |Injury, Risk for (anaphylaxis) , related to adverse reaction to drug |

|Obtain history of allergic reaction to drugs | |

|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 hepatic disease. (Because the |Instruct patient to report history of medical problems to health care |

|metabolism of erythromycin ethylsuccinate (EES) is mainly by the |provider. |

|liver, it increases the patient’s risk for toxicity.) | |

|Monitor WBC, temperature, cultures, and perform infection-focused |Instruct patient: |

|physical examination. (To determine effectiveness of drug therapy.) |To report fever and worsening symptoms of infection. |

| |To report for follow-up examinations. |

|Evaluate patient understanding of treatment regimen. (Patient must |Instruct patient: |

|complete full course of therapy to prevent bacterial resistance.) |To complete full prescription even if feeling better or symptom free. |

| |Take with full glass of water, on an empty stomach one-hour before or |

| |two hours after meals. |

| |Avoid taking with or just after acidic fruit juices or carbonated |

| |drinks. |

|Monitor for evidence of G.I. distress. (May require alternate form of |Instruct patient to report past history of GI problems to health care |

|medication.) |provider. |

|Monitor for ototoxicity in patients receiving high dose, older adults,|Instruct patient to immediately report dizziness, vertigo, nausea, |

|female and history of kidney or liver dysfunction. |tinnitus, roaring noises, or hearing impairment to the health care |

| |provider. |

|Observe for signs and symptoms of superinfection by overgrowth of |Instruct patient to report diarrhea, abdominal pain, vaginal |

|non-susceptible bacteria or fungi. |discharge, or fever. |

|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 Gentamicin (Garamycin)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Injury, Risk for related to renal insufficiency related to |

|Obtain complete health history including allergies, drug history and |aminoglycoside therapy |

|possible drug interactions |Injury, Risk for related to disturbances of balance and impaired |

|Assess for presence/history of local or systemic infection |ability to detect environmental hazards |

|Obtain vital signs |Knowledge, Deficient related to drug therapy and side effects |

|Obtain history of drug allergies | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Maintain normal renal function throughout drug therapy. |

|Demonstrate knowledge of drug therapy and side effects |

|Remain free of physical injury |

|Implementation |

|Interventions and (Rationales) |Patient Education/Discharge Planning |

|Use with caution with impaired renal function or neuromuscular |Instruct patient to provide thorough history of medical conditions and|

|disorders. (Renal impairment can increase the risk of toxicity with |treatment to health care provider. |

|this drug. Patients with neuromuscular disorders may experience | |

|greater muscular weakness due to possible neuromuscular blockade with | |

|the drug’s action.) | |

|Monitor for signs of renal toxicity including unusual appearance of |Instruct patient to: |

|urine (dark, cloudy) intake and output ratio, and the presence of |Increase fluid intake of 2000 ml per day. |

|edema. Report immedately |Report evidence of decreased urinary output to the health care |

| |provider |

|Monitor for evidence of ototoxicity including headache, dizziness or|Instruct patient to notify health care provider if changes in hearing |

|vertigo, nausea or vomiting with motion, ataxia, nystagmus, tinnitus, |occur. |

|roaring noises, sensation of fullness of ears and hearing impairment. | |

|Monitor peak and trough drug levels. (Aminoglycosides have a narrow |Explain to patient that frequent serum drug therapy levels are |

|therapeutic range.) |necessary to prevent and monitor for complications. |

|Observe for symptoms of neurotoxicity or neuromuscular blockade. |Instruct patient to immediately report muscle twitching, numbness, |

| |seizures, weakness, or difficulty breathing to the health care |

| |provider. |

|Observe for signs and symptoms of bacterial overgrowth due to drug’s |Instruct patient to report diarrhea, anogenital itching, vaginal |

|effect to “kill” all bacteria, even normal flora that can lead to |discharge, stomatitis, or glossitis. |

|superinfection. | |

|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 Vancomycin (Vancocin)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Sensory perception, Disturbed related to ototoxicity |

|Obtain complete health history including allergies, drug history and |Injury, Risk for deep vein thrombosis related to chemical irritation |

|possible drug interactions |of vein |

|Assess for presence or history of infections resistant to other |Knowledge, Deficient, related to drug therapy and side effects |

|antibiotics | |

|Obtain history of hearing loss, impaired renal function | |

|Obtain history of cardiovascular disease | |

|Obtain history of hearing loss | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Demonstrate therapeutic response to drug therapy |

|Remain free of phlebitis |

|Maintain normal hearing acuity |

|Implementation |

|Interventions and (Rationales) | Patient Education/Discharge Planning |

|Evaluate hearing acuity. (Contraindicated with previous hearing loss |Inform patient: |

|due to drug’s ototoxic effects.) |That audiometry tests will be done to prevent complications from |

| |possible ototoxicity. |

| |To report symptoms of hearing loss, buzzing in ears |

|Monitor peak and trough vancomycin levels to ensure safe and effective|Inform patient about purpose of laboratory studies. |

|dosage. | |

| | |

|Monitor renal status. (Dosage is adjusted with renal insufficiency.) |Advise patient of importance of laboratory studies to establish |

| |baseline renal function and to monitor function during and after |

| |treatment. |

| | |

|Monitor IV site carefully. (Drug is irritating to tissues and causes |Instruct patient to report pain or other symptoms of discomfort |

|necrosis and severe pain with extravasations.) |immediately during intravenous infusion. |

| | |

|Monitor for proper use of medication. |Patient must take medication as prescribed and complete full course of|

| |treatment. Do not take other antidiarrheal preparations. |

|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 Isoniazid (INH)

|Assessment |Potential Nursing Diagnoses |

|Prior to administration: |Sensory perception, Disturbed related to peripheral neuritis and optic|

|Obtain complete health history including allergies, drug history and |neuritis |

|possible drug interactions |Knowledge, Deficient, related to drug therapy and side effects |

|Assess for presence/history of Positive tuberculin skin test, |Therapeutic regimen management, Ineffective related to long term |

|positive sputum culture or smear, close contact with person recently |therapy |

|infected with tuberculosis, AIDS, | |

|receiving immunosuppressant drugs, | |

|alcohol abuse, liver or kidney disease | |

|Planning: Patient Goals and Expected Outcomes |

|The patient will: |

|Demonstrate adherence to extended drug therapy |

|Demonstrate negative sputum cultures indicating effective drug therapy |

|Demonstrate understanding of drug therapy |

|Implementation |

|Interventions and (Rationales) | Patient Education/Discharge Planning |

|Monitor liver function. (Contraindicated in patients with acute liver |Instruct patient to: |

|disease or history of isoniazid-related liver damage.) |Provide accurate and complete medical, medication and treatment |

| |history. |

| |Avoid alcohol intake during drug therapy |

| |Report signs of liver impairment to health care provider, including |

| |jaundice, itching, fatigue |

|Monitor for negative sputum cultures. Change noted within 2-3 weeks. |Instruct patient to follow through on prescribed lab tests. |

|(To evaluate effectiveness of drug therapy.) | |

|Monitor for presence of peripheral neuritis related to pyroxidine |Instruct patient to: |

|deficiency. (Pyrodoxidine (vitamin B6) deficiency causes neurotoxic |Take pyrodoxine supplement to reduce risk of side effects. |

|effects.) |Report symptoms of numbness, tingling, or burning of feet to the |

| |health care provider |

|Evaluate diet for ingestion of foods containing tyramine. (Ingestion |Advise patient to avoid foods such as aged cheeses, smoked fish, tuna,|

|of tyramine-containing foods may cause palpitation, flushing and BP |sauerkraut juice, and yeast extracts. |

|elevation, and histamine-containing foods may cause exaggerated drug | |

|response with headache, palpitation, sweating, flushing, itching, or | |

|diarrhea.) | |

|Evaluation of Outcome Criteria |

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

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