Gentamicin Sulfate
Garamycin, Garamycin Ophthalmic, Genoptic
Classifications: antiinfective; aminoglycoside antibiotic
Action:
Broad-spectrum aminoglycoside antibiotic derived fromMicromonospora purpurea. Action is usually bacteriocidal.
Indication:
Parenteral use restricted to treatment of serious infections of GI, respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic antimicrobial agents are ineffective or are contraindicated. Has been used in combination with other antibiotics. Also used topically for primary and secondary skin infections and for superficial infections of external eye and its adnexa.
Dosage and Route:
Moderate to Severe Infection
Adult: IV/IM 1.5–2 mg/kg loading dose followed by 3–5 mg/kg/d in 2–3 divided doses Intrathecal 4–8 mg preservative free q.d.Topical 1–2 drops of solution in eye q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d.
Child: IV/IM 6–7.5 mg/kg/d in 3–4 divided doses Intrathecal >3 mo, 1–2 mg preservative free q.d.
Neonate: IV/IM 2.5 mg/kg q12–24h
Acute Pelvic Inflammatory Disease
Adult: IV/IM 2 mg/kg followed by 1.5 mg/kg q8h
Prophylaxis of Bacterial Endocarditis
Adult: IV/IM 1.5 mg/kg 30 min before procedure, may repeat in 8 h
Child: IV/IM < 27 kg, 2 mg/kg 30 min before procedure, may repeat in 8 h
Adult: IV/IM 1.5–2 mg/kg loading dose followed by 3–5 mg/kg/d in 2–3 divided doses Intrathecal 4–8 mg preservative free q.d.Topical 1–2 drops of solution in eye q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d.
Child: IV/IM 6–7.5 mg/kg/d in 3–4 divided doses Intrathecal >3 mo, 1–2 mg preservative free q.d.
Neonate: IV/IM 2.5 mg/kg q12–24h
Acute Pelvic Inflammatory Disease
Adult: IV/IM 2 mg/kg followed by 1.5 mg/kg q8h
Prophylaxis of Bacterial Endocarditis
Adult: IV/IM 1.5 mg/kg 30 min before procedure, may repeat in 8 h
Child: IV/IM < 27 kg, 2 mg/kg 30 min before procedure, may repeat in 8 h
Adverse Effects:
Special Senses: Ototoxicity (vestibular disturbances, impaired hearing), optic neuritis. CNS: neuromuscular blockade: skeletal muscle weakness, apnea, respiratory paralysis (high doses); arachnoiditis (intrathecal use). CV: hypotension or hypertension. GI: Nausea, vomiting, transient increase in AST, ALT, and serum LDH and bilirubin; hepatomegaly, splenomegaly. Hematologic: Increased or decreased reticulocyte counts; granulocytopenia, thrombocytopenia (fever, bleeding tendency), thrombocytopenic purpura, anemia. Body as a Whole: Hypersensitivity (rash, pruritus, urticaria, exfoliative dermatitis, eosinophilia, burning sensation of skin, drug fever, joint pains, laryngeal edema, anaphylaxis). Urogenital: Nephrotoxicity: proteinuria, tubular necrosis, cells or casts in urine, hematuria, rising BUN, nonprotein nitrogen, serum creatinine; decreased creatinine clearance. Other: Local irritation and pain following IM use; thrombophlebitis, abscess, superinfections, syndrome of hypocalcemia (tetany, weakness, hypokalemia, hypomagnesemia).
Contraindication:
History of hypersensitivity to or toxic reaction with any aminoglycoside antibiotic. Safe use during pregnancy (category C) or lactation is not established
Nursing Responsibility:
Assessment & Drug Effects
- Lab tests: Perform C&S and renal function prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity.
- Repeat C&S if improvement does not occur in 3–5 d; reevaluate therapy.
- Note: Dosages are generally adjusted to maintain peak serum gentamicin concentrations of 4– 10 g/mL, and trough concentrations of 1–2 g/mL. Peak concentrations above 12 g/mL and trough concentrations above 2 g/mL are associated with toxicity.
- Draw blood specimens for peak serum gentamicin concentration 30 min–1h after IM administration, and 30 min after completion of a 30–60 min IV infusion. Draw blood specimens for trough levels just before the next IM or IV dose. Use nonheparinized tubes to collect blood.
TABLE
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Drug Name
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Dosage & Route
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Action
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Indication
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Adverse Effects
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Contraindication
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Nursing Responsibility
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GENTAMICIN
SULFATE
(jen-ta-mye'sin)
Garamycin, Garamycin Ophthalmic, Genoptic
Classifications: antiinfective; aminoglycoside antibiotic
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Moderate to Severe Infection
Adult: IV/IM 1.5–2 mg/kg loading dose followed by 3–5 mg/kg/d in 2–3 divided doses Intrathecal 4–8 mg preservative free q.d. Topical 1–2 drops of solution in eye q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d. Child: IV/IM 6–7.5 mg/kg/d in 3–4 divided doses Intrathecal >3 mo, 1–2 mg preservative free q.d. Neonate: IV/IM 2.5 mg/kg q12–24h Acute Pelvic Inflammatory Disease Adult: IV/IM 2 mg/kg followed by 1.5 mg/kg q8h Prophylaxis of Bacterial Endocarditis Adult: IV/IM 1.5 mg/kg 30 min before procedure, may repeat in 8 h Child: IV/IM < 27 kg, 2 mg/kg 30 min before procedure, may repeat in 8 h |
|
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Special Senses: Ototoxicity (vestibular
disturbances, impaired hearing), optic neuritis. CNS: neuromuscular blockade: skeletal muscle weakness, apnea,
respiratory paralysis (high doses); arachnoiditis (intrathecal use). CV: hypotension or hypertension. GI:
Nausea, vomiting, transient increase in AST, ALT, and serum LDH and
bilirubin; hepatomegaly, splenomegaly. Hematologic:
Increased or decreased reticulocyte counts; granulocytopenia,
thrombocytopenia (fever, bleeding tendency), thrombocytopenic purpura,
anemia. Body as a Whole: Hypersensitivity (rash,
pruritus, urticaria, exfoliative dermatitis, eosinophilia, burning sensation
of skin, drug fever, joint pains, laryngeal edema, anaphylaxis). Urogenital: Nephrotoxicity:
proteinuria, tubular necrosis, cells or casts in urine, hematuria, rising
BUN, nonprotein nitrogen, serum creatinine; decreased creatinine
clearance. Other: Local
irritation and pain following IM use; thrombophlebitis, abscess,
superinfections, syndrome of hypocalcemia (tetany, weakness, hypokalemia,
hypomagnesemia).
|
History
of hypersensitivity to or toxic reaction with any aminoglycoside antibiotic.
Safe use during pregnancy (category C) or lactation is not established
|
·
Lab tests: Perform C&S and renal function prior to first
dose and periodically during therapy; therapy may begin pending test results.
Determine creatinine clearance and serum drug concentrations at frequent
intervals, particularly for patients with impaired renal function, infants
(renal immaturity), older adults, patients receiving high doses or therapy
beyond 10 d, patients with fever or extensive burns, edema, obesity.
·
Repeat C&S if improvement does not occur in 3–5 d;
reevaluate therapy.
·
Note: Dosages are generally adjusted to maintain peak serum
gentamicin concentrations of 4– 10 g/mL, and trough concentrations of 1–2
g/mL. Peak concentrations above 12 g/mL and trough concentrations above 2
g/mL are associated with toxicity.
·
Draw blood specimens for peak serum gentamicin concentration 30
min–1h after IM administration, and 30 min after completion of a 30–60 min IV
infusion. Draw blood specimens for trough levels just before the next IM or
IV dose. Use nonheparinized tubes to collect blood.
|
Tag :
Drug Study,
Phenobarbital Sodium
Luminal Sodium
Action:
Long-acting barbiturate. Sedative and hypnotic effects of barbiturates appear to be due primarily to interference with impulse transmission of cerebral cortex by inhibition of reticular activating system. CNS depression may range from mild sedation to coma, depending on dosage, route of administration, degree of nervous system excitability, and drug tolerance. Initially,barbiturates suppress REM sleep, but with chronic therapy REM sleep returns to normal.
Classification:
CENTRAL NERVOUS SYSTEM AGENT; ANTICONVULSANT; SEDATIVE-HYPNOTIC; BARBITURATE
Indication:
Long-term management of tonic-clonic (grand mal) seizures and partial seizures; status epilepticus, eclampsia, febrile convulsions in young children. Also used as a sedative in anxiety or tension states; in pediatrics as preoperative and postoperative sedation and to treat pylorospasm in infants.
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Drug Name
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Dosage & Route
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Action
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Indication
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Adverse Effects
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Contraindication
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Nursing Responsibility
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PHENOBARBITAL
SODIUM
Luminal Sodium
Classifications: central nervous system agent;
anticonvulsant; sedative-hypnotic; barbiturate
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Anticonvulsant
Adult: PO 100–300 mg/d IV/IM 200–600 mg up to 20 mg/kg Child: PO/IV 3–8 mg/kg or 125 mg/m2/d Neonate: PO/IV 3–4 mg/kg/d (max: 5 mg/kg/d) Status Epilepticus Adult/Child: IV 15–18 mg/kg in single or divided doses (max: 20 mg/kg) Neonate: IV 15–20 mg/kg in single or divided doses Sedative Adult: PO 30–120 mg/d IV/IM 100–200 mg/d Child: PO 6 mg/kg/d or 180 mg/m2 in 3 divided doses IV/IM 16–100 mg/d (1–3 mg/kg) |
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Body as a Whole: Myalgia, neuralgia, CNS depression, coma, and death. CNS: Somnolence, nightmares,
insomnia, "hangover," headache, anxiety, thinking abnormalities,
dizziness, nystagmus, irritability, paradoxic excitement and exacerbation of
hyperkinetic behavior (in children); confusion or depression or marked
excitement (older adult or debilitated patients); ataxia. CV: Bradycardia, syncope, hypotension. GI: Nausea, vomiting, constipation, diarrhea, epigastric pain,
liver damage. Hematologic:
Megaloblastic anemia, agranulocytosis,
thrombocytopenia. Metabolic:
Hypocalcemia, osteomalacia, rickets. Musculoskeletal: Folic
acid deficiency, vitamin D deficiency. Respiratory: Respiratory depression. Skin: Mild maculopapular, morbilliform rash;
erythema multiforme, Stevens-Johnson syndrome,
exfoliative dermatitis (rare). .
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Sensitivity to barbiturates; manifest hepatic or familial history of porphyria; severe respiratory or kidney disease; history of previous addiction to sedative hypnotics; uncontrolled pain; pregnancy (particularly early pregnancy) (category D), lactation; sustained release formulation for children <12 y of age. |
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Observe patients receiving large doses closely for at least 30
min to ensure that sedation is not excessive.
·
Keep patient under constant observation when drug is
administered IV, and record vital signs at least every hour or more often if
indicated.
·
Lab tests: Obtain liver function and hematology tests and
determinations of serum folate and vitamin D levels during prolonged therapy.
·
Monitor serum drug levels. Serum concentrations >50 mcg/mL
may cause coma. Therapeutic serum concentrations of 15–40 mcg/mL produce
anticonvulsant activity in most patients. These values are usually attained
after 2 or 3 wk of therapy with a dose of 100–200 mg/d.
·
Expect barbiturates to produce restlessness when given to
patients in pain because these drugs do not have analgesic action.
·
Be prepared for paradoxical responses and report promptly in
older adult or debilitated patient and children (i.e., irritability, marked
excitement [inappropriate tearfulness and aggression in children],
depression, and confusion).
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Tag :
Drug Study,
Pneumonia
INTRODUCTION
Pneumonia is an inflammation of the lungs caused by an infection. It is also called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health. Although pneumonia is a special concern for older adults and those with chronic illnesses, it can also strike young, healthy people as well. It is a common illness that affects thousands of people each year in the Philippines, thus, it remains an important cause of morbidity and mortality in the country.
There are many kinds of pneumonia that range in seriousness from mild to life-threatening. In infectious pneumonia, bacteria, viruses, fungi or other organisms attack your lungs, leading to inflammation that makes it hard to breathe. Pneumonia can affect one or both lungs. In the young and healthy, early treatment with antibiotics can cure bacterial pneumonia. The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. It’s best to do everything we can to prevent pneumonia, but if one do get sick, recognizing and treating the disease early offers the best chance for a full recovery.
A case with a diagnosis of Pneumonia may catch one’s attention, though the disease is just like an ordinary cough and fever, it can lead to death especially when no intervention or care is done. Since the case is a toddler, an appropriate care has to be done to make the patient’s recovery faster. Treating patients with pneumonia is necessary to prevent its spread to others and make them as another victim of this illness.
There are many kinds of pneumonia that range in seriousness from mild to life-threatening. In infectious pneumonia, bacteria, viruses, fungi or other organisms attack your lungs, leading to inflammation that makes it hard to breathe. Pneumonia can affect one or both lungs. In the young and healthy, early treatment with antibiotics can cure bacterial pneumonia. The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. It’s best to do everything we can to prevent pneumonia, but if one do get sick, recognizing and treating the disease early offers the best chance for a full recovery.
A case with a diagnosis of Pneumonia may catch one’s attention, though the disease is just like an ordinary cough and fever, it can lead to death especially when no intervention or care is done. Since the case is a toddler, an appropriate care has to be done to make the patient’s recovery faster. Treating patients with pneumonia is necessary to prevent its spread to others and make them as another victim of this illness.
ANATOMY AND PHYSIOLOGY
The lungs constitute the largest organ in the respiratory system. They play an important role in respiration, or the process of providing the body with oxygen and releasing carbon dioxide. The lungs expand and contract up to 20 times per minute taking in and disposing of those gases.
Air that is breathed in is filled with oxygen and goes to the trachea, which branches off into one of two bronchi. Each bronchus enters a lung. There are two lungs, one on each side of the breastbone and protected by the ribs. Each lung is made up of lobes, or sections. There are three lobes in the right lung and two lobes in the left one. The lungs are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi branch out into minute pathways that go through the lung tissue. The pathways are called bronchioles, and they end at microscopic air sacs called alveoli. The alveoli are surrounded by capillaries and provide oxygen for the blood in these vessels. The oxygenated blood is then pumped by the heart throughout the body. The alveoli also take in carbon dioxide, which is then exhaled from the body.
Inhaling is due to contractions of the diaphragm and of muscles between the ribs. Exhaling results from relaxation of those muscles. Each lung is surrounded by a two-layered membrane, or the pleura, that under normal circumstances has a very, very small amount of fluid between the layers. The fluid allows the membranes to easily slide over each other during breathing.
Air that is breathed in is filled with oxygen and goes to the trachea, which branches off into one of two bronchi. Each bronchus enters a lung. There are two lungs, one on each side of the breastbone and protected by the ribs. Each lung is made up of lobes, or sections. There are three lobes in the right lung and two lobes in the left one. The lungs are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi branch out into minute pathways that go through the lung tissue. The pathways are called bronchioles, and they end at microscopic air sacs called alveoli. The alveoli are surrounded by capillaries and provide oxygen for the blood in these vessels. The oxygenated blood is then pumped by the heart throughout the body. The alveoli also take in carbon dioxide, which is then exhaled from the body.
Inhaling is due to contractions of the diaphragm and of muscles between the ribs. Exhaling results from relaxation of those muscles. Each lung is surrounded by a two-layered membrane, or the pleura, that under normal circumstances has a very, very small amount of fluid between the layers. The fluid allows the membranes to easily slide over each other during breathing.
PATHOPHYSIOLOGY
Pneumonia is a serious infection or inflammation of your lungs. The air sacs in the lungs fill with pus and other liquid. Oxygen has trouble reaching your blood. If there is too little oxygen in your blood, your body cells can’t work properly. Because of this and spreading infection through the body pneumonia can cause death. Pneumonia affects your lungs in two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs.
Bacteria are the most common cause of pneumonia. Of these, Streptococcus pneumoniae is the most common. Other pathogens include anaerobic bacteria, Staphylococcus aureus, Haemophilus influenzae, Chlamydia pneumoniae, C. psittaci, C. trachomatis, Moraxella (Branhamella) catarrhalis, Legionella pneumophila, Klebsiella pneumoniae, and other gram-negative bacilli. Major pulmonary pathogens in infants and children are viruses: respiratory syncytial virus, parainfluenza virus, and influenza A and B viruses. Among other agents are higher bacteria including Nocardia and Actinomyces sp; mycobacteria, including Mycobacterium tuberculosis and atypical strains; fungi, including Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus fumigatus, and Pneumocystis carinii; and rickettsiae, primarily Coxiella burnetii (Q fever).
The usual mechanisms of spread are inhaling droplets small enough to reach the alveoli and aspirating secretions from the upper airways. Other means include hematogenous or lymphatic dissemination and direct spread from contiguous infections. Predisposing factors include upper respiratory viral infections, alcoholism, institutionalization, cigarette smoking, heart failure, chronic obstructive airway disease, age extremes, debility, immunocompromise (as in diabetes mellitus and chronic renal failure), compromised consciousness, dysphagia, and exposure to transmissible agents.
Typical symptoms include cough, fever, and sputum production, usually developing over days and sometimes accompanied by pleurisy. Physical examination may detect tachypnea and signs of consolidation, such as crackles with bronchial breath sounds. This syndrome is commonly caused by bacteria, such as S. pneumoniae and H. influenzae.
NURSING PROFILE
a. Patient’s Profile
Name: R.C.S.B.
Age: 1 yr,1 mo.
Weight:10 kgs
Religion: Roman Catholic
Mother: C.B.
Address: Valenzuela City
b. Chief Complaint: Fever
Date of Admission: 1st admission
Hospital Number: 060000086199
c. History of Present Illness
2 days PTA – (+) cough
(+) nasal congestion, watery to greenish
(+) nasal discharge
Tx: Disudrin OD
Loviscol OD
Few hrs PTA - (+) fever, Tmax= 39.3 C
(+) difficulty of breathing
(+) vomiting, 1 episode
Tx: Paracetamol
Sought consultation at ER: Rx=BPN, Salbutamol neb.
IE: T = 38.3C, CR= 122’s, RR= 30’s
(+) TPC
SCE, (-) retractions, clear BS, (-) cyanosis, (-) edema
d. Past Illness
(-) asthma
(-) allergies
e. Family History
PMHx: (+) asthma (mother)
f. Activities of Daily Living
· Sleeping mostly at night and during afternoon
· Usually wakes up early in the morning (5AM) to be milkfed.
· Eats a lot (hotdogs, chicken, crackers, any food given to her)
· Active, responsive
· BM (1-2 times a day)
· Urinates in her diaper (more than 4 times a day)
· Likes to play with those around her
g. Review of Systems
Neuromuscular: weakness of muscles
Integumentary: (-) cyanosis
Respiratory: tavhypnea; (+) DOB; (+) coarse crackles, (+) wheezes,
Digestive: food aversion, vomits ingested milk
DRUG STUDY
NURSING ACTIONS
INDEPENDENT
- positioning of the patient with head on mid line, with slight flexion
rationale: to provide patent, unobstructed airway , maximum lung excursion - auscultating patient’s chest
rationale: to monitor for the presence of abnormal breath sounds - provide chest and back clapping with vibration
rationale: chest physiotheraphy facilitates the loosening of secretions - considering that the patient is an infant, and has developed a strong stranger anxiety
as manifested by “white coat syndrome” , it is a nursing action to play with the patient.
rationale: to establish rapport, and gain the patients trust
DEPENDENT
- administer due medications as ordered by the physician, bronchodilators, anti pyretics and anti biotics
rationale: bronchodilators decrease airway resistance, secondary to bronchoconstriction,
anti pyretics alleviate fever, antibiotics fight infection - placing patient on TPN prn
rationale: to compensate for fluid and nutritional losses during vomiting
COLLABORATIVE
- assist respiratory therapist in performing nebulization of the patient
rationale: nebulization is a favourable route of administering bronchodilators
and aid in expectorating secretions, hence patient’s breathing
PHYSICIAN’S ORDER SHEET
11/19/06
Admit patient to ROC under the service of Dr. Vitan secure consent for admission and management, TPR every shift then record. May have diet for age with strict aspiration precaution, IVF D5 0.3NaCl 500cc to run at 62-63mgtts/min.May give paracetamol 125mg 1supp/rectum if oral paracetamol is not tolerated.
11/20/06
For urinalysis, IVF to follow D5 0.3 NaCl 500 at SR (62-63mgtt/m Use zinacef brand of cefuroxine 750mg- given ½ vial 375mg every 8hours, nebulize (Ventolin 1 nebule) every 6 hours, paracetamol drugs prn every 4hours (Temp 37.8).
11/21/06
Continue cefuroxine and nebulizer every 6 hours. May not reinsert IVF, revise Cefuroxine IV to Cefuroxine 500mg via deep Intramuscular BID,continue management.
11/22/06
Continue management and refer.
DISCHARGE PLANNING
- Take the entire course of any prescribed medications. After a patient’s temperature returns to normal, medication must be continued according to the doctor’s instructions, otherwise the pneumonia may recur. Relapses can be far more serious than the first attack.
- Get plenty of rest. Adequate rest is important to maintain progress toward full recovery and to avoid relapse.
- Drink lots of fluids, especially water. Liquids will keep patient from becoming dehydrated and help loosen mucus in the lungs.
- Keep all of follow-up appointments. Even though the patient feels better, his lungs may still be infected. It’s important to have the doctor monitor his progress.
- Encourage the guardians to wash patient’s hands. The hands come in daily contact with germs that can cause pneumonia. These germs enter one’s body when he touch his eyes or rub his nose. Washing hands thoroughly and often can help reduce the risk.
- Tell guardians to avoid exposing the patient to an environment with too much pollution (e.g. smoke). Smoking damages one’s lungs’ natural defenses against respiratory infections.
- Give supportive treatment. Proper diet and oxygen to increase oxygen in the blood when needed.
- Protect others from infection. Try to stay away from anyone with a compromised immune system. When that isn’t possible, a person can help protect others by wearing a face mask and always coughing into a tissue.
Tag :
Case Study,
