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    《ISPN学习》总第511期
    日期:2019-07-16 21:36:11    
    《ISPN学习》2019年07月17日总第511期
     
     
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    ISPN  Review        
    Antibiotic Therapy Across the Lifespan
    各年龄段的抗生素疗法
     
    CHILDREN
    儿童
     
    Children are very sensitive to the gastrointestinal and central nervous system (CNS) effects of most antibiotics, and more severe reactions can be expected when these drugs are used in children. It is important to monitor the hydration and nutritional status of children who are adversely affected by drug-induced diarrhea, anorexia, nausea, and vomiting. Superinfections can be a problem for small children as well. For example, thrush (oral candidiasis) is a common superinfection that makes eating and drinking difficult.
     
    儿童对多数抗生素的胃肠和中枢神经系统效应非常敏感,儿童使用这些药物时,可以预期,会出现更为严重的反应。因此,很重要的一点,当儿童出现药物诱发的腹泻、厌食、恶心、呕吐等不良效应时,应密切监测其水化和营养状况。重复感染也可能成为幼儿问题。例如,鹅口疮(口腔念珠菌病)便是常见的重复感染,可以增加饮食和饮水困难。
     
    Many antibiotics do not have proven safety and efficacy in pediatric use, and extreme caution should be used when giving them to children. The fluoroquinolones, for instance, are associated with damage to developing cartilage and are not recommended for growing children. Pediatric dosages of antibiotics should be double-checked to make sure that the child is receiving the correct dose, thereby improving the chance of eradicating the infection and decreasing the risk of adverse effects.
     
    对于儿童使用,很多抗生素的安全性和有效性尚未得到证实。因此,儿童使用时,应极端小心。如,氟喹诺酮类药与软骨发育受损相关,不建议发育期儿童使用。应仔细检查小儿的抗生素剂量,确保小儿所用剂量正确,以提高根治感染机会,降低不良效应风险。
     
    Antibiotic treatment of ear infections, a common pediatric problem, is controversial. Ongoing research suggests that judicious use of decongestants and anti-inflammatories may be just as successful as the use of antibiotics without the risk of development of resistant bacterial strains. Parents, not wanting to see their child sick, may demand antibiotics as a cure-all whenever their child is fussy or feverish. Parent education is very important in helping to cut down the unnecessary use of antibiotics in children.
     
    耳感染抗生素治疗是一个常见的儿科问题,一直存在争议。不断的研究表明,慎重使用鼻充血减轻剂和消炎药,其效果与抗生素一样好,且不会有抗菌株风险。父母不想看到小孩生病,不管什么时候,只要小孩出现不安或发热,就会把抗生素当成万应药来用。所以,父母宣教对帮助减少小儿不必要的抗生素使用极为重要。
     
    ADULTS
    成人
     
    Many adults believe that antibiotics are a cure-all for any discomfort and fever. It is very important to explain that antibiotics are useful against only specific bacteria and actually can cause problems when used unnecessarily for viral infections, such as the common cold.
     
    很多成人认为,抗生素是任何不适和发烧的万应药。告诉他们抗生素只对特定细胞有用,不必要地在病毒感染,如感冒,时使用抗生素就会造成问题,这一点很重要。
     
    Adults need to be cautioned to take the entire course of the medication as prescribed and not to store unused pills for future infections or share antibiotics with symptomatic friends. Pregnant and breast-feeding women should not take antibiotics unless the benefit clearly outweighs the potential risk to the fetus or neonate. Tetracyclines, for example, are associated with pitting of enamel in developing teeth and with calcium deposits in growing bones. These drugs can cause serious problems for neonates. Women of childbearing age should be advised to use barrier contraceptives if any of these drugs are used.
     
    必须提醒成人要按处方服完整个疗程,不要把未用完的药物保存起来供下次感染用,或把抗生素分给有症状的朋友用。孕妇和哺乳期妇女不应使用抗生素,除非用药好处显然大于潜在的胎儿或新生儿风险。如四环素类药与发育期牙齿的牙釉质孔蚀存在相关性,与生长期骨的钙沉着存在相关性。这些药物可能引起严重的新生儿问题。应建议使用这些药物的育龄期妇女使用屏障避孕器。
     
    Many antibiotics interfere with the effectiveness of oral contraceptives, and unplanned pregnancies can occur.
     
    很多抗生素影响口服避孕药效果,可能出现意外妊娠。
     
    OLDER ADULTS
    老年人
     
    In many instances, older adults do not present with the same signs and symptoms of infections as other patients. Therefore, assessing the problem and obtaining appropriate specimens for culture is especially important with this population. Older patients may be more susceptible to the adverse effects associated with antibiotic therapy. Their hydration and nutritional status should be monitored closely, as should the need for safety precautions if CNS effects occur. If hepatic or renal dysfunction is expected (particularly in very old patients, those who may depend on alcohol, and those who are taking other hepatotoxic or nephrotoxic drugs), the dose may need to be lowered and the patient should be monitored more frequently.
     
    在很多情况下,老年人感染症状体征与其他患者并不相同。因此,评估问题、获取适当的培养标本对这一人群特别重要。老年人对抗生素疗法相关不良效应可能更易感。其水化和营养状况应密切监测,包括CNS效应出现时的安全措施需要。如预计会出现肝、肾功能障碍(特别是年龄特别大的老人、酗酒的人、服用其他肝毒性、肾毒性药物的人),剂量需要减少,患者监测应更经常。
     
    Elderly patients also need to be cautioned to complete the full course of drug therapy, even when they feel better, and not to save pills for self-medication at a future time.
     
    还应提醒老年人完成整个用药疗程,即使是他们感觉好转时;不要保存药物预备下次自我给药。
     


    Vocabulary for Today    
    superinfection – n. 二重感染,重复感染
    thrush – n. 鹅口疮
    oral candidiasis – 口腔念珠菌病
    cartilage – n. 软骨
    controversial – a. 有争议的
    cure-all – n. 万灵药
    enamel – n. 牙釉质
    calcium deposits – 钙沉着
     
     
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    Video            
    Pharmacology of Antibiotics 1
     
    Test                 
    1. An antimicrobial medication that has selective toxicity has which characteristic?
    A. Ability to transfer DNA coding
    B. Ability to suppress bacterial resistance
    C. Ability to avoid injuring host cells
    D. Ability to act against a specific microbe
    2. The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what?
    A. Resistant infection
    B. Superinfection
    C. Nosocomial infection
    D. Allergic reaction
     
     
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    本期ISPN Review答案

    1. C. Ability to avoid injuring host cells.
    Selective toxicity refers to an antibiotic that has the ability to injure only invading microbes, not the host. Conjugation is the process through which DNA coding for drug resistance is transferred from one bacterium to another. Antibiotics do not suppress bacterial resistance, but rather promote the emergence of drug-resistant microbes. Antibiotics that are narrow spectrum are active against only a few microbes.
     
    2. B. Superinfection
    Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora is decreased, these organisms can overgrow and cause a new infection, or superinfection.
     




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