Nursing Considerations for Patients Receiving Carbapenems
碳青霉烯类药使用患者的护理考虑
Assessment: History and Examination
评估:病史和检查
• Assess for possible contraindications or cautions: known allergy to any carbapenem or beta-lactam (obtain specific information about the nature and occurrence of allergic reactions); history of renal disease; history of seizures and current pregnancy or lactation status.
• Perform physical assessment to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy.
进行身体评估,确认评估药物效果及药物疗法相关不良效应发生情况的基线数据。
• Perform culture and sensitivity tests at the site of infection.
进行感染部位细菌培养和敏感性试验。
• Conduct orientation and reflex assessment to evaluate any CNS effects of the drug.
进行定向和反射评估,评价药物的CNS效应。
• Assess vital signs: respiratory rate and adventitious sounds to monitor for signs of infection or hypersensitivity reactions; temperature to assess for signs and symptoms of infection.
评估生命体征:呼吸率和附加音,监测感染或超敏反应体征;体温,评估感染体征和症状。
• Perform renal function tests to determine baseline function of the kidneys and, possibly, the need to adjust dose.
进行肾功能试验,确定肾基线功能,可能的话,评估是否需要高速剂量。
Nursing Diagnoses
护理诊断
Nursing diagnoses related to drug therapy might include the following:
• Acute Pain related to GI or CNS effects of the drug
• Risk for Infection related to loss of normal flora
• Deficient Knowledge regarding drug therapy
• Check culture and sensitivity reports to ensure that this is the drug of choice for this patient.
检查细菌培养和敏感性试验报告,确保该药为该患者首选。
• Ensure that the patient receives the full course of the carbapenem as prescribed to increase effectiveness and decrease the risk for the development of resistant strains of bacteria.
保证患者按处方服完完整疗程,增强有效性,降低抗药性菌株出现风险。
• Monitor the site of infection and presenting signs and symptoms (e.g., fever, lethargy) throughout the course of drug therapy. Failure of these signs and symptoms to resolve may indicate the need to reculture the site. Arrange to continue drug therapy for at least 2 days after all signs and symptoms resolve to decrease the development of resistant strains of bacteria.
• Monitor the patient regularly for signs of pseudomembranous colitis, severe diarrhea, or superinfections to effectively arrange for discontinuation of drug or decreased dose, as appropriate, if any of these toxicities occurs.
如出现上述毒性现象,应定期检查患者的假膜性结肠炎、严重腹泻或二重感染体征,有效安排停药或减少剂量,
• Provide safety measures to protect the patient if CNS effects, such as confusion, dizziness, or seizures, occur.
若出现CNS效应,如意识不清、头晕、癫痫,要做好安全措施,保护患者。
• Provide small, frequent meals as tolerated to relieve GI discomfort. Also provide adequate fluids to replace fluid lost with diarrhea, if appropriate.
耐受时,少量多餐,减轻GI不适。适当时,液体充分,补充腹泻引起的液体丢失。
• Ensure that patient is hydrated at all times during drug therapy to minimize renal toxicity from drug exposure.
药物治疗期,确保患者随时水化,尽量减轻药物使用引起的肾毒性。
• Instruct the patient about the appropriate dosage regimen and possible adverse effects to enhance patient knowledge about drug therapy and to promote compliance.
指导患者适当用药,注意可能的不良效应,强化患者药物疗法知识,促进患者顺从性。
• Provide the following patient teaching:
• Take safety precautions, such as changing position slowly and avoiding driving and hazardous tasks, if CNS effects occur.
• Try to drink a lot of fluids and to maintain nutrition (very important) even though nausea, vomiting, and diarrhea may occur.
• Report difficulty breathing, severe headache, severe diarrhea, fever, and signs of infection.
• Monitor patient response to the drug (resolution of bacterial infection).
• Monitor for adverse effects (orientation and effect, superinfections, GI toxicity, severe diarrhea effects).
• Evaluate effectiveness of the teaching plan (patient can name drug, dosage, possible adverse effects to watch for, and specific measures to help avoid adverse effects).
• Monitor effectiveness of comfort and safety measures and compliance with the therapeutic regimen.
Test 1. Before administering intravenous (IV) penicillin, the nurse should do what?
A. Flush the IV site with normal saline.
B. Assess the patient for allergies.
C. Review the patient's intake and output record.
D. Determine the latest creatinine clearance result. 2. Thirty minutes after receiving an intramuscular (IM) injection of penicillin G (Pfizerpen), a patient reports itching and redness at the injection site. Which action should the nurse take first?
A. Elevate the lower legs.
B. Place an ice pack on the site.
C. Make sure the patient stays calm.
D. Administer subcutaneous epinephrine.
本期ISPN Review答案: 1. B. Assess the patient for allergies
The principal adverse effect of penicillins is allergic reaction. Penicillins are contraindicated in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems. IV patency is important, as is monitoring renal function, because impairment can cause penicillins to reach toxic levels; however, these are not as important as determining allergy status.
2. D. Administer subcutaneous epinephrine
Itching and redness at the IM injection site indicate an allergy to penicillin. The primary treatment is epinephrine (subcutaneous, IM, or IV) plus respiratory support. Elevation, ice packs, and calming the patient are done once epinephrine has been administered.