Antibiotic Selection and Considerations, Exams of Nursing

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NRNP 6566 WEEK 9 KNOWLEDGE CHECK WITH

ANSWERS

- Question 2 - Question 3 A 32 year old preschool teacher complains of difficulty swallowing, sore throat, and chills. She is febrile with a temperature of 101.6 along with white patches on her tonsils. Her rapid strep test is positive. Her past medical history is positive for an anaphylactic reaction to cefaclor two years ago. What antibiotic could be safely utilized in this patient?

Correct

Answer: Streptococcus is usually treated with amoxicillin. Her type 1 anaphylactic

re- action to a cephalosporin means you should not use a cephalosporin or peni- cillin. Acceptable alternatives would be macrolide such as azithromycin or clindamycin. A 20 - year old woman was seen by her primary care provider last week and diagnosed with a lower track UTI. Her complaints at that time included burning on urination, frequent urination of a small amount, and superpubic pain. She was prescribed a 3 day course of Bactrim which she completed. She is admitted to the step down unit today with complaints of fever (102.6 and above) for the past 24 hours and CVA tenderness. She appears very ill and is somewhat confused today. Her BP is 100/62. Her family indicates that she has been vomiting for the last 24 hours and been unable to keep food or fluids down. What would your initial plan for this patient include?

Correct

Answer: This^ patient^ has^ classic^ symptoms^ of^ pyelonephritis^ as^ well^ as^ sepsis.^ Her

hightemperature, low blood pressure, vomiting, dehydration, and confusion indicate a need for admission and IV antibiotics. Initial antibiotic options include ceftriazone or ciprofloxin PLUS gentamicin OR ampicillin/ sulbactam. Intravenous fluid administration is also indicated. According to the Surviving Sepsis campaign, an initial bolus of 30 ml/kg over 30 - 60 minutes should be administered. Urine culture and sensitivity should be sent. Antibiotics shouldbe adjusted based on the results of these tests. A 26 year old male is scheduled for a lumbar laminectomy tomorrow. Penicil-lin causes a rash in this patient. His preoperative orders include cefazolin 2 gm IV to be given on call to the OR. The NP is called to change the antibiotic order due to the patients allergy. What is the best action for the NP to take?

Correct

Answer: There is a 5-8% cross allergy between pencilling and cephalosporins in

pa-tients that are allergic to penicillin. The most current literature indicates that patients with a Type 1 anaphylactic reaction to penicillin should not be given cephlosporins. Since this patient has a rash reaction, proceeding with the cefazolin order would be within the current recommendations. Some facilities

- Question 1

A 72 year old male is admitted to the hospital from his long term can facility after complaints of dyspnea and cough for 1 week. He was diagnosed with a COPD exacerbate and started on azithromycin. He has had little improvement after 3 days on this antibiotic. His past medical history includes hypertension, COPD, and hyperlipidemia. Current medications include lisinopril, atrovastatin, salmeterol, and albuterol inhaler. Current symptoms include fever, chills, productive cough, and worsening dyspnea. Current vital signs T 101.6 HR 92. RR 20 BP 138/82. O2 saturation is 96% on 4L of O Chest x-ray shows consolidation in the left lower lobe CBC and CMP are all within normal limits. How would you manage this patient?

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blood cultures and sputum culture and gram staining. Start patient on ciprofloxacin 500mg PO BID x7 days, piperacillin/tazobactam 3.375g Q6hrs x7, Vancomycin weight based dose IVq12hr x 7 days. Adjust antibiotics one culture and sensitivity report is finalized. Since this patient is transferred from another health care facility, he should betreated for health care acquired pneumonia (HAP). Initial treatment is empiric and very broad spectrum until patient specific culture and sensitivity results are available. Initial antibiotic coverage should include a 3 drug resume to cover multi drug resistant pathogens including pseudomonas and MRSA. Sample combinations to utilize would be:

• cefepine, meropenem, piperacillin/tazobactam, OR aztreonam PLUS
• ciprofloxin, levofloxacin, gentamicin, OR tobramycin PLUS
• vancomycin, linezolid, OR telavancin Once culture and sensitive results are available the 3 drug regime should bedeescalated and replaced with appropriate antibiotics. A 54 year old women is 7 days post op following a breast lump removal. She complains of pain, redness, and swelling around her left breast incision. She has a low grade temperature (99.6). The NP determines that she has a post operative wound infection. - Question 7 - Question 6

- Question 8 - Question 9 What antibiotics would be indicated to treat her infection?

Correct

Answer: Most^ post^ operative^ skin^ infections^ are^ caused^ by^ staphylococcus.

Cephalosporins have traditionally been utilized to treat these infections be- cause the penetrate skin tissue very well. If there is concern that MRSA is the causative agent, then Bactrim, doxycycline, or clindamycin should be utilized. Treatment should continue for a minimum of 10 days. Any drainage from the would should be sent for culture and sensitivity. A 16 year old male is admitted to the step down unit following laparotomy for appendici- tis. It was determined during surgery that the appendix had ruptured causing a perito- nitis. What antibiotics would be indicated to treat the peritonitis?

Correct

Answer: Initial^ antibiotics^ would^ include^ cefoxitin^ or^ piperacillin/tazobactam.

Antibiotics are con-tinued until the patient is afebrile and leukocytosis is corrected. For a more severe peritonitis, a carbapenems (such as Merrem) should be utilized. A 19 year old female presents with complaints of crampy abdominal pain. The pain has been present for about 7 days. She verifies unprotected sexual activity with multiple partners over the past 6 months. The pain is worse with movement and exercise. She has purulent vaginal discharge and a low grade temperature (99.6). PID is suspected and cultures have been sent off. What are the most common bacteria in this patient and how are they treated?

Correct

Answer: Approximately^ 50%^ of^ PID^ is^ causes^ by^ N.^ gonorrehea^ or^ C.^ trichmonas.

Other pathogens include Gardnerella vaginalis, Haemophilus influenzae, and anaerobes such as Peptococcus and Bacteroides. Treatment should begin immediately and should include empirical broad- spectrum antibiotics to cover the full range of common organisms. All regimens must be effective against C trachomatis and N gonorrhea. Patients on an intravenous (IV) PID regimen can be transitioned to oral antibiotics 24 hours after clinical improvement. These should be continued for a total of 14 days.