Clostridium difficile [klo-STRID-ee-um dif-uh-SEEL] is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis.
They are diseases that result from C. difficile infections such as Colitis, more serious instestinal conditions, sepsis, and rarely death.
C. difficile colonization
patient exhibits NO clinical symptoms
patient tests positive for C. difficile organism and/or its toxin
more common than C. difficile-associated disease
C. difficile-associated disease
patient exhibits clinical symptoms
patient tests positive for the C. difficile organism and/or its toxin
The risk for disease increases in patients with:
antibiotic exposure
gastrointestinal surgery/manipulation
long length of stay in healthcare settings
a serious underlying illness
immunocompromising conditions
advanced age
Stool culture for C. difficile: This is the most sensitive test available, but the one most often associated with false-positive results due to presence of non-toxigenic strains. Stool cultures for C. difficile also are labor intensive and require the appropriate culture environment to grow anaerobic microorganisms. Results are available within 48-96 hours of the test.
Antigen detection for C. difficile: These are rapid tests (<1 hr) that detect the presence of C. difficile antigen by latex agglutination or immunochromatographicassays. They must be combined with toxin testing to verify diagnosis.
Toxin testing for C. difficile*:
Enzyme immunoassay detects toxin A, toxin B, or both A and B. It is a same-day assay but less sensitive than the tissue culture cytotoxicity assay.
Tissue culture cytotoxicity assay detects toxin B only. This assay requires technical expertise to perform, is costly, and requires 24-48 hr for a final result. It does provide specific and sensitive results for C. difficile-associated disease.
C. difficile toxin is very unstable. The toxin degrades at room temperature and may be undetectable within 2 hours after collection of a stool specimen. False-negative results occur when specimens are not promptly tested or kept refrigerated until testing can be done.
TRANSMISSION
C. difficile is shed in feces. Any surface, device, or material (e.g., commodes, bathing tubs, and electronic rectal thermometers) that becomes contaminated with feces may serve as a reservoir for the C. difficile spores. C. difficile spores are transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item.
Symptoms include:
watery diarrhea (at least three bowel movements per day for two or more days)
fever
loss of appetite
nausea
abdominal pain/tenderness
C. difficile is generally treated for 10 days with antibiotics prescribed by your healthcare provider. The drugs are effective and appear to have few side-effects.
How is C. difficile-associated disease usually treated?
In 23% of patients, C. difficile-associated disease will resolve within 2-3 days of discontinuing the antibiotic to which the patient was previously exposed. The infection can usually be treated with an appropriate course (about 10 days) of antibiotics including metronidazole or vancomycin (administered orally). After treatment, repeat C. difficile testing is not recommended if the patients’ symptoms have resolved, as patients may remain colonized.
How can C. difficile-associated disease be prevented in hospitals and other healthcare settings?
Use antibiotics judiciously
Use Contact Precautions: for patients with known or suspected C. difficile-associated disease:
Place these patients in private rooms.If private rooms are not available, these patients can be placed in rooms (cohorted) with other patients with C. difficile-associated disease.
Perform Hand Hygiene using either an alcohol-based hand rub or soap and water.
If your institution experiences an outbreak, consider using only soap and water for hand hygiene when caring for patients with C. difficile-associated disease; alcohol-based hand rubs may not be as effective against spore-forming bacteria.
Use gloves when entering patients’ rooms and during patient care.
Use gowns if soiling of clothes is likely.
Dedicate equipment whenever possible.
CONTINUE THESE PRECAUTIONS UNTIL DIARRHEA CEASES
Implement an environmental cleaning and disinfection strategy:
Ensure adequate cleaning and disinfection of environmental surfaces and reusable devices, especially items likely to be contaminated with feces and surfaces that are touched frequently.
Use an Environmental Protection Agency (EPA)-registered hypochlorite-based disinfectant for environmental surface disinfection after cleaning in accordance with label instructions; generic sources of hypochlorite (e.g., household chlorine bleach) also may be appropriately diluted and used. (Note: alcohol-based disinfectants are not effective against C. difficile and should not be used to disinfect environmental surfaces.)
Follow the manufacturer’s instructions for disinfection of endoscopes and other devices
Infection control practices in long term care and home health settings are similar to those practices taken in traditional health-care settings.
People in good health usually don’t get C. difficile disease. People who have other illnesses or conditions requiring prolonged use of antibiotics and the elderly are at greater risk of acquiring this disease. The bacteria are found in the feces. People can become infected if they touch items or surfaces that are contaminated with feces and then touch their mouth or mucous membranes. Healthcare workers can spread the bacteria to other patients or contaminate surfaces through hand contact.
If you are infected you can spread the disease to others. However, only people that are hospitalized or on antibiotics are likely to become ill. For safety precautions you may do the following to reduce the chance of spread to others:
wash hands with soap and water, especially after using the restroom and before eating;
clean surfaces in bathrooms, kitchens and other areas on a regular basis with household detergent/disinfectants.
What can I use to clean and disinfect surfaces and devices to help control C. difficile?
Surfaces should be kept clean, and body substance spills should be managed promptly as outlined in CDC’s “Guidelines for Environmental Infection Control in Health-Care Facilities.” Hospital cleaning products can be used for routine cleaning. Hypochlorite-based disinfectants have been used with some success for environmental surface disinfection in those patient-care areas where surveillance and epidemiology indicate ongoing transmission of C. difficile. Consult the aforementioned guidelines for use conditions for generic sources of hypochlorite-based products (e.g., household chlorine bleach) for disinfection of environmental surfaces.
Note: EPA-registered hospital disinfectants are recommended for general use whenever possible in patient-care areas. At present there are no EPA-registered products with specific claims for inactivating C. difficile spores, but there are a number of registered products that contain hypochlorite. If an EPA-registered proprietary hypochlorite product is used, consult the label instructions for proper and safe use conditions.
Thursday, February 4, 2010
NCLEX-RN Topic 18: venlafaxine hydrochloride (Effexor XR)
venlafaxine hydrochloride
(Effexor‡, Effexor, Effexor XR )
Pharmacologic Class: selective serotonin and norepinephrine reuptake inhibitor (SNRI)
Therapeutic Class: antidepressant
Indications:
Depression
Generalized anxiety disorder
Panic disorder
Social anxiety disorder
Adjust-a-dose: For patients with renal impairment, reduce daily amount by 25%. For those undergoing hemodialysis, reduce daily amount by 50% and withhold dose until dialysis is completed. For patients with hepatic impairment, reduce daily amount by 50%.
To prevent major depressive disorder relapse
Action
May increase the amount of norepinephrine, serotonin, or both in the CNS by blocking their reuptake by the presynaptic neurons.
Adverse reactions
CNS: headache, suicidal behavior, somnolence, dizziness, nervousness, insomnia, anxiety, tremor, abnormal dreams, paresthesia, agitation, asthenia.
CV: hypertension, tachycardia, vasodilation.
EENT: blurred vision.
GI: nausea, constipation, vomiting, dry mouth, anorexia, diarrhea, dyspepsia, flatulence.
GU: abnormal ejaculation, impotence, urinary frequency, impaired urination.
Metabolic: weight loss.
Skin: diaphoresis, rash.
Other: yawning, chills, infection.
Interactions
Drug-drug
MAO inhibitors (MAOIs), such as phenelzine, selegiline, tranylcypromine: May cause serotonin syndrome. Avoid using within 14 days of MAOI therapy.
Tramadol: May cause serotonin syndrome. Monitor patient closely.
Triptans: May cause serotonin syndrome (restlessness, hallucinations, loss of coordination, fast heartbeat, rapid changes in blood pressure, increased body temperature, hyperreflexia, nausea, vomiting, and diarrhea). Use cautiously and with increased monitoring at the start of therapy and with dose increase.
Drug-herb
Yohimbe: May cause additive stimulation. Urge caution.
Contraindications & cautions
Contraindicated in patients hypersensitive to drug or within 14 days of MAOI therapy.
Use cautiously in patients with renal impairment, diseases or conditions that could affect hemodynamic responses or metabolism, and in those with history of mania or seizures.
Use in third trimester of pregnancy may be associated with neonatal complications at birth. Consider the risk versus benefit of treatment during this time.
Nursing considerations
Alert: Closely monitor patients being treated for depression for signs and symptoms of clinical worsening and suicidal ideation, especially at the beginning of therapy and with dosage adjustments. Symptoms may include agitation, insomnia, anxiety, aggressiveness, or panic attacks.
Alert: Drug may increase the risk of suicidal thinking and behavior in children and adolescents with major depressive disorder or other psychiatric disorder.
Carefully monitor blood pressure. Drug therapy may cause sustained, dose-dependent increases in blood pressure. Greatest increases (averaging about 7 mm Hg above baseline) occur in patients taking 375 mg daily.
Monitor patient's weight, particularly underweight, depressed patients.
Patient teaching
If medication is to be stopped, inform patient who has received drug for 6 weeks or longer that drug will be stopped gradually by tapering dosage over a 2-week period as instructed by prescriber. Patient shouldn't abruptly stop taking the drug.
Alert: Warn family members to closely monitor patient for signs of worsening condition or suicidal ideation.
Warn patient to avoid hazardous activities that require alertness and good coordination until effects of drug are known.
Tell patient to avoid alcohol and to consult prescriber before taking other prescription or OTC drugs.
Advise woman of childbearing age to contact prescriber if she becomes pregnant or intends to become pregnant during therapy or if she's breast-feeding.
NCLEX-RN Topic 17: diclofenac sodium (Voltaren XR)/diclofenac potassium (Cataflam)
diclofenac potassium
(Cataflam)
diclofenac sodium
(Fenac‡, Voltaren, Voltaren-XR, Voltaren Rapide†, Voltaren SR†)
Pharmacologic Class: NSAID
Therapeutic Class: antiarthritic; anti-inflammatory
Indications
Ankylosing spondylitis
Osteoarthritis
Rheumatoid arthritis
Action
May inhibit prostaglandin synthesis, to produce anti-inflammatory, analgesic, and antipyretic effects.
Adverse reactions
CNS: anxiety, depression, dizziness, drowsiness, insomnia, irritability, headache, aseptic meningitis.
CV: heart failure, hypertension, edema, fluid retention.
EENT: tinnitus, laryngeal edema, swelling of the lips and tongue, blurred vision, eye pain, night blindness, epistaxis, reversible hearing loss.
GI: abdominal pain or cramps, constipation, diarrhea, indigestion, nausea, abdominal distention, flatulence, taste disorder, peptic ulceration, bleeding, melena, bloody diarrhea, appetite change, colitis.
GU: proteinuria, acute renal failure, oliguria, interstitial nephritis, papillary necrosis, nephrotic syndrome, fluid retention.
Hepatic: jaundice, hepatitis, hepatotoxicity.
Metabolic: hypoglycemia, hyperglycemia.
Musculoskeletal: back, leg, or joint pain.
Respiratory: asthma.
Skin: rash, pruritus, urticaria, eczema, dermatitis, alopecia, photosensitivity reactions, bullous eruption, Stevens-Johnson syndrome, allergic purpura.
Other: anaphylaxis, anaphylactoid reactions, angioedema.
Interactions
Drug-drug
Anticoagulants, including warfarin: May cause bleeding. Monitor patient closely.
Aspirin: May decrease effectiveness of diclofenac and increase GI toxicity. Avoid using together.
Beta blockers: May decrease antihypertensive effects. Monitor patient closely.
Cyclosporine, digoxin, lithium, methotrexate: May reduce renal clearance of these drugs and increase risk of toxicity. Monitor patient closely.
Diuretics: May decrease effectiveness of diuretics. Avoid using together.
Insulin, oral antidiabetics: May alter requirements for antidiabetics. Monitor patient closely.
Potassium-sparing diuretics: May enhance retention and increase level of potassium. Monitor potassium level.
Drug-herb
Dong quai, feverfew, garlic, ginger, horse chestnut, red clover: May cause bleeding based on the known effects or components. Discourage use together.
White willow: Herb and drug contain similar components. Discourage use together.
Drug-lifestyle
Sun exposure: May cause photosensitivity reactions. Advise patient to avoid excessive sunlight exposure.
Effects on lab test results
May increase ALT, AST, bilirubin, BUN, and creatinine levels. May increase or decrease glucose level.
Contraindications & cautions
Contraindicated in patients hypersensitive to drug and in those with hepatic porphyria or history of asthma, urticaria, or other allergic reactions after taking aspirin or other NSAIDs.
Avoid using during late pregnancy or breast-feeding.
Use cautiously in patients with history of peptic ulcer disease, hepatic dysfunction, cardiac disease, hypertension, fluid retention, or impaired renal function.
Nursing considerations
Because NSAIDs impair the synthesis of renal prostaglandins, they can decrease renal blood flow and lead to reversible renal impairment, especially in patients with renal or heart failure or liver dysfunction, in elderly patients, and in those taking diuretics. Monitor these patients closely.
Liver function test values may increase during therapy. Monitor transaminase, especially ALT, levels periodically in patients undergoing long-term therapy. Make first transaminase measurement no later than 8 weeks after therapy begins.
Because of their antipyretic and anti-inflammatory actions, NSAIDs may mask the signs and symptoms of infection.
Serious GI toxicity, including peptic ulcers and bleeding, can occur in patient taking NSAIDs, despite lack of symptoms.
Look alike-sound alike: Don't confuse diclofenac with Diflucan.
Patient teaching
Tell patient to take drug with milk, meals, or antacids to minimize GI distress.
Instruct patient not to crush, break, or chew enteric-coated tablets.
Advise patient not to take this drug with any other diclofenac-containing products (such as Arthrotec).
Teach patient signs and symptoms of GI bleeding, including blood in vomit, urine, or stool; coffee-ground vomit; and black, tarry stool. Tell him to notify prescriber immediately if any of these occurs.
Teach patient the signs and symptoms of damage to the liver, including nausea, fatigue, lethargy, itching, yellowed skin or eyes, right upper quadrant tenderness, and flulike symptoms. Tell patient to contact prescriber immediately if these symptoms occur.
Advise patient to avoid consuming alcohol or aspirin during drug therapy.
Tell patient to wear sunscreen or protective clothing because drug may cause sensitivity to sunlight.
Warn patient to avoid hazardous activities that require alertness until it is known whether the drug causes CNS symptoms.
Tell pregnant woman to avoid use of drug during last trimester.
Advise patient that use of OTC NSAIDs and diclofenac may increase the risk of GI toxicity.
(Cataflam)
diclofenac sodium
(Fenac‡, Voltaren, Voltaren-XR, Voltaren Rapide†, Voltaren SR†)
Pharmacologic Class: NSAID
Therapeutic Class: antiarthritic; anti-inflammatory
Indications
Ankylosing spondylitis
Osteoarthritis
Rheumatoid arthritis
Action
May inhibit prostaglandin synthesis, to produce anti-inflammatory, analgesic, and antipyretic effects.
Adverse reactions
CNS: anxiety, depression, dizziness, drowsiness, insomnia, irritability, headache, aseptic meningitis.
CV: heart failure, hypertension, edema, fluid retention.
EENT: tinnitus, laryngeal edema, swelling of the lips and tongue, blurred vision, eye pain, night blindness, epistaxis, reversible hearing loss.
GI: abdominal pain or cramps, constipation, diarrhea, indigestion, nausea, abdominal distention, flatulence, taste disorder, peptic ulceration, bleeding, melena, bloody diarrhea, appetite change, colitis.
GU: proteinuria, acute renal failure, oliguria, interstitial nephritis, papillary necrosis, nephrotic syndrome, fluid retention.
Hepatic: jaundice, hepatitis, hepatotoxicity.
Metabolic: hypoglycemia, hyperglycemia.
Musculoskeletal: back, leg, or joint pain.
Respiratory: asthma.
Skin: rash, pruritus, urticaria, eczema, dermatitis, alopecia, photosensitivity reactions, bullous eruption, Stevens-Johnson syndrome, allergic purpura.
Other: anaphylaxis, anaphylactoid reactions, angioedema.
Interactions
Drug-drug
Anticoagulants, including warfarin: May cause bleeding. Monitor patient closely.
Aspirin: May decrease effectiveness of diclofenac and increase GI toxicity. Avoid using together.
Beta blockers: May decrease antihypertensive effects. Monitor patient closely.
Cyclosporine, digoxin, lithium, methotrexate: May reduce renal clearance of these drugs and increase risk of toxicity. Monitor patient closely.
Diuretics: May decrease effectiveness of diuretics. Avoid using together.
Insulin, oral antidiabetics: May alter requirements for antidiabetics. Monitor patient closely.
Potassium-sparing diuretics: May enhance retention and increase level of potassium. Monitor potassium level.
Drug-herb
Dong quai, feverfew, garlic, ginger, horse chestnut, red clover: May cause bleeding based on the known effects or components. Discourage use together.
White willow: Herb and drug contain similar components. Discourage use together.
Drug-lifestyle
Sun exposure: May cause photosensitivity reactions. Advise patient to avoid excessive sunlight exposure.
Effects on lab test results
May increase ALT, AST, bilirubin, BUN, and creatinine levels. May increase or decrease glucose level.
Contraindications & cautions
Contraindicated in patients hypersensitive to drug and in those with hepatic porphyria or history of asthma, urticaria, or other allergic reactions after taking aspirin or other NSAIDs.
Avoid using during late pregnancy or breast-feeding.
Use cautiously in patients with history of peptic ulcer disease, hepatic dysfunction, cardiac disease, hypertension, fluid retention, or impaired renal function.
Nursing considerations
Because NSAIDs impair the synthesis of renal prostaglandins, they can decrease renal blood flow and lead to reversible renal impairment, especially in patients with renal or heart failure or liver dysfunction, in elderly patients, and in those taking diuretics. Monitor these patients closely.
Liver function test values may increase during therapy. Monitor transaminase, especially ALT, levels periodically in patients undergoing long-term therapy. Make first transaminase measurement no later than 8 weeks after therapy begins.
Because of their antipyretic and anti-inflammatory actions, NSAIDs may mask the signs and symptoms of infection.
Serious GI toxicity, including peptic ulcers and bleeding, can occur in patient taking NSAIDs, despite lack of symptoms.
Look alike-sound alike: Don't confuse diclofenac with Diflucan.
Patient teaching
Tell patient to take drug with milk, meals, or antacids to minimize GI distress.
Instruct patient not to crush, break, or chew enteric-coated tablets.
Advise patient not to take this drug with any other diclofenac-containing products (such as Arthrotec).
Teach patient signs and symptoms of GI bleeding, including blood in vomit, urine, or stool; coffee-ground vomit; and black, tarry stool. Tell him to notify prescriber immediately if any of these occurs.
Teach patient the signs and symptoms of damage to the liver, including nausea, fatigue, lethargy, itching, yellowed skin or eyes, right upper quadrant tenderness, and flulike symptoms. Tell patient to contact prescriber immediately if these symptoms occur.
Advise patient to avoid consuming alcohol or aspirin during drug therapy.
Tell patient to wear sunscreen or protective clothing because drug may cause sensitivity to sunlight.
Warn patient to avoid hazardous activities that require alertness until it is known whether the drug causes CNS symptoms.
Tell pregnant woman to avoid use of drug during last trimester.
Advise patient that use of OTC NSAIDs and diclofenac may increase the risk of GI toxicity.
NCLEX-RN Topic 16: Selegine (Eldepryl, Zelapar)
Eldepryl
Generic Name: selegiline (oral) (se LE ji leen)
Brand Names: Eldepryl, Zelapar
Eldepryl prevents the breakdown of a chemical in your brain called dopamine (DO pa meen). Low levels of this chemical are associated with Parkinson's disease.
Eldepryl is used together with other medicines to treat symptoms of Parkinson's disease.
IMPORTANT INFORMATION
There are many other medicines that can cause serious medical problems if you take them together with Eldepryl. Tell your doctor about all other prescription and over-the-counter medications you use, including vitamins, minerals, and herbal products.
While taking Eldepryl, do not drink alcohol or eat foods that are high in tyramine. Eating tyramine while you are using Eldepryl can raise your blood pressure to dangerous levels and cause life-threatening symptoms.
You should become very familiar with the list of foods to avoid while you are using Eldepryl.
Do not stop taking Eldepryl suddenly or you may have harmful side effects. Keep taking the medicine as prescribed. Talk with your doctor before stopping the medication.
You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medication. Talk with your doctor if you believe you have any intense or unusual urges while taking Eldepryl.
Do not use Eldepryl if you are allergic to selegiline, or if you have used any of the following drugs within the past 14 days:
• cough or cold medicine that contains dextromethorphan;
• meperidine (Demerol), propoxyphene (Darvon, Darvocet), or tramadol (Ultram, Ultracet);
• methadone (Dolophine, Methadose); or
• other MAO inhibitors such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or transdermal selegiline (Emsam).
After you stop taking Eldepryl, you must wait at least 14 days before taking any of the medications listed above.
Before using this medicine, tell your doctor if you have kidney disease, liver disease, heart disease, high or low blood pressure, or a seizure disorder. If you have any of these conditions, you may not be able to use Eldepryl, or you may need a dosage adjustment or special tests during treatment.
FDA pregnancy category C. It is not known whether this medication is harmful to an unborn baby. Before you take Eldepryl, tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether selegiline passes into breast milk or if it could harm a nursing baby. Do not take Eldepryl without telling your doctor if you are breast-feeding a baby
Zelapar disintegrating tablets may contain phenylalanine. Talk to your doctor before using this form of selegiline if you have phenylketonuria (PKU).
Generic Name: selegiline (oral) (se LE ji leen)
Brand Names: Eldepryl, Zelapar
Eldepryl prevents the breakdown of a chemical in your brain called dopamine (DO pa meen). Low levels of this chemical are associated with Parkinson's disease.
Eldepryl is used together with other medicines to treat symptoms of Parkinson's disease.
IMPORTANT INFORMATION
There are many other medicines that can cause serious medical problems if you take them together with Eldepryl. Tell your doctor about all other prescription and over-the-counter medications you use, including vitamins, minerals, and herbal products.
While taking Eldepryl, do not drink alcohol or eat foods that are high in tyramine. Eating tyramine while you are using Eldepryl can raise your blood pressure to dangerous levels and cause life-threatening symptoms.
You should become very familiar with the list of foods to avoid while you are using Eldepryl.
Do not stop taking Eldepryl suddenly or you may have harmful side effects. Keep taking the medicine as prescribed. Talk with your doctor before stopping the medication.
You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medication. Talk with your doctor if you believe you have any intense or unusual urges while taking Eldepryl.
Do not use Eldepryl if you are allergic to selegiline, or if you have used any of the following drugs within the past 14 days:
• cough or cold medicine that contains dextromethorphan;
• meperidine (Demerol), propoxyphene (Darvon, Darvocet), or tramadol (Ultram, Ultracet);
• methadone (Dolophine, Methadose); or
• other MAO inhibitors such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or transdermal selegiline (Emsam).
After you stop taking Eldepryl, you must wait at least 14 days before taking any of the medications listed above.
Before using this medicine, tell your doctor if you have kidney disease, liver disease, heart disease, high or low blood pressure, or a seizure disorder. If you have any of these conditions, you may not be able to use Eldepryl, or you may need a dosage adjustment or special tests during treatment.
FDA pregnancy category C. It is not known whether this medication is harmful to an unborn baby. Before you take Eldepryl, tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether selegiline passes into breast milk or if it could harm a nursing baby. Do not take Eldepryl without telling your doctor if you are breast-feeding a baby
Zelapar disintegrating tablets may contain phenylalanine. Talk to your doctor before using this form of selegiline if you have phenylketonuria (PKU).
Monday, February 1, 2010
NCLEX-RN Topic 15: VRE
What is VRE (vancomycin-resistant enterococci)?
• Enterococci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections.
• Vancomycin is an antibiotic that is often used to treat infections caused by enterococci. In some cases, enterococci have become resistant to vancomycin and are called vancomycin-resistant enterococci or VRE. Most VRE infections occur in people in hospitals.
What types of infections does VRE cause?
• VRE can live in the human intestines and female genital tract without causing disease (often called colonization). However, sometimes, it can be the cause infections of the urinary tract, the bloodstream or of wounds.
Are certain people at risk of getting VRE?
• The following persons are at an increased risk becoming infected with VRE:
• People who have been previously treated with the antibiotic vancomycin or other antibiotics for long periods of time.
• People who are hospitalized, particularly when they receive antibiotic treatment for long periods of time
• People with weakened immune systems such as patients in Intensive Care Units, or in cancer or transplant wards
• People who have undergone surgical procedures such as abdominal or chest surgery
• People with medical devices that stay in for some time such as urinary catheters or central intravenous (IV) catheters.
• People who are colonized with VRE
How common is VRE?
• Information collected by the Centers for Disease Control and Prevention during 2006 and 2007 showed that enterococci caused about 1 of every 8 infections in hospitals and only about 30% of these are VRE. VRE can be more common in certain groups of people such as those with weakened immune systems.
What is the treatment for VRE?
• People who are colonized (bacteria are present, but have no symptoms of an infection) with VRE do not usually need treatment.
• Most VRE infections can be treated with antibiotics other than vancomycin. Laboratory testing of the VRE can determine which antibiotics will work. For people who get VRE infections in their bladder and have urinary catheters, removal of the catheter when it is no longer needed can also help get rid of the infection.
How is VRE spread?
• VRE is often passed from person to person by the hands of caregivers.
o VRE can get onto a caregiver's hands after they have contact with other people with VRE or after contact with contaminated surfaces. VRE can also be spread directly to people after they touch surfaces that are contaminated with VRE. VRE is not usually spread through the air by coughing or sneezing.
How can I prevent the spread of VRE?
• If you or someone in your household has VRE, the following are some things you can do to prevent the spread of VRE:
• Keep your hands clean. Always wash your hands thoroughly after using the bathroom and before preparing food. Clean your hands after contact with persons who have VRE. Wash with soap and water (particularly when visibly soiled) or use alcohol-based hand rubs.
• Frequently clean areas of your home such as your bathroom that may become contaminated with VRE.
• Wear gloves if you may come in contact with body fluids that may contain VRE, such as stool or bandages from infected wounds. Always wash your hands after removing gloves.
• If you have VRE, be sure to tell healthcare providers caring for you that you have VRE so that they are aware of your infection. Healthcare facilities use special precautions to help prevent the spread of VRE to others.
• Enterococci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections.
• Vancomycin is an antibiotic that is often used to treat infections caused by enterococci. In some cases, enterococci have become resistant to vancomycin and are called vancomycin-resistant enterococci or VRE. Most VRE infections occur in people in hospitals.
What types of infections does VRE cause?
• VRE can live in the human intestines and female genital tract without causing disease (often called colonization). However, sometimes, it can be the cause infections of the urinary tract, the bloodstream or of wounds.
Are certain people at risk of getting VRE?
• The following persons are at an increased risk becoming infected with VRE:
• People who have been previously treated with the antibiotic vancomycin or other antibiotics for long periods of time.
• People who are hospitalized, particularly when they receive antibiotic treatment for long periods of time
• People with weakened immune systems such as patients in Intensive Care Units, or in cancer or transplant wards
• People who have undergone surgical procedures such as abdominal or chest surgery
• People with medical devices that stay in for some time such as urinary catheters or central intravenous (IV) catheters.
• People who are colonized with VRE
How common is VRE?
• Information collected by the Centers for Disease Control and Prevention during 2006 and 2007 showed that enterococci caused about 1 of every 8 infections in hospitals and only about 30% of these are VRE. VRE can be more common in certain groups of people such as those with weakened immune systems.
What is the treatment for VRE?
• People who are colonized (bacteria are present, but have no symptoms of an infection) with VRE do not usually need treatment.
• Most VRE infections can be treated with antibiotics other than vancomycin. Laboratory testing of the VRE can determine which antibiotics will work. For people who get VRE infections in their bladder and have urinary catheters, removal of the catheter when it is no longer needed can also help get rid of the infection.
How is VRE spread?
• VRE is often passed from person to person by the hands of caregivers.
o VRE can get onto a caregiver's hands after they have contact with other people with VRE or after contact with contaminated surfaces. VRE can also be spread directly to people after they touch surfaces that are contaminated with VRE. VRE is not usually spread through the air by coughing or sneezing.
How can I prevent the spread of VRE?
• If you or someone in your household has VRE, the following are some things you can do to prevent the spread of VRE:
• Keep your hands clean. Always wash your hands thoroughly after using the bathroom and before preparing food. Clean your hands after contact with persons who have VRE. Wash with soap and water (particularly when visibly soiled) or use alcohol-based hand rubs.
• Frequently clean areas of your home such as your bathroom that may become contaminated with VRE.
• Wear gloves if you may come in contact with body fluids that may contain VRE, such as stool or bandages from infected wounds. Always wash your hands after removing gloves.
• If you have VRE, be sure to tell healthcare providers caring for you that you have VRE so that they are aware of your infection. Healthcare facilities use special precautions to help prevent the spread of VRE to others.
NCLEX-RN Topic 14: MRSA
What is MRSA (methicillin-resistant Staphylococcus aureus)?
• Some staph bacteria are resistant to antibiotics.
• MRSA is a type of staph that is resistant to antibiotics called beta-lactams.
o Beta-lactam antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin.
• While 25% to 30% of the population is colonized with staph, approximately 1% is colonized with MRSA.
Who gets staph or MRSA infections?
• Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems.
• These healthcare-associated staph infections include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia.
What is community-associated MRSA (CA-MRSA)?
• Staph and MRSA can also cause illness in persons outside of hospitals and healthcare facilities.
• MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA infections.
• Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.
How common are staph and MRSA infections?
• Staph bacteria are one of the most common causes of skin infection in the United States and are a common cause of pneumonia, surgical wound infections, and bloodstream infections.
• The majority of MRSA infections occur among patients in hospitals or other healthcare settings; however, it is becoming more common in the community setting.
• Data from a prospective study in 2003, suggests that 12% of clinical MRSA infections are community-associated, but this varies by geographic region and population.
What does a staph or MRSA infection look like?
• Staph bacteria, including MRSA, can cause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage.
• More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections.
Are certain people at increased risk for community-associated staph or MRSA infections?
• CDC has investigated clusters of CA-MRSA skin infections among athletes, military recruits, children, Pacific Islanders, Alaskan Natives, Native Americans, men who have sex with men, and prisoners.
o Factors that have been associated with the spread of MRSA skin infections include: close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions, and poor hygiene.
How can I prevent staph or MRSA skin infections?
• Practice good hygiene:
1. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
2. Keep cuts and scrapes clean and covered with a bandage until healed.
3. Avoid contact with other people’s wounds or bandages.
4. Avoid sharing personal items such as towels or razors.
Are people who are positive for the human immune deficiency virus (HIV) at increased risk for MRSA? Should they be taking special precautions?
• People with weakened immune systems, which include some patients with HIV infection, may be at risk for more severe illness if they get infected with MRSA.
• People with HIV should follow the same prevention measures as those without HIV to prevent staph infections, including practice good hygiene, cover wounds (e.g., cuts or abrasions) with clean dry bandages, avoid sharing personal items such as towels and razors, and contact their doctor if they think they have an infection.
Can I get a staph or MRSA infection at my health club?
• In the outbreaks of MRSA, the environment has not played a significant role in the transmission of MRSA.
• MRSA is transmitted most frequently by direct skin-to-skin contact.
o You can protect yourself from infections by practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using an alcohol-based hand rub and showering after working out); covering any open skin area such as abrasions or cuts with a clean dry bandage; avoiding sharing personal items such as towels or razors; using a barrier (e.g., clothing or a towel) between your skin and shared equipment; and wiping surfaces of equipment before and after use.
Are staph and MRSA infections treatable?
• Yes. Most staph and MRSA infections are treatable with antibiotics. If you are given an antibiotic, take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time.
• However, many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider.
• If after visiting your healthcare provider the infection is not getting better after a few days, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.
Is it possible that my staph or MRSA skin infection will come back after it is cured?
• Yes. It is possible to have a staph or MRSA skin infection come back (recur) after it is cured. To prevent this from happening, follow your healthcare provider’s directions while you have the infection, and follow the prevention steps after the infection is gone.
If I have a staph, or MRSA skin infection, what can I do to prevent others from getting infected?
• You can prevent spreading staph or MRSA skin infections to others by following these steps:
1. Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages until healed. Follow your healthcare provider's instructions on proper care of the wound. Pus from infected wounds can contain staph, including MRSA, so keeping the infection covered will help prevent the spread to others. Bandages and tape can be discarded with the regular trash.
2. Clean your hands. You, your family, and others in close contact should wash their hands frequently with soap and water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound.
3. Do not share personal items. Avoid sharing personal items, such as towels, washcloths, razors, clothing, or uniforms, that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Use a dryer to dry clothes completely.
4. Talk to your doctor. Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection
• Some staph bacteria are resistant to antibiotics.
• MRSA is a type of staph that is resistant to antibiotics called beta-lactams.
o Beta-lactam antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin.
• While 25% to 30% of the population is colonized with staph, approximately 1% is colonized with MRSA.
Who gets staph or MRSA infections?
• Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems.
• These healthcare-associated staph infections include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia.
What is community-associated MRSA (CA-MRSA)?
• Staph and MRSA can also cause illness in persons outside of hospitals and healthcare facilities.
• MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA infections.
• Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.
How common are staph and MRSA infections?
• Staph bacteria are one of the most common causes of skin infection in the United States and are a common cause of pneumonia, surgical wound infections, and bloodstream infections.
• The majority of MRSA infections occur among patients in hospitals or other healthcare settings; however, it is becoming more common in the community setting.
• Data from a prospective study in 2003, suggests that 12% of clinical MRSA infections are community-associated, but this varies by geographic region and population.
What does a staph or MRSA infection look like?
• Staph bacteria, including MRSA, can cause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage.
• More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections.
Are certain people at increased risk for community-associated staph or MRSA infections?
• CDC has investigated clusters of CA-MRSA skin infections among athletes, military recruits, children, Pacific Islanders, Alaskan Natives, Native Americans, men who have sex with men, and prisoners.
o Factors that have been associated with the spread of MRSA skin infections include: close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions, and poor hygiene.
How can I prevent staph or MRSA skin infections?
• Practice good hygiene:
1. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
2. Keep cuts and scrapes clean and covered with a bandage until healed.
3. Avoid contact with other people’s wounds or bandages.
4. Avoid sharing personal items such as towels or razors.
Are people who are positive for the human immune deficiency virus (HIV) at increased risk for MRSA? Should they be taking special precautions?
• People with weakened immune systems, which include some patients with HIV infection, may be at risk for more severe illness if they get infected with MRSA.
• People with HIV should follow the same prevention measures as those without HIV to prevent staph infections, including practice good hygiene, cover wounds (e.g., cuts or abrasions) with clean dry bandages, avoid sharing personal items such as towels and razors, and contact their doctor if they think they have an infection.
Can I get a staph or MRSA infection at my health club?
• In the outbreaks of MRSA, the environment has not played a significant role in the transmission of MRSA.
• MRSA is transmitted most frequently by direct skin-to-skin contact.
o You can protect yourself from infections by practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using an alcohol-based hand rub and showering after working out); covering any open skin area such as abrasions or cuts with a clean dry bandage; avoiding sharing personal items such as towels or razors; using a barrier (e.g., clothing or a towel) between your skin and shared equipment; and wiping surfaces of equipment before and after use.
Are staph and MRSA infections treatable?
• Yes. Most staph and MRSA infections are treatable with antibiotics. If you are given an antibiotic, take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time.
• However, many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider.
• If after visiting your healthcare provider the infection is not getting better after a few days, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.
Is it possible that my staph or MRSA skin infection will come back after it is cured?
• Yes. It is possible to have a staph or MRSA skin infection come back (recur) after it is cured. To prevent this from happening, follow your healthcare provider’s directions while you have the infection, and follow the prevention steps after the infection is gone.
If I have a staph, or MRSA skin infection, what can I do to prevent others from getting infected?
• You can prevent spreading staph or MRSA skin infections to others by following these steps:
1. Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages until healed. Follow your healthcare provider's instructions on proper care of the wound. Pus from infected wounds can contain staph, including MRSA, so keeping the infection covered will help prevent the spread to others. Bandages and tape can be discarded with the regular trash.
2. Clean your hands. You, your family, and others in close contact should wash their hands frequently with soap and water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound.
3. Do not share personal items. Avoid sharing personal items, such as towels, washcloths, razors, clothing, or uniforms, that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Use a dryer to dry clothes completely.
4. Talk to your doctor. Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection
Tuesday, January 19, 2010
NCLEX-RN Topic 13: Indomethacin (Indocin)
indomethacin (Apo-Indomethacin†, Arthrexin‡, Indocid‡†, Indocid SR†, Indocin, Indocin SR, Novo-Methacin†)
Pharmacologic Class: NSAID
Therapeutic Class: nonopioid analgesic; antipyretic; anti-inflammatory
Indications & dosages
Moderate to severe rheumatoid arthritis or osteoarthritis, ankylosing spondylitis; Acute gouty arthritis; Acute painful shoulders (bursitis or tendinitis)
Adverse reactions
P.O. and P.R.
CNS: headache, dizziness, depression, drowsiness, confusion, somnolence, fatigue, peripheral neuropathy, psychic disturbances, syncope, vertigo.
CV: hypertension, edema.
EENT: hearing loss, tinnitus.
GI: nausea, anorexia, diarrhea, abdominal pain, peptic ulceration, GI bleeding, constipation, dyspepsia, pancreatitis.
GU: hematuria.
Hematologic: iron-deficiency anemia.
Metabolic: hyperkalemia.
Skin: pruritus, urticaria, Stevens-Johnson syndrome.
Other: hypersensitivity reactions.
GU: hematuria, proteinuria, interstitial nephritis.
Interactions
Drug-drug
Aminoglycosides, cyclosporine, methotrexate: May enhance toxicity of these drugs. Avoid using together.
Anticoagulants: May cause bleeding. Monitor patient closely.
Antihypertensives: May decrease antihypertensive effect. Monitor patient closely.
Antihypertensives, furosemide, thiazide diuretics: May impair response to both drugs. Avoid using together, if possible.
Aspirin: May decrease level of indomethacin. Avoid using together.
Aspirin, corticosteroids: May increase risk of GI toxicity. Avoid using together.
Bisphosphonates: May increase risk of gastric ulceration. Monitor patient for symptoms of gastric irritation or GI bleeding.
Diflunisal, probenecid: May decrease indomethacin excretion. Watch for increased indomethacin adverse reactions.
Digoxin: May prolong half-life of digoxin. Use together cautiously.
Dipyridamole: May enhance fluid retention. Avoid using together.
Lithium: May increase lithium level. Monitor patient for toxicity.
Penicillamine: May increase bioavailability of penicillamine. Monitor patient closely.
Phenytoin: May increase phenytoin level. Monitor patient closely.
Triamterene: May cause nephrotoxicity. Avoid using together.
Drug-herb
Dong quai, feverfew, garlic, ginger, horse chestnut, red clover: May cause bleeding. Discourage use together.
Senna: May inhibit diarrheal effects. Discourage use together.
White willow: Herb and drug contain similar components. Discourage use together.
Drug-lifestyle
Alcohol use: May cause GI toxicity. Discourage use together.
Effects on lab test results
May increase potassium level. May decrease hemoglobin level and hematocrit.
May increase liver function test values.
May cause positive direct Coombs test results.
Contraindications & cautions
Contraindicated in patients hypersensitive to drug and in those with a history of aspirin- or NSAID-induced asthma, rhinitis, or urticaria.
Contraindicated in pregnant or breast-feeding women and in neonates with untreated infection, active bleeding, coagulation defects or thrombocytopenia, congenital heart disease needing patency of the ductus arteriosus, necrotizing enterocolitis, or significant renal impairment. Suppositories are contraindicated in patients with history of proctitis or recent rectal bleeding.
Contraindicated in pregnant women.
Use cautiously in elderly patients, those with history of GI disease, and those with epilepsy, parkinsonism, hepatic or renal disease, CV disease, infection, and mental illness or depression.
Nursing considerations
Because of the high risk of adverse effects from long-term use, drug shouldn't be used routinely as an analgesic or antipyretic.
Sustained-release capsules shouldn't be used for acute gouty arthritis.
Give oral dose with food, milk, or antacid to decrease GI upset.
If ductus arteriosus reopens, a second course of one to three doses may be given. If ineffective, surgery may be needed.
Watch for bleeding in patients receiving anticoagulants, patients with coagulation defects, and neonates.
Because NSAIDs impair synthesis of renal prostaglandins, they can decrease renal blood flow and lead to reversible renal impairment, especially in patients with renal failure, heart failure, or liver dysfunction; in elderly patients; and in those taking diuretics. Monitor these patients closely.
Drug causes sodium retention; watch for weight gain (especially in elderly patients) and increased blood pressure in patients with hypertension.
Monitor patient for rash and respiratory distress, which may indicate a hypersensitivity reaction.
Because of their antipyretic and anti-inflammatory actions, NSAIDs may mask signs and symptoms of infection.
Serious GI toxicity (including peptic ulcers and bleeding) can occur in patient taking NSAIDs, despite lack of symptoms.
NSAIDs may cause increased risk of thrombotic events, MI, and stroke. Risk may be increased with duration of use and in patients with history of cardiovascular disease or risk factors of cardiovascular disease.
Monitor patient on long-term oral therapy for toxicity by conducting regular eye examinations, hearing tests, CBCs, and kidney function tests.
Patient teaching
Tell patient to take oral drug with food, milk, or antacid to prevent GI upset.
Alert patient that using oral form with aspirin, alcohol, other NSAIDs, or corticosteroids may increase risk of adverse GI reactions.
Teach patient signs and symptoms of GI bleeding, including blood in vomit, urine, or stool; coffee-ground vomit; and black, tarry stool. Tell him to notify prescriber immediately if any of these occurs.
Tell patient to immediately report signs or symptoms of cardiac events, such as chest pain, shortness of breath, weakness, and slurred speech.
Warn patient to avoid hazardous activities that require mental alertness until CNS effects are known.
Tell patient to notify prescriber immediately if visual or hearing changes occur
Pharmacologic Class: NSAID
Therapeutic Class: nonopioid analgesic; antipyretic; anti-inflammatory
Indications & dosages
Moderate to severe rheumatoid arthritis or osteoarthritis, ankylosing spondylitis; Acute gouty arthritis; Acute painful shoulders (bursitis or tendinitis)
Adverse reactions
P.O. and P.R.
CNS: headache, dizziness, depression, drowsiness, confusion, somnolence, fatigue, peripheral neuropathy, psychic disturbances, syncope, vertigo.
CV: hypertension, edema.
EENT: hearing loss, tinnitus.
GI: nausea, anorexia, diarrhea, abdominal pain, peptic ulceration, GI bleeding, constipation, dyspepsia, pancreatitis.
GU: hematuria.
Hematologic: iron-deficiency anemia.
Metabolic: hyperkalemia.
Skin: pruritus, urticaria, Stevens-Johnson syndrome.
Other: hypersensitivity reactions.
GU: hematuria, proteinuria, interstitial nephritis.
Interactions
Drug-drug
Aminoglycosides, cyclosporine, methotrexate: May enhance toxicity of these drugs. Avoid using together.
Anticoagulants: May cause bleeding. Monitor patient closely.
Antihypertensives: May decrease antihypertensive effect. Monitor patient closely.
Antihypertensives, furosemide, thiazide diuretics: May impair response to both drugs. Avoid using together, if possible.
Aspirin: May decrease level of indomethacin. Avoid using together.
Aspirin, corticosteroids: May increase risk of GI toxicity. Avoid using together.
Bisphosphonates: May increase risk of gastric ulceration. Monitor patient for symptoms of gastric irritation or GI bleeding.
Diflunisal, probenecid: May decrease indomethacin excretion. Watch for increased indomethacin adverse reactions.
Digoxin: May prolong half-life of digoxin. Use together cautiously.
Dipyridamole: May enhance fluid retention. Avoid using together.
Lithium: May increase lithium level. Monitor patient for toxicity.
Penicillamine: May increase bioavailability of penicillamine. Monitor patient closely.
Phenytoin: May increase phenytoin level. Monitor patient closely.
Triamterene: May cause nephrotoxicity. Avoid using together.
Drug-herb
Dong quai, feverfew, garlic, ginger, horse chestnut, red clover: May cause bleeding. Discourage use together.
Senna: May inhibit diarrheal effects. Discourage use together.
White willow: Herb and drug contain similar components. Discourage use together.
Drug-lifestyle
Alcohol use: May cause GI toxicity. Discourage use together.
Effects on lab test results
May increase potassium level. May decrease hemoglobin level and hematocrit.
May increase liver function test values.
May cause positive direct Coombs test results.
Contraindications & cautions
Contraindicated in patients hypersensitive to drug and in those with a history of aspirin- or NSAID-induced asthma, rhinitis, or urticaria.
Contraindicated in pregnant or breast-feeding women and in neonates with untreated infection, active bleeding, coagulation defects or thrombocytopenia, congenital heart disease needing patency of the ductus arteriosus, necrotizing enterocolitis, or significant renal impairment. Suppositories are contraindicated in patients with history of proctitis or recent rectal bleeding.
Contraindicated in pregnant women.
Use cautiously in elderly patients, those with history of GI disease, and those with epilepsy, parkinsonism, hepatic or renal disease, CV disease, infection, and mental illness or depression.
Nursing considerations
Because of the high risk of adverse effects from long-term use, drug shouldn't be used routinely as an analgesic or antipyretic.
Sustained-release capsules shouldn't be used for acute gouty arthritis.
Give oral dose with food, milk, or antacid to decrease GI upset.
If ductus arteriosus reopens, a second course of one to three doses may be given. If ineffective, surgery may be needed.
Watch for bleeding in patients receiving anticoagulants, patients with coagulation defects, and neonates.
Because NSAIDs impair synthesis of renal prostaglandins, they can decrease renal blood flow and lead to reversible renal impairment, especially in patients with renal failure, heart failure, or liver dysfunction; in elderly patients; and in those taking diuretics. Monitor these patients closely.
Drug causes sodium retention; watch for weight gain (especially in elderly patients) and increased blood pressure in patients with hypertension.
Monitor patient for rash and respiratory distress, which may indicate a hypersensitivity reaction.
Because of their antipyretic and anti-inflammatory actions, NSAIDs may mask signs and symptoms of infection.
Serious GI toxicity (including peptic ulcers and bleeding) can occur in patient taking NSAIDs, despite lack of symptoms.
NSAIDs may cause increased risk of thrombotic events, MI, and stroke. Risk may be increased with duration of use and in patients with history of cardiovascular disease or risk factors of cardiovascular disease.
Monitor patient on long-term oral therapy for toxicity by conducting regular eye examinations, hearing tests, CBCs, and kidney function tests.
Patient teaching
Tell patient to take oral drug with food, milk, or antacid to prevent GI upset.
Alert patient that using oral form with aspirin, alcohol, other NSAIDs, or corticosteroids may increase risk of adverse GI reactions.
Teach patient signs and symptoms of GI bleeding, including blood in vomit, urine, or stool; coffee-ground vomit; and black, tarry stool. Tell him to notify prescriber immediately if any of these occurs.
Tell patient to immediately report signs or symptoms of cardiac events, such as chest pain, shortness of breath, weakness, and slurred speech.
Warn patient to avoid hazardous activities that require mental alertness until CNS effects are known.
Tell patient to notify prescriber immediately if visual or hearing changes occur
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