NUR 431 exam 1 2022 with complete solutions

antimicrobial drugs that work on many different organisms (bacteria, viruses, fungi, protozoa, helminths) antibiotic subcategory of antimicrobial that can kill or inhibit growth of bacteria 00:03 01:08 bacteriostatic slow or inhibit the growth of bacteria bactericidal kill bacteria super infection infection that occurs because of or during treatment of primary infection, different microbe or resistant microbe prophylactic antibiotic use surgical procedures: orthopedic, cardiac, abd dental procedures in pts high risk for endocarditis: prosthetic valve, hip, knee replacement immunocompromised: neutropenia- HIV, chemo, immunosuppression opportunistic infection organism takes advantage of opportunity that isnt normally there weakened immune system, altered microbiome, breached integumentary system organisms cause no infection in healthy host injury short period of vasoconstriction: helps to stop bleeding, prevents movement of invading organisms prolonged vasodilation: increased blood flow, brings immune cells, contributes to inflammation serous white/yellow serosanguinous pink fibrinous increased protein, clumpy/stringy purulent pus, increased debris from cells and tissues hemmorhagic frank blood transudative pleural effusion occurs due to increased hydrostatic pressure or low plasma oncotic pressure CHF, cirrhosis, nephrotic syndrome, PE, hypoalbuminemia low in protein and ldh exudative pleural effusion occurs due to inflammation and increased capillary permeability pneumonia, cancer, TB, viral infection, PE, autoimmune high in protein and ldh systemic process total body response simulation of hypothalamic fever set point interleukins and tumor necrosis factor nosocomial infection infections that occur within healthcare facilities increased virulence of organisms incresed temp=increased metabolic rate (not good for cardiac pts) antimicrobial considerations -community vs hospital acquired -site of infection -suspected organisms -culture -allergies -age -renal and liver function get cultures before abx EXCEPT meningitis, severe sepsis trough levels specific time schedule to give antimicrobial peak levels specific concentration to achieve C.diff normal intestinal flora killed by antimicrobials diarrhea: orange, watery, couple of days to months, abd cramping and tenderness stool PCR, culture takes too long C.diff precautions wash hands soap and water po/iv metronidazole, po vanc never give antidiarrheals Pseudomembranous colitis if antidiarrheals given with dilation of colon which may need decompression candidiasis antimicrobial agents kill normal flora, overgrowth of fungus mucous membranes (oral, vaginal), skin mycostatin: swish in mouth, vag suppositories melt in warm environment nystatin: powder or ointment b-lactamase mediated resistance cleave b-lactam ring can compromise any antibiotic that contains a b-lactam ring (except aztreonam) contributions to antimicrobial resistance patients demand abx buying online stop when you feel better polymixin bactericidal for gram - poor tissue distribution substantial toxicity bacitracin penicillin naturally occurring in mold broad activity, low toxicity disrupt synthesis of cell wall use with actively reproducing inhibits transpeptidases activates autolysis penicillin binding protein pcn categories 1: PCN G (IV or IM), PCN V (oral) 2: methicillin, nafcillin 2: ampicillin, amoxicillin 3: ticarcillin, piperacillin (+tazobactam= zosyn for pseudomonas gram -) pcn excretion metabolized by liver, eliminated by kidneys zosyn is excreted mostly unchanged by kidney, dose in adjusted with renal failure, IV, disrupts plt function cephalosporin penicillin-binding protein disrupt cell wall synthesis activates autolysis low toxicity cross-sensitivity to penicillin maculopapular rash ceftriaxone rocephin 1st line tx for bacterial meningitis tx gonorrhea 2rd gen rapidly penetrate gram - outer membrane cephalosporin excretion poor oral absorption, give IV most eliminated by the kidneys carbapenems very broad coverage "last resort" CROs meropenem broad coverage, no degradation by kidney enzymes, less seizure activity vancomycin glycopeptide abx no b-lactam ring inhibits cell wall synthesis wide distribution gram + (MRSA)