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ACTIVE LEARNING TEMPLATE

Medication
Mary Erickson
NAME _____________________________________________________

CONTENT __________________________________________________
Pediatrics REVIEW MODULE CHAPTER _______________
anti-infectives
TOPIC DESCRIPTOR ___________________________________________________________________________________
Vancomycin
MEDICATION __________________________________________________________________________________________
Binds to bacterial cell wall, resulting in cell death. Therapeutic Effects: Bactericidal action against susceptible organisms.
EXPECTED Spectrum: Active against gram-positive pathogens, including: Staphylococci (including methicillin-resistant strains of Staphylococcus aureus),
PHARMACOLOGICAL Group A beta-hemolytic streptococci, Streptococcus pneumoniae, Corynebacterium, Clostridium difficile, Enterococcus faecalis, Enterococcus faecium.
ACTION:

Therapeutic Uses
IV: Treatment of potentially life-threatening infections when less toxic anti-infectives are contraindicated. Particularly
useful in staphylococcal infections, including: Endocarditis, Meningitis, Osteomyelitis, Pneumonia, Septicemia,
Soft-tissue infections in patients who have allergies to penicillin or its derivatives or when sensitivity testing demonstrates
resistance to methicillin.
PO Treatment of staphylococcal enterocolitis or diarrhea due to Clostridium difficile.
IV: Part of endocarditis prophylaxis in high-risk patients who are allergic to penicillin.

EENT: ototoxicity. Adverse Effects Nursing Interventions


CV: hypotension. - Assess patient for infection (vital signs; appearance of wound,
GI: nausea, vomiting. sputum, urine , and stool; WBC) at beginning of and throughout therapy.
GU: nephrotoxicity. - Obtain specimens for culture and sensitivity prior to initiating therapy.
First dose may be given before receiving results.
Derm: rashes.
- Monitor IV site closely.Vancomycin is irritating to tissues and causes
Hemat: eosinophilia, leukopenia. necrosis and severe pain with extravasation. Rotate infusion site.
Local: phlebitis. - Monitor BP throughout IV infusion.
MS: back and neck pain. - Evaluate eighth cranial nerve function by audiometry and serum
Misc: hypersensitivity reactions including ANAPHYLAXIS, chills, fever, red man syndrome (with rapid infusion), vancomycin levels prior to and throughout therapy in patients with
superinfection. borderline renal function
- Monitor I and O ratios and daily weight. Cloudy or pink urine may be
a sign of nephrotoxicity.
- Assess patient for signs of superinfection(black, furry overgrowth on
tongue; vaginal itching or discharge; loose or foul-smelling stools).
Contraindications -Observe patient for signs and symptoms of anaphylaxis
(rash, pruritus, laryngeal edema, wheezing). Discontinue drug and
notify health care professional immediately if these problems occur.
Keep epinephrine, an antihistamine, and resuscitation
Contraindicated in: Hypersensitivity. equipment close by in case of an anaphylactic reaction.
Use Cautiously in: Renal impairment (dosage reduction required if CCr less than or equal to 80 mL/ min);
Hearing impairment; Intestinal obstruction or inflammation (increase systemic absorption when given orally)
Client Education
- Advise patients on oral vancomycin to take as directed. Take missed doses as
soon as remembered unless almost time for next dose; do not double dose.
- Instruct patient to report signs of hypersensitivity, tinnitus, vertigo, or hearing loss.
- Advise patient to notify healthcare professional if no improvement is seen in a
few days.
- Patients with a history of rheumatic heart disease or valve replacement need to
Medication/Food Interactions be taught importance of using antimicrobial prophylaxis prior to invasive dental or
medical procedures.
Drug-Drug: May cause additive ototoxicity and nephrotoxicity with other ototoxic and nephrotoxic drugs
(aspirin, aminoglycosides, cyclosporine, cisplatin, loop diuretics). May enhance neuromuscular blockade
from nondepolarizing neuromuscular blocking agents. Increase risk of histamine flush when used with
general anesthetics in children.

Medication Administration Evaluation of Medication


IV (Children > 1 mo): 40 mg/kg/day divided q 6 8 hr Staphylococcal CNS infection 60 mg/kg/day divided
q 6 hr, maximum dose: 1 g/dose. Effectiveness
IV (Neonates 1 wk 1 mo): <1200 g: 15 mg/kg/day q 24 hr. 1200 2000 g: 10 15 mg/kg/dose q 8 12 hr.
- Resolution of signs and symptoms of infection. Length of time for complete
>2000 g: 15 20 mg/kg/dose q 8 hr. resolution depends on organism and site of infection.
IV (Neonates < 1 wk): <1200 g: 15 mg/kg/day q 24 hr. 1200 2000 g: 10 15 mg/ kg/dose q 1218hr. - Endocarditis prophylaxis.
>2000g:1015mg/kg/dose q 812hr.
IT (Children): 5 20 mg/day.
IT (Neonates): 5 10 mg/day.
Endocarditis Prophylaxis in Penicillin-Allergic Patients:
IV (Adults and Adolescents): 1-g single dose 1-hr preprocedure.
IV (Children): 20-mg/kg single dose 1-hr preprocedure.
Diarrhea Due to C. difficile:
PO (Children): 40 mg/kg/day divided into 3 or 4 doses for 7 10 days (not to ex- ceed 2 g/day).
Staphylococcal Enterocolitis: www.atitesting.com 2015 Assessment Technologies Institute, LLC.
PO (Children): 40 mg/kg/day in 3 4 divided doses for 7 10 days (not to exceed 2 g/day).