What is cloxacillin?

Cloxacillin is an antibiotic in the class of drugs called penicillins. It fights bacteria in your body.

Cloxacillin is used to treat many different types of infections caused by staphylococcus bacteria
("staph" infections).

Cloxacillin may also be used for purposes other than those listed in this medication guide.

CLASSIFICATION

Antibiotic

ALTERNATE NAME

ORBENIN, TEGOPEN, BACTOPEN

INDICATIONS

• semisynthetic penicillin for treatment of infections due to susceptible beta-lactamase producing

staphylococci and mixed infections of penicillin resistant organisms

Side Effects by Body System

Gastrointestinal
Common gastrointestinal complaints include nausea, vomiting, and diarrhea. Rarely the use of
cloxacillin has been associated with pseudomembranous colitis.

Hematologic
Hematologic adverse effects include neutropenia, leukopenia, and thrombocytopenia.
Neutropenia has occurred in 17% of patients and occurs most commonly with higher doses and
longer durations of therapy. Neutropenia occurs most often after 14 days of therapy and is
reversible upon discontinuation.

Hepatic
Hepatic side effects include transient increases in serum transaminases and the development of
cholestatic hepatitis. Liver transaminases may take several weeks to return to normal following
discontinuation of therapy. Frequent monitoring of liver function tests is recommended in patients
with liver disease.

Hypersensitivity
Hypersensitivity reactions include rash, fever, eosinophilia, pruritus, fever, chills, and myalgia

Hypersensitivity to penicillins.
 Cefuroxime Indication.
For the treatment of many different types of bacterial infections such as bronchitis,
sinusitis, tonsillitis, ear infections, skin infections, gonorrhea, and urinary tract
infections.
Cefuroxime Contraindications.
Cefuroxime for Injection USP and Dextrose Injection USP is contraindicated in
patients with known allergy to the cephalosporin group of antibiotics. Solutions
containing dextrose may be contraindicated in patients with hypersensitivity to corn
products.
Cefuroxime Prescription.
Cefuroxime is prescribed to treat certain infections caused by bacteria, such as
bronchitis; gonorrhea; Lyme disease; and infections of the ears, throat, sinuses,
urinary tract, and skin. Cefuroxime is in a class of prescription called cephalosporin
antibiotics. It works by stopping the growth of bacteria. Antibiotics will not work for
colds, flu, or other viral infections.

Broad-spectrum cephalosporin antibiotic resistant to beta-lactamase. It has been

proposed for infections with gram-negative and gram-positive organisms, gon
Cefuroxime side effects.
- diaper rash;
- diarrhea;
- difficulty breathing or swallowing;
- hives;
- itching;
- painful sores in the mouth or throat;
- severe skin rash;
- stomach pain;
- upset stomach;
- vaginal itching and discharge;
- vomiting;
- wheezing;
NR
Should checks the patient name,route,dosage and frequency of the medicine that
should be given.

DRUG CLASS AND MECHANISM: Celecoxib is a nonsteroidal antiinflammatory drug (NSAID)

that is used to treat arthritis, pain, menstrual cramps, and colonic polyps. Prostaglandins are
chemicals that are important contributors to the inflammation of arthritis that causes pain, fever,
swelling and tenderness. Celecoxib blocks the enzyme that makes prostaglandins
(cyclooxygenase 2), resulting in lower concentrations of prostaglandins. As a consequence,
inflammation and its accompanying pain, fever, swelling and tenderness are reduced. Celecoxib
differs from other NSAIDs in that it causes less inflammation and ulceration of the stomach and
intestine (at least with short-term use) and does not interfere with the clotting of blood.

Classifications
Like these people said, celecoxib is a COX-2 (cyclooxygenase) inhibitor in the same family as
other non-steroidal anti-inflammatory drugs (NSAIDs). Aspirin also belongs in this same category
(NSAIDs), but it works by inhibiting both cyclooxygenase 1 and 2. With celecoxib working almost
exclusively at COX-2, the potential for developing gastric and duodenal ulcers from being on
long-term, higher dose aspirin (more than just a baby aspirin a day, which is GOOD for people
who want to reduce their risks for cardiovascular events) is greatly reduced.

Gastrointestinal ADRs

In theory the COX-2 selectivity should result in a significantly lower incidence of

gastrointestinal ulceration than traditional NSAIDs. The main body of evidence touted
to support this theory were the preliminary (6 month) results of the Celecoxib Long-
term Arthritis Safety Study (CLASS) as published in 2000, which demonstrated a
significant reduction in the combination of symptomatic ulcers plus ulcer
complications in those taking celecoxib versus ibuprofen or diclofenac, provided they
were not on aspirin (Silverstein ''et al.'', 2000). However, this was not significant at
12 months (full study length).

Patients with prior history of ulcer disease or GI bleeding. Moderate to severe hepatic
impairment, GI toxicity can occur with or without warning symptoms in patients
treated with NSAIDs

Allergy

Celecoxib contains a sulfonamide moiety and may cause allergic reactions in those
allergic to other sulfonamide-containing drugs. This is in addition to the
contraindication in patients with severe allergies to other NSAIDs.

Hypersensitivity to Celecoxib

CELEBREX is contraindicated in patients with known hypersensitivity to celecoxib. Return to top

Allergic reactions Tosulfonamides

CELEBREX should not be given to patients who have demonstrated allergic-type reactions to
sulfonamides. Return to top

Allergive reactions to NSAIDs

CELEBREX should not be given to patients who have experienced asthma, urticaria, or allergic-
type reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like
reactions to NSAIDs have been reported in such patients. Return to top

Peri-Operative Pain

CELEBREX is contraindicated for the treatment of peri-operative pain in the setting of coronary
artery bypass graft (CABG) surgery. Return to top
Nursing Diagnosis: Impaired Physical Mobility
Immobility

NOC Outcomes (Nursing Outcomes Classification)

Suggested NOC Labels

 Ambulation: Walking

 Joint Movement: Active

 Mobility Level

NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels

 Exercise Therapy: Ambulation

 Joint Mobility

 Fall Precautions

 Positioning

 Bed Rest Care

NANDA Definition: Limitation in independent, purposeful physical movement of the

body or of one or more extremities

Alteration in mobility may be a temporary or more permanent problem. Most disease

and rehabilitative states involve some degree of immobility (e.g., as seen in strokes,
leg fracture, trauma, morbid obesity, and multiple sclerosis). With the longer life
expectancy for most Americans, the incidence of disease and disability continues to
grow. And with shorter hospital stays, patients are being transferred to rehabilitation
facilities or sent home for physical therapy in the home environment.

Mobility is also related to body changes from aging. Loss of muscle mass, reduction
in muscle strength and function, stiffer and less mobile joints, and gait changes
affecting balance can significantly compromise the mobility of elderly patients.
Mobility is paramount if elderly patients are to maintain any independent living.
Restricted movement affects the performance of most activities of daily living
(ADLs). Elderly patients are also at increased risk for the complications of immobility.
Nursing goals are to maintain functional ability, prevent additional impairment of
physical activity, and ensure a safe environment.

Defining Characteristics:
  Inability to move purposefully within physical environment, including bed
mobility, transfers, and ambulation
 Reluctance to attempt movement
 Limited range of motion (ROM)
 Decreased muscle endurance, strength, control, or mass
 Imposed restrictions of movement including mechanical, medical protocol,
and impaired coordination
 Inability to perform action as instructed

Related Factors:

 Activity intolerance
 Perceptual or cognitive impairment
 Musculoskeletal impairment
 Neuromuscular impairment
 Medical restrictions
 Prolonged bed rest
 Limited strength
 Pain or discomfort
 Depression or severe anxiety

Expected Outcomes

 Patient performs physical activity independently or with assistive devices as

needed.
 Patient is free of complications of immobility, as evidenced by intact skin,
absence of thrombophlebitis, and normal bowel pattern.

Ongoing Assessment

• Assess for impediments to mobility (see Related Factors in this care

plan). Identifying the specific cause (e.g., chronic arthritis versus
stroke versus chronic neurological disease) guides design of optimal
treatment plan.

• Assess patient’s ability to perform ADLs effectively and safely on a daily

basis.

Suggested Code for Functional Level Classification

0 Completely independent
1 Requires use of equipment or device
2 Requires help from another person for assistance, supervision, or teaching
3 Requires help from another person and equipment or device
4 Is dependent, does not participate in activity Restricted movement
affects the ability to perform most ADLs. Safety with ambulation is an
important concern.

• Assess patient or caregiver’s knowledge of immobility and its

implications. Even patients who are temporarily immobile are at risk
for effects of immobility such as skin breakdown, muscle weakness,
thrombophlebitis, constipation, pneumonia, and depression.
 • Assess for developing thrombophlebitis (e.g., calf pain, Homans’ sign,
redness, localized swelling, and rise in temperature). Bed rest or immobility
promote clot formation.

• Assess skin integrity. Check for signs of redness, tissue ischemia

(especially over ears, shoulders, elbows, sacrum, hips, heels, ankles, and
toes).

• Monitor input and output record and nutritional pattern. Assess nutritional
needs as they relate to immobility (e.g., possible hypocalcemia, negative
nitrogen balance). Pressure sores develop more quickly in patients with
a nutritional deficit. Proper nutrition also provides needed energy for
participating in an exercise or rehabilitative program.

• Assess elimination status (e.g., usual pattern, present patterns, signs of

constipation). Immobility promotes constipation.

• Assess emotional response to disability or limitation.

• Evaluate need for home assistance (e.g., physical therapy, visiting nurse).

• Evaluate need for assistive devices. Proper use of wheelchairs, canes,

transfer bars, and other assistance can promote activity and reduce
danger of falls.

• Evaluate the safety of the immediate environment. Obstacles such as

throw rugs, children’s toys, and pets can further impede one’s ability
to ambulate safely.

Therapeutic Interventions

• Encourage and facilitate early ambulation and other ADLs when possible.
Assist with each initial change: dangling, sitting in chair, ambulation.The
longer the patient remains immobile the greater the level of
debilitation that will occur.

• Facilitate transfer training by using appropriate assistance of persons or

devices when transferring patients to bed, chair, or stretcher.

• Encourage appropriate use of assistive devices in the home

setting. Mobility aids can increase level of mobility.

• Provide positive reinforcement during activity. Patients may be

reluctant to move or initiate new activity due to a fear of falling.

• Allow patient to perform tasks at his or her own rate. Do not rush patient.
Encourage independent activity as able and safe. Hospital workers and
family caregivers are often in a hurry and do more for patients than
needed, thereby slowing the patient’s recovery and reducing his or
her self-esteem.

• Keep side rails up and bed in low position. This promotes a safe
environment.

• Turn and position every 2 hours or as needed. This optimizes

circulation to all tissues and relieves pressure.
• Maintain limbs in functional alignment (e.g., with pillows, sandbags,
wedges, or prefabricated splints). This prevents footdrop and/or
excessive plantar flexion or tightness. Support feet in dorsiflexed position.

Use bed cradle. This keeps heavy bed linens off feet.

• Perform passive or active assistive ROM exercises to all

extremities. Exercise promotes increased venous return, prevents
stiffness, and maintains muscle strength and endurance.

• Promote resistance training services. Research supports that strength

training and other forms of exercise in older adults can preserve the
ability to maintain independent living status and reduce risk of
falling.

• Turn patient to prone or semiprone position once daily unless

contraindicated. This drains bronchial tree.

• Use prophylactic antipressure devices as appropriate. This prevents

tissue breakdown.

• Clean, dry, and moisturize skin as needed.

• Encourage coughing and deep-breathing exercises. These prevent

buildup of secretions.

Use suction as needed.

Use incentive spirometer. This increases lung expansion. Decreased

chest excursions and stasis of secretions are associated with
immobility.

• Encourage liquid intake of 2000 to 3000 ml/day unless

contraindicated. Liquids optimize hydration status and prevent
hardening of stool.

• Initiate supplemental high-protein feedings as appropriate.

If impairment results from obesity, initiate nutritional counseling as

indicated. Proper nutrition is required to maintain adequate energy
level.

• Set up a bowel program (e.g., adequate fluid, foods high in bulk, physical
activity, stool softeners, laxatives) as needed. Record bowel activity level.

• Administer medications as appropriate. Antispasmodic medications

may reduce muscle spasms or spasticity that interfere with mobility.

• Teach energy-saving techniques. These optimize patient’s limited

reserves.

• Assist patient in accepting limitations. Emphasize abilities.

Education/Continuity of Care

• Explain progressive activity to patient. Help patient or caregivers to

establish reasonable and obtainable goals.

• Instruct patient or caregivers regarding hazards of immobility. Emphasize

importance of measures such as position change, ROM, coughing, and
exercises.

• Reinforce principles of progressive exercise, emphasizing that joints are to

be exercised to the point of pain, not beyond. "No pain, no gain" is not
always true!

• Instruct patient/family regarding need to make home environment safe. A

safe environment is a prerequisite to improved mobility.

• Refer to multidisciplinary health team as appropriate. Physical

therapists can provide specialized services.

• Encourage verbalization of feelings, strengths, weaknesses, and concerns.