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Drug Study: Ciprofloxacin (Ciprobay)Classification: Antibiotics – Quinolones

Action: Inhibits bacterial DNA gyrase thus preventing replication in susceptible bacteria.

Indication: Infections of the respiratory tract, middle ear, paranasal sinuses, eyes, kidneys and/or urinary tract, genital organs including adnexitis, gonorrhea, prostatitis, abdominal cavity (e.g. infections of GIT or biliary tract, peritonitis), skin and soft tissue, bones and joints; sepsis, infections or imminent risk of infection (prophylaxis) in patients whose immune system has been weakened (e.g. patients on immunosuppresants or have neutropenia). Selective intestinal contamination in ummunosuppresed patients. Acute uncomplicated UTI (acute cystitis). COmplicated UTI including acute uncomplicated pyelonephritis.

Adverse Reactions: Common: Nausea, diarrhea, injection site reactions, vomiting, transient increase in transaminases, rash. Uncommon: Candida infections, eosinophilia, anorexia, psychomotor hyperactivity, agitation, headache, dizziness, sleep disorders, taste disorders, GI and abdominal pains, dyspepsia, flatulence, increased bilirubin, rash, pruritis, urticaria, arthralgia, renal impairment, unspecific pain, feeling unwell, fever, transient increase in blood alkaline phosphatase, thrombocytopenia, thrombocytemia, confusion, disorientation, hallucinations, seizures, vertigo, visual disturbances, hearing loss, tachycardia, vasodilation, hypotension, transient hepatic impairment, jaundice, renal failure, tendon rupture.

Nursing Considerations

Assessment

  • Assess patient for previous sensitivity reaction
  • Assess patient for signs and symptoms of infection before and during treatment: fever, earache, characteristics of wounds, sputum, urine, stool and WBC > 10,000mm³
  • Obtain C&S before beginning drug therapy to identify if correct treatment has been initiated
  • Assess for allergic reaction and anaphylaxis: rash, urticaria, pruritus, chills, fever, wheezing, laryngeal edema or joint pain. Angioedema may occur a few days after the beginning of therapy. Epinephrine and resuscitation equipment should be available for anaphylactic reaction
  • Assess renal funtionc before and during therapy: urine output, BUN and creatinine. Monitor for nephrotoxicity.
  • Monitor hematologic, electrolyte and hepatic status if patient is on long term therapy. Hematologic: bleeding, echymosis, bleeding gums, hematuria, stool guaiac, CBC and hematocrit. Electrolyte: sodium, potassium and chloride. Hepatic: AST, ALT, LDH, bilirubin, alkaline phosphatase and Coomb’s test monthly.
  • Assess for possible adverse reactions
  • Assess for possible superinfection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea and change in cough or sputum. Severe diarrhea may indicate pseudomembranous colitis
  • Assess patient’s and family’s knowledge of drug therapy

Nursing Diagnoses

  • Risk for infection
  • Diarrhea
  • Risk for injury related to drug induced adverse reaction
  • Knowledge deficit
  • Noncompliance

Planning

  • PO route
    • Give around the clock to maintain proper blood levels
    • Administer 2 hours before or 2 hours after antacids, zinc, iron, calcium
  • IV route
    • Check for irritation, extravasation, phlebitis daily
    • For intermittent infusion, dilute 1-2 mg/dL of D5W0.9% NaCl; give over 60 minutes; it will remain stable under refrigeration for 2 weeks.

Implementation

  • Instruct patient to take all medication prescribed for the length of time ordered. The drug must be taken around the clock to maintain adequate blood levels.
  • Advise patient to report occurrence of any adverse reaction
  • Teach patient to report sore throat, bruising, bleeding and joint pain which may indicate blood dyscrasias (rare)
  • Advise patient to report perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea and change in cough or sputum. Severe diarrhea may indicate pseudomembranous colitis.
  • Advise patient to rinse mouth frequently, use sugarless candy or gum for dry mouth

Evaluation

  • Absence of signs and symptoms of infection
  • Observed and experienced improvement in symptoms of infection
  • Negative C&S
  • Absence of drug induced adverse reaction