Preparing to Administer Antimicrobial Medication

Antimicrobial medication requires the nurse to follow the same general administration procedures that are required for any type of medication. The most critical step is to determine if the patient has allergies to drugs, food, environmental stimuli, and a family history of allergies to antibiotics. There is also a high incidence of cross sensitivity between some antibiotics such as penicillin and cephalasporins. Always display allergies in red and clearly write them on the patient's record. Even if the patient's record indicates that the patient doesn't have allergies, always ask the patient each time you administer the antimicrobial medication.

Always have emergency medications such as epinephrine, Benadryl, and steroids handy so they can be given to counteract any adverse side effect of the antimicrobial medication. Be sure to carefully monitor the patient for a half hour after the medication is given to determine if the patient experiences an adverse reaction.

During treatment, you'll need to monitor the therapeutic effect of the medication by monitoring the signs and symptoms of the disease and by obtaining the patient's white blood cell count. Although you can monitor the antimicrobial serum level to determine if the medication has achieved a therapeutic level, this is only done in cases where the therapeutic range is narrow resulting in possible toxicities (i.e., vancomycin ototoxicity).

It is important to administer antimicrobials at the times described in the pre-scriber's order in order to maintain a therapeutic blood level of the medication.

Otherwise, this can lead to undertreatment or ineffective treatment if not maintained. Sometimes a double dose of an antibiotic is administered as the first dose to quickly achieve a therapeutic level. This is called a loading dose.

Intramuscular injections of antibiotics should be given deep into the muscle and sites should be rotated if more than one injection is prescribed. Stop orders and the need for renewal orders will depend on the healthcare agency policy. However, it is common that antibiotic orders are for 72 hours only until the results of a culture and sensitivity test can be obtained. Antibiotic prescriptions are usually not renewed. This is an effort to limit the opportunity for the microbial to become resistant to the medication.

In severe cases, aggressive treatment is necessary to control the growth and destroy the microbial quickly. To do this, the medication is administered par-enterally in an IV dose that is diluted in a neutral solution (pH 7.0 to 7.2) such as normal saline (N.S.) or isotonic sodium chloride or 5% dextrose and water (D5W). Antibiotics should not be mixed together or administered at the same time. They can be administered as a piggyback infusion. Information about how long an interval should occur between the infusion of different antibiotics should be obtained from the pharmacy or the drug insert.

The following nursing diagnoses can be used for patients who are taking antibiotics:

• Risk of infection related to treatment failure or superinfection.

• Risk of fever related to treatment failure or superinfection.

• Risk of fluid volume deficit related to adverse GI reaction such as anorexia, nausea/vomiting/diarrhea, and complications of allergic reaction.

They are also at risk for having the following collaborative problems:

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