Antimicrobials
3.4 Clinical Reasoning and Decision-Making for Infection
Now that we have reviewed antimicrobial basics, we will take a closer look at specific antimicrobial classes and administration considerations, therapeutic effects, adverse effects, and specific teaching needed for each class of antimicrobials. But before we do that, let’s reexamine the importance of the nursing process in guiding the nurse who administers antimicrobial medications. The nursing process consists of assessment, diagnosis, outcome identification, planning, implementation of interventions, and evaluation. Because diagnosis, outcome identification, and planning are specifically tailored to the individual client, we will broadly discuss considerations related to assessment, implementation of interventions, and evaluation when administering antimicrobials.
Assessment
Although there are numerous details to consider when administering medications, it is always important to first think more broadly about what you are giving and why. As a nurse who is administering an antimicrobial, you must remember some important broad considerations.
First, let’s think of the WHY? Recognizing cues…
Antimicrobials are given to prevent or treat infection. If a client is prescribed an antimicrobial, an important piece of the nursing assessment is to recognize and analyze cues. The nurse should look for signs and symptoms of infection, and always know WHY the client is receiving an antimicrobial to effectively evaluate whether the client is improving or deteriorating. Remember, the nurse must assess how this medication is working, and having pre-administration assessment information is an important part of this process.
In order to define a baseline, typical data that a nurse collects at the start of a shift include:
- temperature
- heart rate
- blood pressure
- respiratory rate, and
- white blood cell count.
Focused assessments are then made based on the type of infection. For example, if it is a wound infection, the wound should be assessed for redness, inflammation, drainage type and amount, and pain. If it is a respiratory infection, the nurse should assess the client’s lung sounds, and type/consistency of respiratory expectorate. If a client has a urinary tract infection (UTI), the urine and symptoms related to a UTI (pain with urination, cloudy urine, foul-smelling urine) should be assessed.
The following image summarizes some common signs and symptoms of infection (by system) that a nurse needs to monitor for.
Additionally, whenever a client has an infection, it is important to continually monitor for the development of sepsis, a life-threatening condition caused by severe infection. As you recall from the previous chapter, early signs of sepsis include new-onset confusion, elevated heart rate, decreased blood pressure, increased respiratory rate, and elevated fever.
Additional baseline information to collect prior to the administration of any new medication order includes a clien