Question

A client with community-acquired pneumonia has been receiving intravenous Geopen (carbenicillin). Which finding should alert the nurse to an adverse drug reaction? A. Burning at the infusion site B. Diarrhea containing blood and mucus C. Loss of appetite D. Headache and myalgia

Short answer

A. Burning at the infusion site B. Diarrhea containing blood and mucus C. Loss of appetite D. Headache and myalgia Answer: B. Diarrhea containing blood and mucus

Step-by-step solution

Understand what carbenicillin is and its side effects

Carbenicillin is a semisynthetic penicillin antibiotic, primarily used to treat bacterial infections. Like other antibiotics, carbenicillin may cause side effects such as diarrhea, headache, myalgia, or an allergic reaction. It is essential to identify which of the symptoms listed in the question is most suggestive of an adverse drug reaction in order to properly address the issue.

Analyze each symptom and determine its relevance

A. Burning at the infusion site: This symptom could indicate an irritation or allergy to the medication or the IV site. However, it is not necessarily indicative of a severe adverse reaction. B. Diarrhea containing blood and mucus: This symptom is a sign of a more severe adverse reaction called pseudomembranous colitis, which can be caused by antibiotics, including carbenicillin. This condition requires immediate medical attention. C. Loss of appetite: A decreased appetite can be a side effect of many medications, including antibiotics, but it is not necessarily indicative of a severe adverse reaction. D. Headache and myalgia: Headache and myalgia are common side effects of antibiotics, but they are not necessarily indicative of a severe adverse reaction.

Choose the symptom that is most indicative of an adverse drug reaction

Based on the analysis of the symptoms, the one that should alert the nurse to an adverse drug reaction is: B. Diarrhea containing blood and mucus This symptom indicates a more severe adverse reaction called pseudomembranous colitis, requiring immediate medical attention.

Key concepts

Carbenicillin Adverse Reactions

Carbenicillin, a semi-synthetic penicillin, plays an important role in treating infections, but it's crucial to monitor patients for adverse reactions. One such severe reaction is pseudomembranous colitis, characterized by diarrhea with blood and mucus. It's important to discern this from less severe side effects like local irritation at the infusion site, which may present as a burning sensation. While loss of appetite, headaches, and myalgia are also noted with carbenicillin use, they do not usually signal a serious condition. Pseudomembranous colitis, however, is a medical emergency and requires immediate intervention.

Nurses and healthcare providers should be vigilant for symptoms like watery diarrhea, abdominal pain, and fever as they might indicate this adverse effect. Appropriate measures, including discontinuation of the offending antibiotic and possibly starting treatment with metronidazole or vancomycin, should be taken to manage this life-threatening condition.

Community-Acquired Pneumonia Treatment

When treating community-acquired pneumonia, healthcare professionals choose antibiotics based on the severity of the illness, patient's age, and resistance patterns. Carbenicillin is not commonly used for pneumonia and is instead reserved for infections caused by Pseudomonas aeruginosa and other specific bacteria. Standard treatments for community-acquired pneumonia often include macrolides like azithromycin or clarithromycin, fluoroquinolones such as levofloxacin, or beta-lactams like amoxicillin-clavulanate. It's essential to start therapy promptly and to adjust as needed based on the patient's response and culture results.

Quality care also involves supporting measures like oxygen therapy for hypoxemia, hydration, and rest. Vaccination programs against influenza and Streptococcus pneumoniae are effective preventative strategies. It is good practice to reassess antibiotic therapy after 48-72 hours to ensure the selected treatment is effective.

Pseudomembranous Colitis

Pseudomembranous colitis is a serious condition caused by an overgrowth of Clostridium difficile in the colon after the normal gut flora has been disrupted by antibiotic therapy. It's essential for healthcare providers to know that this condition, while often associated with clindamycin, can occur with practically any antibiotic, including carbenicillin. Symptoms include profuse diarrhea, abdominal cramping, and fever. To confirm diagnosis, stool tests for C. difficile toxins are necessary.

In mild cases, discontinuation of the implicated antibiotic may suffice, but more severe cases require specific therapy with metronidazole or vancomycin. Fecal microbiota transplantation is a new therapy used in recurrent cases. Prevention revolves around judicious antibiotic use and rigorous infection control practices to prevent the spread of C. difficile.