2
"Expect the medication to cause constipation for the first few days of therapy."
"Take the medication at the same time each day."
"This medication is used for short-term therapy until your symptoms improve."
"Take this medication 1 hour before meals."
ii. A nurse is caring for an infant who has gastroesophageal reflux (GER). Which of the
following actions should the nurse take to prevent regurgitation? (Select all that
apply.)
Thicken the infant's formula with cereal.
Avoid giving the infant citrus juices.
Position the child with their head elevated after meals.
Place the infant's head on a soft pillow while sleeping.
Administer an antiemetic to the infant.
iii. A nurse is providing discharge teaching to the parent of a school-age child who has
pharyngitis caused by group A ß-hemolytic streptococci (GABHS). Which of the
following instructions should the nurse include in the teaching? (Select all that
apply.)
"Schedule a time for your child to receive the pneumococcal vaccine within 2 weeks."
"Provide your child with their own towel for drying their face and hands at home."
"Replace your child's toothbrush 24 hours after beginning antibiotic therapy."
"Your child can return to school 24 hours after their first does of antibiotics."
"Replace your child's orthodontic appliances prior to beginning antibiotic therapy."
iv. A nurse is caring for a 4-month-old infant who is immediately postoperative
following cleft palate repair. Which of the following actions should the nurse take?
Give the infant liquids using a small spoon with a long handle.
Apply elbow restraints to the infant.
Gently check the infant's suture line using a padded tongue depressor.
Place the infant in a supine position.
Open Resources for Nursing (Open RN)
Tetracyclines are broad-spectrum antibiotics that are bacteriostatic, subsequently inhibiting bacterial growth.
Indications: Tetracycline medications are useful for the treatment of many gram-positive and gram-negative infectious processes, yet are limited due to the significance of side effects experienced by many patients.
Mechanism of Action: Tetracyclines work by penetrating the bacterial cell wall and binding to the 30S ribosome, inhibiting the protein synthesis required to make the cellular wall.[1]
Special Administration Considerations: Significant side effects of tetracycline drug therapy include photosensitivity, discoloration of developing teeth and enamel hypoplasia, and renal and liver impairment.[2] Tetracyclines are contraindicated in pregnancy and for children ages 8 and under. Small amounts may be excreted in breast milk.
Patient Teaching & Education: Patients should be instructed to avoid direct sunlight exposure and wear sunscreen to prevent skin sensitivities. Additionally, it is important for patients to be educated regarding potential impaired absorption of tetracycline with the use of dairy products. Patients who are on oral contraceptives should be educated that tetracyclines may impede the effectiveness of the oral contraceptive and an alternative measure of birth control should be utilized while on the antibiotic. Female patients must be aware to immediately stop tetracycline if they become pregnant. Expired tetracycline should be immediately disposed of as it can become toxic.[3]
Now let’s take a closer look at the medication grid for tetracycline in Table 3.13.[4]
Table 3.13 Tetracycline Medication Grid
| tetracycline | Check allergies Alert: Check expiration date. Using outdated or deteriorated drug has been linked to severe reversible nephrotoxicity (Fanconi syndrome) Effectiveness is reduced when drug is given with milk or other dairy products, antacids, or iron products For best drug absorption, give drug with a full glass of water on an empty stomach at least 1 hour before or 2 hours after meals Give drug at least 1 hour before bedtime to prevent esophageal irritation or ulceration Use caution with renal or hepatic impairment Avoid using in children younger than age 8 because drug may cause permanent discoloration of teeth, enamel defects, and bone growth retardation Avoid in pregnancy due to toxic effects on the developing fetus (often related to retardation of skeletal development and teeth) | Monitor for systemic signs of infection: -WBCs – Fever Monitor actual site of infection | Gastrointestinal symptoms C-diff Photosensitivity Oral candidiasis Permanent teeth discoloration if given to patients < 8 y.o. Intracranial hypertension: Monitor for headache, blurred vision, diplopia, and vision loss Decreased effectiveness of oral contraceptives |
Critical Thinking Activity 3.13a
Using the above grid information, consider the following clinical scenario question:
The nurse is providing medication teaching to a parent of a six-year-old child with strep throat in a clinic setting. Due to multiple drug allergies, tetracycline was prescribed by a doctor who is new to the clinic. What is the nurse’s best response and why?
Note: Answers to the Critical Thinking activities can be found in the “Answer Key” sections at the end of the book.