Hi, welcome to our video on
Okay, now, don't be underwhelmed
by that first title
because this is something really cool
that you get to be a part of.
This is a role that nurses play
that is so amazing
in helping our patients get better.
See, I want you to start thinking
about this question,
but I don't expect you to answer it;
how does a health care provider
select the best antibiotic?
See, that's the whole point of this video,
is I want you to walk through the process,
so even in your clinical rotations,
you can be involved in that process.
So, hold on to that thought on
how a health care provider
can select the best antibiotic,
and we'll answer that by
the end of this video.
Okay, so let's get started.
There's a couple pieces of information you
need to have as we're walking through this.
First of all, I want you to understand
between narrow and broad spectrum.
A narrow-spectrum antibiotic
acts against a really limited
group of bacteria.
So, therefore, a broad-spectrum antibiotic
acts against a larger group of bacteria.
Now, take a look at the graphics,
these are pretty cool.
See, the narrow-spectrum antibiotic
has, really, a very
simple, straightforward, same type of
bacteria that it goes against.
But look at the broad spectrum.
You've got all different kinds of
bacteria that it works against.
Now we're going to talk about why it's better
to use either a narrow or a broad
spectrum as we keep walking
through the process of the role you'll play
as a healthcare provider, team member,
on how we find the best antibiotic
for your patient.
So here's your first question.
What do you think?
Do you think our goal should
be to keep a patient
on the broadest spectrum antibiotic
or the narrowest spectrum
antibiotic, and why?
So, take a minute, and jot your answer
down in the margin of your notes.
Now, I'm going to ask you one more question.
What test could we use to determine if the
patient was on an effective antibiotic?
Again, just write your thoughts in the notes.
Okay, now, don't worry. We're going to actually
talk about the answers to these questions.
So, the first question, do you think our
goal should be to keep the patient
on the broadest spectrum antibiotic
or the narrowest spectrum antibiotic?
The answer is we want them on the
narrowest spectrum antibiotic,
Because we want to do everything
we can to limit the possibility
of the bugs developing
resistance to our drugs.
So it's really important
that you can get your patient on the
narrowest spectrum antibiotic
that will still wipe out their infection
as quickly as possible.
Now, what test we could use to determine if
the patient was on an effective antibiotic,
hat's a culture, and even a culture and
sensitivity test would tell us that.
All right, so let's talk about what that is.
Let's start digging into what a culture
and sensitivity report would look like.
So let's say you're the nurse for this
patient who's receiving clindamycin.
Clindamycin is an antibiotic.
So the clindamycin is used to treat
organism number 2.
Okay, so look at the report
that you have in your downloadable notes
and follow over organism 2.
Do you see the name --
Based on this culture and
what is the name for organism 2?
Okay, if you see the name as MRSA,
you got the correct answer.
You already know now
how to read the type of organism on
a culture and sensitivity report.
Congratulations. That's a really cool that
you're already at that step.
Now, here's the really important part.
an effective antibiotic for this organism,
and why or why not?
So by looking at this report, you can
tell the answer to that question.
So pause for just a minute. Take your time.
Look at clindamycin and you determine --
Pretend that you're this patient's nurse,
and you determine if that antibiotic
is effective for them or not.
Remember, the name of this organism is MRSA
and is clindamycin an effective antibiotic?
Well, you look at clindamycin
and you follow it over on the chart,
you'll see an R there.
Well, we know, from the previous videos,
that an R means resistant.
If you haven't got to see that video yet,
then keep in mind, R means resistant,
S means sensitive.
That means -- R means the bug is
resistant to that drug,
S means the bug is sensitive
to that antibiotic
and will be killed by it.
So is clindamycin a good choice?
Is it the best choice or even
an effective choice
for this patient who has methicillin
resistant Staphylococcus aureus or MRSA?
The answer is no.
So, whether you got that or not,
don't get worried about that.
Now you know how to look at a chart.
When you look at a culture
and sensitivity test,
you'll see that you have -- Look,
this patient has 2 organisms.
You'll see the name of the
organism on the chart.
You'll also see a listing of antibiotics,
which you see there, clindamycin happens
to be the one this patient is taking.
But we see -- oh my, it's got an R by it,
meaning it won't treat this bug.
So what's our next step as a nurse?
Contact the healthcare provider.
"Hello, Dr. So and So. My name is Rhonda.
I'm taking care of your patient in 5 East.
I just wanted to let you know
that the culture and sensitivity
report came back.
The patient is taking clindamycin,
and the report showed
that it's resistant to this drug."
That's our role. That's when
things get really fun,
because then you get to talk to the health-
care provider, and together, you come up
with a next best step for your patient.
So, now, let's talk about mechanisms of action.
Now, this might not seem
extremely exciting to you,
but it's just a way that we organize
the medications, the antibiotics.
So there's lots of different
mechanisms. They can
inhibit bacterial cell walls synthesis.
They can increase the cell
Yeah, that's not good, because
then they -- they explode.
They can cause a lethal -- that means a
deadly inhibition of bacterial proteins.
They can cause a non-lethal inhibition
of bacterial protein synthesis.
They can inhibit bacterial synthesis.
They can be antimetabolites,
or they can suppress viral replication.
So, I know that's 7.
Those are 7 of the predominant mechanisms
of action of these antibiotics.
We're going to look at 4, so I'm going
to wheel that down for you,
from 7 to 4 of the most common mechanisms
of action that you'll see.
Now, on the other slide, you'll see
that I give you examples
of antibiotics from each 1 of those
mechanisms of action.
This is just a way to categorize
and to give you a system
to, kind of, see how the
antibiotics work, okay?
There's other ways that you can
but we're going to roll with
this system for the video.
So let's look at the 4 most common.
First, they interfere with
cell wall synthesis.
Second, could be a group of antibiotics that
interfere with protein synthesis.
Third, they interfere with DNA replication,
or fourth, they're acting as a metabolite,
that messes with some critical metabolic
reactions inside the bacterial cell.
So those are the 4 most common
ones that you'll see.