Now we want to talk about the difference
versus empiric therapy, and we're talking
about when we use antibiotics.
Prophylactic therapy means I'm about
to undergo a situation where
I'm at risk for infection.
So, maybe I'm going to surgery.
Well, surgery puts me at risk for infection
because you're going to make some
significant breaks in my skin, right?
So, anytime you puncture my skin,
I'm at risk for infection.
So, I know that, going to surgery,
I'm going to put
my patient at increased risk for infection,
so I give them an antibiotic
before they ever have surgery.
Now, there's really tight timeframes.
When you're caring for a patient in the
hospital and they're going for surgery,
your hospital will have a
protocol that tells you
X number of minutes of time when they
want the patient to have that antibiotic
before the surgeon cuts.
So they try to keep that time,
get the perfect window so the drug
treatment will be the most effective,
and that's a really important part
of your pre-surgery checklist.
So, check with your hospital
policy and procedures
and they'll be very clear at the timing
of an antibiotic before surgery.
So, that's 1 use of prophylactic antibiotic
therapy. Also, dental procedures.
If we know that someone is going
to have a dental procedure
and there's an infection there or they
have some previous risk factors,
like some known heart disease,
they'll prophylactically put them
on antibiotic therapy.
So prophylactic antibiotic therapy,
the patient doesn't have a known infection,
but we're going to put their body
under some type of stress:
surgery or a dental procedure
and it puts them at risk for infection, and
that's why it's called prophylactic.
The other one is -- term is empiric therapy.
Now, in empiric therapy,
the patient has a definite infection, okay?
They have an infection, but we
don't have culture reports back.
So, we're going to give it our
best clinical educated guess
before we get more complete information.
So, prophylactic, you don't have an infection,
but we know that we're going to
put you at risk for infection,
so we'll pre-medicate you prophylactically
with an antibiotic.
Empiric therapy says, "Oh,
you've got an infection, we just don't have
the culture and sensitivity report back yet
because those take a period
of days to come back
and give us complete information.
So that's why we're going to give it
our best clinical educated guess."
Now, really, we do have some
pretty good guesses,
and it's usually community based.
Let me give you an example. If I was
in the ER taking care of patients
and they come in with pneumonia, we call
that community acquired pneumonia.
They didn't get it in the hospital, they came
to us from the community with pneumonia.
We have a pretty good feel, as
of what are the most common
bugs in our community.
It'll be different community to community,
but we know what the predominant
bugs are in our community.
And so, we're going to treat it with a pretty
broad spectrum antibiotic that will
knock out the majority of the bugs
that we know that we've seen
lately in pneumonia cases. And so,
we're going to give them a broad
give us our best shot at knocking
out that infection.
We're going to get a culture and sensitivity,
and as soon as that comes back,
we're going to want to get them on a much
more narrow spectrum antibiotic
that will deal with that pneumonia,
but we want them on a narrow
so that we can minimize the risk for, what?
Yep, I heard you, you got it.
We want to minimize the risk for resistance.
Okay, so, prophylactic, it's preventative.
You don't have an infection yet.
But we're going to put you in a situation
where you're at risk for an infection,
so then we give you an
like surgery or a dental procedure.
Empiric, I'm sorry to say
you have an infection.
We just don't know for sure what it is,
but we're pretty good at guessing,
based on what we've seen with
other people in our community.
So, we're going to give you a
broad spectrum antibiotic
until your culture and sensitivity
reports come back,
and then we're going to get you on
a narrower spectrum antibiotic.
And the whole reason is
because I want to diminish the
risk of microbial resistance.
Okay, so you're doing really
well at keeping up with us
and knowing what we're going through.
Now, let's talk about how, as a nurse,
can I evaluate the effectiveness
of a antibiotic therapy?
Because this isn't just the responsibility
of the health care provider,
the nurse practitioner, or the nurse.
You get to play a really big role in this.
So what you should be looking
for -- Okay, and if
that wasn't enough of a
selling point for you,
this is also a huge part of pharmacology
on the NCLEX
because they're going to test your
knowledge and your ability
to address the effectiveness
of any medication.
Well, the effectiveness of
has to be that the signs of the
infection should be resolving.
So you should be looking for things like
decreased pain, less redness, less drainage,
the white cell count is going
back to normal.
Look for all those signs of
infection to be resolving.
Now, you want to look at the culture and
sensitivity report as soon as you can.
So, your goal here is to take
a look at that lab report.
Don't just wait for the health care provider
to come around and make rounds.
You need to be proactive,
be watching for that report,
know when it's supposed to come
back and take a look at it.
Make sure the organism that has
been identified in your patient
is the S word,
susceptible and not resistant to
the antibiotic that they're on.
It's a really cool thing if you
review the reports,
so when your healthcare provider
hits the unit for rounds,
you can greet them and say,
"Hello Dr. So and So,"
or if you're talking to the
or the physician's assistant,
you can let them know, "Hey, good morning,
I've taken care of your patient, Mr. So and So.
I just want to let you know I reviewed
the culture and sensitivity reports,
and that we're on the right antibiotic.
Looks like things are resolving."
When you do those simple things,
you start to build a reputation
and a relationship with the
You will have a much better collaborative
experience with them,
and you'll be able to advocate for your
patients in a really effective way.
So, the more you stay on top
of things and are prepared
to give pertinent clinical information
to the health care provider,
when they're around, it's really going
to help both your experience
and definitely help your patient experience.
So, remember, if the patient's
drug is not sensitive
to that medication that they're on,
you want to notify the healthcare
provider very quickly
because time is infection.
The longer we let a bug go untreated,
the worse the chances for infection can be.
Now, the worst case scenario
for any infection is sepsis,
and sepsis puts the patient
at risk for death.
So that's why not every infection,
obviously, ends up that way,
but we always want to make sure
that we try and get that infection
as quickly as possible.
So, we're coming back to the
question that we started with;
how does a health care provider
select the best antibiotic?
Now you know, so I want
you to pause the video,
take a look at your notes
and answer this question.
Okay, good work on working
through that question.
You'll see the answer written in
your notes there,
and thank you for watching our video.
And I want each of you to feel confident
when you're practicing in your
professional nursing practice,
that you're a valuable member of the team
that helps each patient
get the most effective antibiotic
for their plan of care.