Beta-Lactam Antibiotics: Vancomycin (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Now, on to the one drug that is not a beta-lactam ring antibiotic.

    00:06 So, this one doesn't have a beta-lactam ring, and we absolutely want to limit the use of this.

    00:12 We have a super bug called vancomycin- resistant enterococcus.

    00:18 So we don't want to use vancomycin unless it is absolutely necessary.

    00:23 So, vancomycin treats C. diff.

    00:27 If you've never taken care of a patient, yet, with C. diff, you will, and never forget the experience.

    00:33 C. diff causes profuse diarrhea.

    00:38 When I would get off the elevator for 1 of my shift, there's 2 things I always knew: if we had a patient with C. diff, or if we had a patient who was a GI bleed, because both have intensely noxious odors.

    00:52 So, as a nurse, you have to really work on your poker face and staying calm because when you walk in the room the smell will be overwhelming, but you don't want to make the patient feel uncomfortable.

    01:04 So, I promise you, the first time you smell a C. diff patient, it's almost not even worth the time to do a culture, which we always do just to prove it, but everybody on the unit knows when a patient has C. diff diarrhea.

    01:17 We can also use vancomycin for MRSA, methicillin-resistant Staphylococcus aureus.

    01:24 And it works well for people who have a penicillin allergy or other serious infections.

    01:28 But please remember, most hospitals have very strict policies that you have to meet several criteria before vancomycin can be ordered, because we overused it and we created the super bug, vancomycin-resistant enterococcus.

    01:44 So, you want to remember, we're going to use that to treat C. diff -- remember that smell – MRSA, and for people who have penicillin allergies or a really serious infection.

    01:57 Now, remember, vancomycin is not a beta-lactam ring antibiotic, but it also weakens the bacterial cell wall.

    02:04 That's why it got grouped together with the beta-lactam rings.

    02:08 So, the adverse effects could be this really intense hypersensitivity reaction.

    02:13 We think this is probably linked to, like, a hypersensitivity or allergic reaction called red man syndrome.

    02:21 Now, that's been its name for a very long time, so it is not meant to be offensive, but that is why it is called that because the patient develops this severe flushing and rash, severe itching, tachycardia, and low blood pressure.

    02:36 My sweet, little godson developed this, and when his mother sent me pictures of him, I could hardly stand it.

    02:43 This is really, really uncomfortable for your patients, and you can help minimize the chance that any patient, pediatric or older, experience this type of reaction.

    02:53 If you infuse it very slowly and consider pre-medicating them with acetaminophen, which is Tylenol, and diphenhydramine, which is also known as Benadryl.

    03:03 So, it's your job, as a nurse, to make sure that you minimize the risk of your patients on vancomycin having to go through this red man syndrome allergic anaphylactic-type reaction.

    03:17 Now, the most serious effect for vancomycin is renal toxicity.

    03:22 We've also seen that word as nephrotoxicity.

    03:26 You already knew that toxicity means, you know, death to cells or damage and whatever is in front of it lets us know which organ is in danger.

    03:34 So, nephrotoxicity or renal toxicity is a really negative side effect of vancomycin.

    03:41 So, that's why you want to limit the use of other nephrotoxic drugs, like NSAIDs, nonsteroidal anti- inflammatory drugs: ibuprofen, naproxen -- you may know that as Aleve or Motrin.

    03:55 You want to be very careful with the use of aminoglycosides because remember, that's another group of drugs that are really difficult on the kidneys, or possibly, nephrotoxic.

    04:05 The last one is cyclosporine. Now, I recommend that you start making some main list and we'll include those in your downloadable notes.

    04:13 But this is another group of drugs -- make sure you want to keep in mind which drugs are nephrotoxic, which drugs are ototoxic, which drugs are hepato or liver toxic.

    04:23 The more that you can group and chunk things together, it's just going to be easier for your brain to encode and retrieve that information when you really need it.

    About the Lecture

    The lecture Beta-Lactam Antibiotics: Vancomycin (Nursing) by Rhonda Lawes, PhD, RN is from the course Anti-Infective Drugs in Nursing.

    Included Quiz Questions

    1. Clostridium difficile
    2. Methicillin-resistant Staphylococcus aureus
    3. Entamoeba histolytica
    4. Mycoplasma pneumoniae
    5. Rickettsia
    1. Red man syndrome
    2. Nausea and vomiting
    3. Severe diarrhea
    4. High blood pressure
    1. Flushing
    2. Rashes
    3. Severe itching
    4. Bradycardia
    5. High blood pressure
    1. Renal toxicity
    2. Liver toxicity
    3. Nerve toxicity
    4. Brain toxicity
    1. Limit other nephrotoxic drugs.
    2. Monitor vital signs every hour.
    3. Assess the IV line frequently.
    4. Initiate fall precautions.

    Author of lecture Beta-Lactam Antibiotics: Vancomycin (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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