CASE STUDY:

Staphylococcal
Scald Skin Syndrome
(SSSS)

Immanuel Sy
BSN III-I
Group 3

Mrs. Jeorjet Evangelista

September 3, 2009
INTRODUCTION

A. Background of the Study

The client is a 1-year old female who was admitted last August 23, 2009 at 5:50
in the evening due to ulcerated wounds in the body. Staphylococcal scalded skin
syndrome (SSSS), also known as Ritter von Ritterschein disease (in newborns), Ritter
disease, and staphylococcal epidermal necrolysis, encompasses a spectrum of superficial
blistering skin disorders caused by the exfoliative toxins of some strains of
Staphylococcus aureus. It is a syndrome of acute exfoliation of the skin typically
following an erythematous cellulitis. Severity of staphylococcal scalded skin syndrome
varies from a few blisters localized to the site of infection to a severe exfoliation affecting
almost the entire body.

B. Rationale of the Study

The researcher decided to choose this case because I want to acquire knowledge about
Staphylococcal scalded skin syndrome that may cause severe damage of our skin, thus
making us more prone to external acquisition of infection. I want to use the knowledge
that I acquired in promoting awareness and sharing my knowledge to the people. With
this information, people would not neglect simple wounds to become a threat for their
own safety and health.

C. Significance of the Study

This study can help Nurses in providing information about proper management and care
for patient who has the said disease. It also benefits us nursing students in gaining extra
knowledge and information that we can use in the future. It can also educate people who
lacks in information about the disease and also those people who are already
experiencing or have the possibility of having it. Every individual is vulnerable in
acquiring the disease, so everyone should be educated the importance of having a healthy
lifestyle and clean environment to decrease the number of cases of SSSS.
BIOGRAPHIC DATA
Name: Ms. A.C Age: 1 year old Weight: 11.5 kg
Birthday: October 2, 2007 Gender: Female
Civil Status: Single Religion: Roman Catholic
Address: Brgy. Punta, Calamba City

Date of Confinement: Aug, 23 2009

Time 5:50 pm

NURSING HISTORY
I. History

Ms. A.C. is a 1 year old female. She was born on October 2, 2007. Prior to her
confinement she lives with her parents at Punta, Calamba Laguna. A Filipino citizen &
her religious orientation is Roman Catholic. She has a medical insurance from Panasonic.

II. Past History

Ms. AC experienced past illnesses such as cough and colds. According to her
mother, she had a complete vaccination (BCG, OPV, DPT, AMV, and AHB). She has no
identified allergic response. There was no incident of any injuries and hospitalization in
the past.

III. Present Illness

Ms. AC experienced the scaling of her skin four days prior to admission. She was
not febrile. Three days prior to admission, wounds have started to appear. They bought
ointments to apply on the infected area for two days. Ms. AC manifested signs of fever
and was rushed to Emergency Room.

IV. Chief Complaint

Ms. AC’s chief complaint was skin lesions and fever. According to her mother,
three (3) days prior to admission, Ms. A.C. had skin lesions in the upper back, legs,
buttocks and nose. Ms. A.C. also experienced fever the day prior to admission.

V. Family History

According to Ms. AC’s father, they have history no known history of family
illnesses while Hypertension is a family illness in her maternal side.
Functional Health Pattern
A. Health Perception Pattern

Ms. AC’s mother stated that this is her baby’s first confinement. The mother
states that they self medicate using OTC drugs and will settle for hospitalization if no
progress results.

B. Nutritional-Metabolic Pattern

Ms. AC his typical daily meals before his illness begun was rice, chicken,
vegetable and commercial milk. She eats 3 times a day; morning afternoon and merienda.
She usually does not eat for supper. According to her mother, Ms. AC drinks 1 bottle of
commercial milk and 1 bottle of water per day. The mother states that “hindi pa
ngtutoothbrush yan”. Her weight was 11.5 kg. She was taking a vitamin C supplement in
syrup form.

C. Elimination Pattern

Ms. AC’s usual bowel elimination pattern was twice a day. It’s yellow in color
and not form. The frequency of urination is unidentified because she is still wearing
diapers. She usually changes diapers three times a day. There was no presence of blood in
the stool and urine.

D. Activity-Exercise Pattern

Ms. AC daily activity was playing inside and outside the house. Her exercise
includes walking in the morning and playing in the afternoon. She was very active and
alert.

E. Sleep-Rest Pattern

Mr. AC sleeps at night for 8 hours. He sleeps at 10:00 pm and rise at 6:00 am. She
sleeps continuously with no disturbances. When she needs to sleep, her mother feed her
with milk and sings lullaby. She does not take naps in the morning.

F. Role-relationship Pattern

Ms. AC lives with her parents. She is the only daughter of the family. Her needs
were supplemented by her parents. According to her parents, Ms. AC serves as their
happiness in life.
 Physical Assessment

Name: Ms. A.C Age: 1 year old

Gender: Female Weight: 11.5 kilograms

Vital Signs
Temp: 36.3◦ C
Respiratory Rate: 27
Cardiac Rate: 132

ANALYSIS and
AREA TECHNIQUE NORMS FINDINGS
INTERPRETATION

SKULL
Size, Inspection Normocephalic Rounded, Normal
shape and Palpation and symmetrical, normocephalic;
symmetry with frontal, smooth skull
of the parietal, and contour
skull occipital symmetrically
prominences;
Smooth skull
contour

Presence Palpation Smooth, uniform Has no Normal

of Inspection consistence; tenderness; no
nodules, absence of masses nor
masses, nodules or nodules
and masses
depressio
ns
 HAIR
Evenness Inspection Evenly distributed Evenly Normal
of growth, Palpation and covers the distributed hair
thickness, whole scalp; but few; does
or maybe thick or not cover the
thinness thin whole scalp
of hair

Texture Inspection Silky; resilient Silky; smooth Normal

and Palpation hair and resilient
oiliness hair.
over the
scalp
Presence Inspection No infection and No infection and Normal
of Palpation infestation infestation
infection
and
infestation

EYES
EYEBROWS

Hair Inspection Symmetrical and Symmetrical and Normal

distribution, in line with each aligned with
alignment, other; maybe each other;
skin quality black, brown or black; evenly
and blond depending distributed,
movement on race; evenly movements are
distributed symmetrical.

EYELASHES
Evenness of Inspection Evenly Turned outward Normal
distribution distributed; eyelashes: hair
and direction turned equally
of curl outward distributed.

EYELIDS

Surface Inspection Upper eyelids Able to close Normal

characteristic cover the the eyes and
s and small portion has the ability
position (in of the iris, to blink.
relation to cornea, and
the cornea, sclera when
ability to eyes open;
blink, and eyelids meet
frequency of completely
blinking) when the eyes
are closed;
symmetrical

SCLERA
Color and Inspection White in color; White sclera Normal
clarity clear; no with some
yellowish visible
discoloration; capillaries
some capillaries
maybe visible

PUPILS
Color, Inspection Color depends Pupil equally Normal.
shape, on the round.
and person’s race;
symmetry size ranges
of size from 3-7 mm,
and are equal
in size;
equally round
Light Inspection Constrict Dilates when Normal
reaction briskly/sluggis looking at far
and hly when light objects and
accommo is directed to constrict when
dation the eye, both looking at near
directly and objects.
consensual

EXTRAOCULAR MUSCLE

Eye Inspection Both eyes Eyed moves with Normal

alignment coordinated parallel
and movement in alignment.
coordinati unison, with
on parallel
alignment

EARS
Color, Inspection Color same as Same color as Normal
symmetry facial skin; the facial skin;
of size and symmetrical; tip of auricle
position auricle aligned aligned at the
with outer outer canthus of
canthus of the eye.
eye, about 10
degrees from
vertical
Texture, Palpation Mobile, firm, Smooth in Normal
elasticity and not texture, flexible
and areas tender; pinna and elastic
of recoils after it pinna; no
tenderness is folded tenderness.

NOSE

Any Inspection Symmetric Symmetric and Normal

deviation in and straight; straight; uniform
shape, size, no discharge color with no
or color and or flaring; nasal flaring.
flaring or uniform color
discharge
from the
nares
Nasal Inspection Nasal septum Nasal septum Normal
septum Palpation intact and in intact and in
middle midline.

Tenderness Palpation Not tender; No tenderness Wounds can attribute to

, masses no lesions wound present increase susceptibility to
and infection
displaceme
nts of bone
and
cartilage

MOUTH
LIPS
Symmetry Inspection Uniform pink Symmetrical; Dry and crack lips may
of Palpation color; soft, dry lips and indicate deficient fluid
contour, moist, smooth crack lower lip intake or improper oral
color and texture; hygiene
texture symmetry of
contour;
ability to
purse lips

BUCCAL MUCOSA
Color, Inspection Uniform pink Uniform pink Normal
moisture, color; moist, color; moist,
texture, smooth, soft, smooth, soft
and the glistening,
presence and elastic
of lesions texture

TEETH
Color, Inspection Teeth are Teeth are Normal
number starting to starting to grow;
and grow; white, white, shiny
condition shiny
and
presence
of
dentures
GUMS

Color and Inspection Pink gums Pink gums. Normal

condition

TONGUE

Color and Inspection Pink color; moist; Pink color; Normal

texture of slightly rough; thin moist; thin
the mouth whitish coating; whitish coating;
floor and moves freely; no moves freely;
frenulum tenderness no tenderness
Position, Inspection Central position; Geographical Patches in tongue
color and pink color; smooth tongue with may indicate
texture, tongue base with patches, central deficient fluid
movement prominent veins position intake or improper
and base of oral hygiene
the tongue

THORAX

ANTERIOR THORAX
Breathing Inspection Quiet, rhythmic, Rhythmic, quiet Normal
pattern and effortless breathing.
respirations
Temperature, Palpation Skin intact; Has intact skin; Normal
tenderness, uniform has equal
masses temperature; chest warmth on both
wall intact; no sides. No
tenderness; no masses.
masses

POSTERIOR THORAX
Shape, Inspection Anteroposterior to Symmetrical Normal
symmetry, and Palpation transverse chest.
comparison of diameter in ratio
anteroposterior 1:2; chest
thorax to symmetric
transverse
diameter

Spinal Inspection Spine vertically Spine vertically Normal

alignment aligned aligned
Temperature, Palpation Skin intact; No masses nor Wounds can cause
tenderness, uniform tenderness: has increase
masses, temperature; chest equal warmth susceptibility to
lesions wall intact; no on each side; infection
tenderness; no skin not intact
masses ; no with lesions
lesions
AXILLAE

Axillary, Inspection No tenderness, No tenderness, Normal

subclavicular, masses, or nodules masses, or
and nodules
supraclavicular
lymph nodes

ABDOMEN

Skin integrity Inspection Unblemished skin; Uniform color. Normal

uniform color

Abdominal Inspection Flat, rounded Has a flat and Normal

contour (convex) concave
abdomen

Symmetry of Inspection Symmetric contour Has a Normal

contour symmetrical
abdominal
contour.
MUSCLES
Muscle size Inspection Proportionate to Proportionate to Normal
and the body: even in the body; in
comparison both sides both sides.
on the other
Category Normal Findings Actual Findings
side
Mental Status

Tremors
Level in Inspection
of Consciousness NoAwake
tremors No tremors.
Awake Normal
the muscles

Orientation Oriented Oriented

Muscle Palpation Even and firm Firm muscle Normal

tonicity muscle tone tone

JOINTS

Joint swelling Inspection No swelling, no Absence of Normal

warmth, no swelling, pain
redness, no pain or redness.

Extremities Inspection No swelling, no Absence of Normal

Palpation warmth, no swelling,
redness, no pain. redness or pain.

Neurological Assessment

Laboratory Results

Urinalysis
Normal Findings Interpretations
Color Colorless-dark Yellow normal
yellow
Transparency Clear Clear normal
Reaction 4.6-8.0 pH Alkaline Alkalinity may be
caused by disease
and infection
Specific Gravity 1.005-1.030 1.010 Normal
Albumin absent Negative Normal
Sugar absent Negative Normal
Pus Cells 0-4 hpf 0-2/hpf Normal
RBC 0-3 hpf 0-2/hpf Normal
ANATOMY AND PHYSIOLOGY
Skin

In zoology and dermatology, skin is an organ of the integumentary system made up of a

layer of tissues that guard underlying muscles and organs. As the interface with the
surroundings, it plays the most important role in protecting against pathogens. Its other
main functions are insulation and temperature regulation, sensation and vitamin D and B
synthesis. Skin is considered one of the most important parts of the body.

Skin has pigmentation, melanin, provided by melanocytes, which absorbs some of the
potentially dangerous radiation in sunlight. It also contains DNA repair enzymes which
reverse UV damage, and people who lack the genes for these enzymes suffer high rates of
skin cancer. One form predominantly produced by UV light, malignant melanoma, is
particularly invasive, causing it to spread quickly, and can often be deadly. Human skin
pigmentation varies among populations in a striking manner. This has sometimes led to
the classification of people(s) on the basis of skin color.

The skin is often known as "the largest organ in the human body", weighing
approximately 4.5 kilograms. This applies to exterior surface, as it covers the body,
appearing to have the largest surface area of all the organs. Moreover, it applies to
weight, as it weighs more than any single internal organ, accounting for about 15 percent
of body weight. For the average adult human, the skin has a surface area of between 1.5-
2.0 square meters; most of it is between 2-3 mm thick. The average square inch of skin
holds 650 sweat glands, 20 blood vessels, 60,000 melanocytes, and more than a thousand
nerve endings. Being the outer protective covering of the body, and being exposed to the
environment, the skin is very vulnerable to growths, rashes, discolorations, cysts, burns,
injuries, infections, and other disorders. Damaged skin will try to heal by forming scar
tissue, often giving rise to discoloration and depigmentation of the skin.
Layers
The skin has two major layers which are made of different tissues and have very different
functions.

Skin is composed of the epidermis and the dermis. Below these layers lies the
hypodermis or subcutaneous adipose layer, which is not usually classified as a layer of
skin.

EPIDERMIS
 The outermost epidermis consists of stratified squamous keratinizing epithelium
with an underlying basement membrane. It contains no blood vessels, and is nourished by
diffusion from the dermis. The main type of cells which make up the epidermis are
keratinocytes, with melanocytes and Langerhans cells also present.

The epidermis can be further subdivided into the following strata (beginning with
the outermost layer): corneum, lucidum, granulosum, spinosum, basale. Cells are formed
through mitosis at the innermost layers. They move up the strata changing shape and
composition as they differentiate, inducing expression of new types of keratin genes.
They eventually reach the corneum and become sloughed off (desquamation). This
process is called keratinization and takes place within about 30 days. This layer of skin is
responsible for keeping water in the body and keeping other harmful chemicals and
pathogens out.

Blood capillaries are found beneath the epidermis, and are linked to an arteriole
and a venule. Arterial shunt vessels may bypass the network in ears, the nose and
fingertips.
DERMIS

The dermis lies below the epidermis and contains a number of structures
including blood vessels, nerves, hair follicles, smooth muscle, glands and lymphatic
tissue. It consists of loose connective tissue otherwise called areolar connective tissue -
collagen, elastin and reticular fibers are present. Erector muscles, attached between the
hair papilla and epidermis, can contract, resulting in the hair fiber pulled upright and
consequentially goose bumps. The main cell types are fibroblasts, adipocytes (fat storage)
and macrophages. Sebaceous glands are exocrine glands which produce, a mixture of
lipids and waxy substances: lubrication, water-proofing, softening and antibactericidal
actions are among the many functions of sebum. Sweat Glands open up via a duct onto
the skin by a pore.

The dermis is made of an irregular type of fibrous connective tissue consisting of

collagen and elastin fibers. It can be split into the papillary and reticular layers. The
papillary layer is outermost and extends into the epidermis to supply it with vessels. It is
composed of loosely arranged fibers. Papillary ridges make up the lines of the hands
giving us fingerprints. The reticular layer is denser and is continuous with the
hypodermis. It contains the bulk of the structures (such as sweat glands). The reticular
layer is composed of irregularly arranged fibers and resists stretching.

The hypodermis is not part of the skin, and lies below the dermis. Its purpose is to
attach the skin to underlying bone and muscle as well as supplying it with blood vessels
and nerves. It consists of loose connective tissue and elastin. The main cell types are
fibroblasts, macrophages and adipocytes (the hypodermis contains 50% of body fat). Fat
serves as padding and insulation for the body.

FUNCTIONS

1. Protection: Skin gives an anatomical barrier between the internal and external
environment in bodily defense; Langerhans cells in the skin are part of the
immune system
2. Sensation: Skin contains a variety of nerve endings that react to heat, cold, touch,
pressure, vibration, and tissue injury; see somatosensory system and touch.
3. Heat regulation: The skin contains a blood supply far greater than its
requirements which allows precise control of energy loss by radiation, convection
and conduction. Dilated blood vessels increase perfusion and heat loss while
constricted vessels greatly reduce subcutaneous blood flow and conserve heat.
Erector pili muscles are significant in animals.

DRUG STUDY
Drug’s Name Indication Contraindication Side effects Action Nursing
Consideration
Brand name: Systemic Contraindicated CNS: Penicillinase- Before giving
Bactocil infections in patients neuropathy, resistant drug, as
caused by hypersensitive to irritability, penicillin that patient if there
Generic name: staphylococci drug or other lethargy, inhibits cell- is allergic
Oxacillin penicillins dizziness, fatiguewall synthesis reaction to
sodium during penicillin.
CV: microorganis
Therapeutic thrombophlebitis. m Give drug 1-2
Class: multiplication. hours before
Anti-infective GI: oral lesions, meals or 2-3
nausea, vomiting, Bacteria resist hours after
Pharmacologic diarrhea penicillin by meals.
class: producing
Penicillins GU: nephropathy penicillinase-
enzymes that
convert
penicillin to
inactive
penicillic acid.
Oxacillin
resists these
enzymes and
inhibits the
formation of
the cell wall
preventing
binding sites
of cells, thus
prevents
multiplication.

Drug’s Name Indication Contraindication Side effects Action Nursing

 Consideration
Brand name: Treatment Contraindicated Skin: skin Bactericidal Restrict use of
Gentamycin and in patients that are irritation, drug that drug to selected
prophylaxis hypersensitive allergic disrupts patients;
Generic name: of dermatitis bacterial widespread use
Gentamicin superficial protein may lead to
sulfate infections synthesis by resistant
binding to organism
Therapeutic Treatment ribosomes.
Class: of Disruption of Prolonged use
Local anti- superficial the protein may result to
infective burns of the mechanism of overgrowth of
skin caused the bacterial non-susceptible
Pharmacologic by cell prevents organisms
class: susceptible the
Topical drugs bacteria development
and growing of
the cell leading
to death, thus,
prevents further
multiplication
Drug’s Name Indication Contraindication Side effects Action Nursing
Consideration
Brand name: Topical Contraindicated Skin: rash, Bactericidal or Clean skin
Bactifree infections, in patients pruritis, allergic Bacteriostatic before
abrasions, hypersensitive to dermatitis depending on applying the
Generic name: cuts, minor drug and patients organism and ointment
Bacitracin burns or with atopy concentration
wounds of drug. Prolonged use
Therapeutic Inhibits cell- may caused
Class: wall synthesis overgrowth of
Local anti- by disrupting non-
infective the formation susceptible
of the cell wall organisms,
Pharmacologic preventing particularly
class: binding sites Candida
Topical drugs of bacterial species
cells, thus
prevents
multiplication.

NURSING CARE PLAN

ASSESMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
S: “lage nyang Risk for The client > Encourage bed > Resting Client is free
kinakamot Infection will be able rest restores body from infection
yung sugat to be free energy, thus,
nya” stated by Risk from increasing
the mother of Factor: infection body’s
the client Broken after shift via immune
skin interventions system
O: scratching of >NANDA
skin
Open > Encouraged > Hand
wounds mother to wash washing is the
hands frequently best way to
when attending her prevent
daughter transmission
and acquiring
of
microorganism.
>Fundamen
tals of Nursing
8th Ed. Taylor

>monitoring
>check vital signs for risk factors
every 4 hours >Nursing
Process: A
Clinical Guide.
Sam

ASSESMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S: “1 bote lang Risk for After health > monitor I/O > to have a The client
ng gatas at deficient teaching, the every shift picture of the demonstrates
 tubig ang Fluid Volume client will be fluid status of compliance with
iniinom nya sa able to the client the interventions
isang araw” as Risk demonstrate applied
stated by the Factor: willingness
mther of the Low fluid to follow > Provide a sheet > promotes
client intake interventions. of paper where the awareness and
family members cooperation
O: dry scaly can list the I/O of between the
skin the client family
poor skin members of
turgor the client
dry lips
> advised the client > to increase
to drink at least 2 and maximize
bottles of water per fluid intake
day

> Advised the > alcohol

relatives to not use when applied
alcohol in cleaning to skin can
the client’s body easily
evaporate
including the
fluids, making
skin drier

>advised to change > dry skin are

positions frequenly more prone to
injuries when
pressured

>NAN
DA

ASSESMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S: “madami pa Impaired Skin After > keep the affected > moisture is The client’s skin
syang sugat Integrity R/T hospitalization, body parts clean best breeding lesions were
eh” mechanical the client’s and dry ground for healed
“kinakamot factors(lesions) skin lesions microorganism
nya lage yan will heal >Fundament
sugat nya” without an als of Nursing
as stated by complications 5th Ed. Taylor
the mother
of he client > blood
> stimulate circulation
O: open circulation to containing
wounds affected area WBC in the
Redness affected area
Swollen increases
area around body’s process
the wound of repairing

> to monitor
> Periodically the progress of
measure the wound wound healing
and see if
complications
occur.
> for quick
> administer and better
ointments healing
prescribed process

>NAN
DA
ASSESMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
S: “may Risk for Fall The client > Raise side rails > serves as The client was
kakulitan nga will be able guard to free from injury
yan bata na Risk Factors: to be free prevent falling
yan” as stated <2 years from injury
by the mother of age during shift > Assist client to >to decrease
of the client sit or sleep far chances of
from the edge of falling
O: side rails the bed
not raise
Client >Instruct the SO >learning
sleeping near on how to safety
the edge of the manipulate measures
bed (raising/lowering) promotes safe
1 year old side rails environment

> Advised the SO > Infants are at

to always watch greater risk for
the client falling because
of
developmental
issues

>NANDA
 ASSESMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
S: “konti lang Impaired The client > Advised to drink > to prevent The client’s oral
sya uminom” Oral Mucous will be able at least 3-4 bottles dehydration of mucousa was
“hindi pa Membrane to restore of fluid everyday he body restored
nagtutoothbrush” R/T integrity of
as stated by the ineffective oral mucosa > Wet lips >lubricating
mother of the oral hygiene before frequently the skin of the
client discharge lips decrease
the possibility
O: Dry lips of disruptions
Geographical
tongue > Promote oral > early
Desquamation hygiene initiation of
of lower lip proper oral
Crack on lips health
practices
lessens oral
problems

> Encourage use of > for the

pacifier stimulation of
the saliva to
lubricate the
oral mucousa

>NAN
DA
 ANTIBIOTIC
&
DRUG STUDY:
Immanuel Sy
BSN III-I
Group 3

Mrs. Jeorjet Evangelista

September 3, 2009
INTRODUCTION

Antibiotic (from the Ancient Greek: anti, "against", and bios, "life") is a substance or
compound used to treat infections caused by bacteria and other microorganisms. It usual
action is that it kills or inhibits the growth of bacteria. Originally, an antibiotic was a
substance produced by one microorganism that selectively inhibits the growth of another.
Synthetic antibiotics, usually chemically related to natural antibiotics, have since been
produced that accomplish comparable tasks.

RANGE OF ANTIBIOTIC EFFECTIVENESS

1. Narrow-spectrum antibiotic is effective against only specific families of

bacteria.
2. Broad-spectrum antibiotic refers to an antibiotic with activity against a wide
range of disease-causing bacteria. It is also means that it acts against both Gram-
positive and Gram-negative bacteria.

In some species of bacteria, the cell wall consists primarily of a thick layer of
peptidoglycan. Other species have a much thinner layer of peptidoglycan and an outer as
well as an inner membrane. When bacteria are subjected to Gram's stain, these
differences in structure affect the differential staining of the bacteria with a dye called
gentian violet. The differences in staining coloration (gram-positive bacteria appear
purple and gram-negative bacteria appear colorless or reddish, depending on the process
used) are the basis of the classification of bacteria into gram-positive (those with thick
peptidoglycan) and gram-negative (those with thin peptidoglycan and an outer
membrane), because the staining properties correlate with many other bacterial
properties.
Kinds of Antibacterial Effects and Modes of Actions
I- BACTERICIDAL EFFECT

1. Cell wall synthesis inhibitors Cell wall synthesis inhibitors generally inhibit
some step in the synthesis of bacterial peptidoglycan. Generally they exert their
selective toxicity against eubacteria because human cells lack cell walls.

Example:

Bacitracin is a polypeptide antibiotic produced by Bacillus species. It prevents

cell wall growth by inhibiting the release of the muropeptide subunits of
peptidoglycan from the lipid carrier molecule that carries the subunit to the
outside of the membrane Teichoic acid synthesis, which requires the same carrier,
is also inhibited. Bacitracin has a high toxicity which precludes its systemic use. It
is present in many topical antibiotic preparations, and since it is not absorbed by
the gut, it is given to "sterilize" the bowel prior to surgery.

2. Cell membrane inhibitors disorganize the structure or inhibit the function of

bacterial membranes. The integrity of the cytoplasmic and outer membranes is
vital to bacteria, and compounds that disorganize the membranes rapidly kill the
cells. However, due to the similarities in phospholipids in eubacterial and
eukaryotic membranes, this action is rarely specific enough to permit these
compounds to be used systemically.

II- BACTERIOSTATIC EFFECT

1. Protein synthesis inhibitors Many therapeutically useful antibiotics owe their

action to inhibition of some step in the complex process of translation. Their
attack is always at one of the events occurring on the ribosome and rather than the
 stage of amino acid activation or attachment to a particular tRNA. Most have an
affinity or specificity for 70S (as opposed to 80S) ribosomes, and they achieve
their selective toxicity in this manner.

Example:

The aminoglycosides are products of Streptomyces species and are represented by

streptomycin, kanamycin, tobramycin and gentamicin. These antibiotics exert
their activity by binding to bacterial ribosomes and preventing the initiation of
protein synthesis.

DRUG STUDY
 Drug’s Indication Contraindication Side effects Action Nursing
Name Consideration
Brand Maintenance Contraindicated CNS: Synthetic > Use
name: treatment of in headache, glucocorticoid cautiously in
Seretide asthma as hypersensitive dizziness, with potent breastfeeding
prophylactic patients nervousness, anti- client
Generic therapy migraine inflammatory
name: Patient with activity. > monitor
fluticasone For patients acute episodes GI: Inflammation client,
propionate requiring oral of asthma in abdominal is an important especially
corticosteroid which intensive discomfort, component in post-
treatment for measures are nausea, the operative or
chronic needed vomiting, pathogenesis during period
asthma of asthma. of stress, for
GU: irregular Glucocorticoid evidence of
menstrual inhibits many inadequate
cycle, cell types and adrenal
inflammation mediator response
of the pelvis production or
secretion
Resp: chest involved in the
congestion, asthmatic
dyspnea response.
These anti-
Skin: inflammatory
dermatitis, actions of
urticaria fluticasone
may
Others: fever, contribute to
influenza the efficacy in
asthma.
 Drug’s Indication Contraindication Side effects Action Nursing
Name Consideration
Brand name: For the Contraindicated EENT: dry Tiotropium is >Do not
Spiriva long-term, in patients with mouth, a long-acting, swallow
once-daily, a history of blurred antimuscarini capsules.
Generic maintenance hypersensitivity vision, c agent, which
name: treatment of to atropine or its is often >Keep
Tiotropium
bronchospas derivatives, GU: referred to as capsules away
bromide
m associated including constipation, an from heat and
with ipratropium, or urinary anticholinergic. cold (do not
(COPD), to any difficulty & It has similar freeze)
including component of retention. affinity to the
chronic this product. subtypes of >Throw away
bronchitis Others: muscarinic any unused
and increased receptors, M1 capsules that
emphysema. heart rate. to M5. In the have been
airways, it open to air.
exhibits
pharmacologi
cal effects
through
inhibition of
M3-receptors
at the smooth
muscle
leading to
bronchodilation
Drug’s Name Indication Contraindication Side effects Action Nursing
Consideration
Brand name: Acute Contraindicated Cardiac: arrhythmia Interferes with > Drug may
Avelox Bacterial in persons with action of enzymes be given
Sinusitis a history of GI: vomiting, necessary for without
Generic name: hypersensitivity abnormal liver bacterial regards to
moxifloxacin Acute replication.
to moxifloxacin function test, meal
hydrochloride Bacterial Inhibits
or any member dyspepsia, dry mouth, topoisomerases of
Exacerbation of the quinolone flatulence, oral DNA gyrase (is
> Give at he
of Chronic class of moniliasis, an enzyme that same time
Bronchitis antimicrobial constipation, super coils each day
agents. increased, anorexia, DNA) therefore
Community stomatitis, glossitis impairing > use
Acquired processes of cautiously
Pneumonia HEMIC AND bacterial DNA with patients
LYMPHATIC: replication, who has
Uncomplicat leukopenia, transcription, history of
ed Skin and eosinophilia, repair, and seizure or
Skin prothrombin decrease recombination CNS
Structure disorders
Infections METABOLIC:
increased, amylase
Complicated increased
Intra-
Abdominal MUSCULOSKELE
Infections TAL arthralgia,
myalgia
Complicated
Skin and CNS: insomnia,
Skin nervousness, vertigo,
Structure somnolence, anxiety,
Infections tremor

SKIN: rash pruritus,

sweating, urticaria

GU: vaginal
moniliasis, vaginitis
Drug’s Name Indication Contraindication Side effects Action Nursing
Consideration
Brand name: Symptomatic Systemic fungal Cardiac: Congestive Naturally Medical advice
Medrol sarcoidosis infections and heart failure in occurring should be
known susceptible patients glucocorticoids sought without
Generic name: Berylliosis hypersensitivity Hypertension (hydrocortisone delay for
Methyl and cortisone),
to components. patients
prednisolone which also have
Loeffler's GI: Peptic ulcer with exposed
salt-retaining
syndrome possible perforation properties, are
and hemorrhage used as Persons who
Fulminating Pancreatitis replacement are on
or Abdominal distention therapy in immunosuppres
disseminated adrenocortical sant, doses of
pulmonary MUSCULOSKELE deficiency corticosteroids
tuberculosis TAL Muscle states. Their should be
weakness synthetic warned to avoid
Aspiration Loss of muscle mass analogs are exposure to
primarily used
pneumonitis chickenpox or
for their potent
CNS: Convulsions measles.
anti-
Vertigo inflammatory
Headache effects in
disorders of
SKIN: Impaired many organ
wound healing. systems.
May suppress
reactions to skin tests, Glucocorticoids
Thin fragile skin, cause profound
Facial erythema, and varied
Increased sweating metabolic
effects. In
addition, they
Metabolism: Fluid modify the
retention body's immune
Potassium loss responses to
Hypokalemic diverse stimuli.
alkalosis
 Drug’s Name Indication Contraindication Side effects Nursing
Consideration
Brand name: Management of Contraindicated Cardiac: > take care to avoid
Duavent reversible in patients arrhythmia leakage around he
bronchospasm hypersensitive to mask
Generic name: drug and in those GI: nausea
ipratropium bronchial hypersensitive to > use cautiously in
bromide- asthma, soy lecithin or MUSCULOSKEL patients with angle-
salbutamol related foods such ETAL: arthralgia, closure glaucoma,
COPD. as soybeans and myalgia prostatic hyperplasia,
peanuts or bladder neck
CNS: Headache obstruction

RESP: sinusitis,
rhinitis.
dyspnea,
coughing

DRUG ACTION:

Ipratropium bromide is a potent bronchodilator, particularly in large bronchial airways;

however, some evidence suggests that it also has bronchodilator activity in small airways.
Bronchodilation results from relaxation of smooth muscles of the bronchial tree. The
extent of bronchodilation produced by ipratropium appears to be determined by the level
of cholinergic parasympathetic bronchomotor tone and by inhibition of
bronchoconstriction resulting from neural reflex activation of cholinergic pathways.

Salbutamol: Salbutamol stimulates adenyl cyclase, the enzyme which catalyzes the
formation of cyclic-3', 5'-adenosine monophosphate (cAMP) from adenosine triphosphate
(ATP). The cAMP thus formed mediates the cellular response eg, bronchial smooth
muscle relaxation. Salbutamol has been shown in most controlled studies to have more
effect on respiratory tract, in the form of bronchial smooth muscle relaxation, than
isoproterenol at comparable doses while producing fewer cardiovascular effects.

Rationale of Combination: Ipratropium bromide-salbutamol fixed-dose combination

maximizes the response to treatment in patients with bronchial asthma and chronic
obstructive pulmonary disease (COPD) by increasing bronchodilation through 2
distinctly different mechanisms ie, anticholinergic (parasympatholytic) and β2-agonist
(sympathomimetic) effects. Simultaneous administration of both an anticholinergic
(ipratropium bromide) and a β2-sympathomimetic (salbutamol sulfate) produces a greater
bronchodilator effect than when either drug is used alone.
Drug’s Name Indication Contraindication Side effects Action Nursing
Consideration
Brand name: deep vein Allergy to CARDIAC: Contains the active USE WITH
Clexane thrombosis heparin or other thrombocytopenia, ingredient CAUTION IN:
enoxaparin, which
low molecular bleeding is a type of
Generic name: pulmonary weight heparins medicine called a People over 80
enoxaparin embolism MUSCULOSKELE low molecular years of age
Bacterial TAL osteoporosis weight heparin. It is
angina infection of the used to stop blood People who are
clots forming within
heart valves and CNS: Blood clots in the blood vessels.
underweight or
Kidney the lining the spinal cord overweight
failure surrounding the Blood clots
heart SKIN: Death of skin normally only form Decreased
cells (necrosis) at the to stop bleeding that kidney function
Active major site of injection has occurred as a
result of injury to
bleeding. Decreased liver
the tissues. The
METABOLISM: clotting process is function
Recent stroke hyperkalaemia complicated and
caused by begins when blood People with
bleeding in the cells called platelets problems
clump together and
brain stopping
produce chemicals
that activate the bleeding
clotting process.
The final part of this Diabetes
process involves a
substance called People having
thrombin being
activated to produce spinal or
a protein called epidural
fibrin. Fibrin binds anesthesia
the platelets
together, forming a
blood clot. This is
the body’s way of
repairing itself
Drug’s Name Indication Contraindication Side effects Action Nursing
Consideration
Brand name: Asthma Hypersensitive CARDIAC: adenosine-non- Monitor V/S
Ansimar with ansimar palpitations, blocking anti-
and tachycardia asthmatic drug Check for chest
Generic name: hypotension with potent pains
Doxofylline CNS: dizziness, bronchodilator
drowsiness activity Monitor if
nervousness tachycardia
occurs
METABOLISM:
diaphoresis

GI: Nausea and

vomiting,