Infection Control Flashcards

Safety precautions, Antibiotics and Immune System Drugs (91 cards)

1
Q

Standard Precautions

A

Standard Precautions apply to 1) blood; 2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain visible blood; 3) nonintact skin; and 4) mucous membranes.

Use Standard Precautions, or the equivalent, for the care of all clients.

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2
Q

Handwashing

A

Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn.

Wash hands immediately after gloves are removed, between client contacts, and when otherwise indicated to avoid transfer of microorganisms to other clients or environments.

It may be necessary to wash hands between tasks and procedures on the same
client to prevent cross-contamination of different body sites.

Use soap and water for routine handwashing.

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3
Q

GLoves

A
Wear gloves (clean, nonsterile gloves are adequate) when touching blood,
body fluids, secretions, excretions, and contaminated items.

Put on clean gloves just before touching mucous membranes and nonintact skin.

Change gloves between tasks and procedures on the same client after contact
with material that may contain a high concentration of microorganisms.

Remove gloves promptly after use, before touching noncontaminated items
and environmental surfaces, and before going to another client, and wash hands immediately to avoid transfer of microorganisms to other clients
or environments.

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4
Q

Mask

A

Wear a mask and eye protection or a face shield to protect mucous
membranes of the eyes, nose, and mouth during procedures and client-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.

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5
Q

Gown

A

Wear a gown (a clean, nonsterile gown is adequate) to protect skin and to prevent soiling of clothing during procedures and client-care activities that are likely to generate splashes or sprays of blood, body
fluids, secretions, or excretions.

Remove a soiled gown as promptly as possible, and wash hands to avoid transfer of microorganisms to other clients or environments.

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6
Q

Client Care Equipment

A

Handle used client-care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous
membrane exposures, contamination of clothing, and transfer of microorganisms to other clients and environments.

Ensure that reusable equipment is not used for the care of another client until it has been cleaned and reprocessed appropriately.

Ensure that single-use items are discarded properly.

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7
Q

Linens

A

Handle, transport, and process used linen soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures and contamination of clothing and that avoids transfer of microorganisms to other clients and environments.

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8
Q

Needle disposal

A

Used needles and any “sharps” are placed directly into puncture - resistant containers. Do not recap or use two hand technique. Sharps with built-in safety features are used when available.

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9
Q

Contact Precautions

A

Contact Precautions are designed to reduce the risk of transmission of microorganisms by direct or indirect contact.

Direct-contact transmission involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person, such as occurs when personnel turn clients, bathe clients, or perform other client-care activities that require physical contact.

Direct-contact transmission also can occur between two clients.

Indirect-contact transmission involves contact of a susceptible host with a
contaminated intermediate object, usually inanimate, in the client’s environment.

In addition to Standard Precautions, use Contact Precautions, or the equivalent,
for specified clients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct
contact with the client (hand or skin-to-skin contact that occurs when performing
client-care activities that require touching the client’s dry skin) or indirect contact (touching) with environmental surfaces or client-care items in the client’s
environment.

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10
Q

Contact Precautions: Client Placement, Glove and Handwashing,

A

Client Placement:
Place the client in a private room.
When a private room is not available, place the client in a room with a client(s) who has active infection with the same microorganism but with
no other infection

Glove:
During the course of providing care for a client, change gloves after having contact with infective material that may contain high concentrations of
microorganisms (fecal material and wound drainage).
Remove gloves before leaving the client’s room and wash hands immediately with an antimicrobial agent or a waterless antiseptic agent. For a client with a C. difficile do not use an alcohol-based, hand rub because it is not effective
on C. difficile. Instead use soap and water.

After glove removal and handwashing, ensure that hands do not touch
potentially contaminated environmental surfaces or items in the client’s
room to avoid transfer of microorganisms to other clients or environments.

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11
Q

Contact Precautions: Gown and Client Transport

A

Gowns:
In addition to wearing a gown as outlined under Standard Precautions, wear a gown (a clean, nonsterile gown is adequate) when entering the
room if you anticipate that your clothing will have substantial contact with the client, environmental surfaces, or items in the client’s room, or if
the client is incontinent or has diarrhea, an ileostomy, a colostomy, or wound drainage not contained by a dressing.

Remove the gown before leaving the client’s environment.

After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces to avoid transfer of microorganisms
to other clients or environments.

Client Transport:
Limit the movement and transport of the client from the room to essential
purposes only.

If the client is transported out of the room, ensure that precautions are maintained to minimize the risk of transmission of microorganisms to other clients and contamination of environmental surfaces or equipment

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12
Q

Aire Borne Precautions

A

Airborne Precautions are designed to reduce the risk of airborne transmission of
infectious agents.

Airborne Precautions apply to clients known or suspected to be infected with pathogens that can be transmitted by the airborne route. In addition to Standard Precautions, use Airborne Precautions, for clients known or suspected to be infected with microorganisms transmitted by airborne droplet nuclei or evaporated droplets containing microorganisms that remain suspended in the air and that can be dispersed widely by air currents within a room or over a long distance.

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13
Q

Airborne Precautions: Client Placement

A

Client Placement:
Place the client in an airborne infection isolation room (AIIR), which is a private room that has: 1) monitored negative air pressure in relation to the
surrounding areas, 2) 6 to 12 air changes per hour, and 3) appropriate discharge of air outdoors or monitored high-efficiency filtration of room air
before the air is circulated to other areas in the hospital.

Keep the room door closed and the client in the room.

Client should have a private room.

When a private room is not available, place the client in a room with a client
who has active infection with the same microorganism but with no other infection.

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14
Q

Airborne Precautions: Resp Protection and Client Transport

A

Respiratory Protection:
Wear respiratory protection (N95 respirator) when entering the room of a client with known or suspected infectious pulmonary tuberculosis.

Susceptible persons should not enter the room of clients known or vsuspected to have measles (rubeola) or varicella (chickenpox) if other immune
caregivers are available. If they must enter, they should wear a respirator mask

Client Transport:
Limit the movement and transport of the client from the room to essential
purposes only.

If transport or movement is necessary, place a surgical mask on the client

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15
Q

Droplet Precautions

A

Droplet Precautions are designed to reduce the risk of droplet transmission
of infectious agents.

Droplet transmission involves contact of the conjunctivae or the mucous
membranes of the nose or mouth of a susceptible person.

Droplets are generated from the source person primarily during coughing,
sneezing, or talking and during the performance of certain procedures such as suctioning and bronchoscopy.

Transmission via large-particle droplets requires close contact between source and recipient persons, because droplets do not remain suspended
in the air and generally travel only short distances, usually 3 ft or less, through the air.

Because droplets do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission.

Droplet Precautions apply to any client known or suspected to be infected with pathogens that can be transmitted by infectious droplets.

In addition to Standard Precautions, use Droplet Precautions, or the equivalent, for a client known or suspected to be infected with microorganisms transmitted by droplets.

Place the client in a private room.

When a private room is not available, place the client in a room with a client(s) who has active infection with the same microorganism but with no
other infection.

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16
Q

Droplet Precautions: Mask and Client Transport

A

In addition to wearing a mask as outlined under Standard Precautions, wear a mask when working within 3 ft of the client. (Logistically, some hospitals may want to implement the wearing of a mask to enter the room.)

Limit the movement and transport of the client from the room to essential purposes
only.

If transport or movement is necessary, place a surgical mask on the client.

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17
Q

Amebiasis/Dysentery

A

Contact precautions.

Spread through Feces.

Isolated for duration of illness until symptom free.

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18
Q

Bronchiolitis

A

Contact Precautions (for infants and young children only).

Spread through respiratory secretions.

Duration of illness until
symptom free. If respiratory
syncytial virus (RSV) antigen positive, refer to RSV.

Various etiologic agents have been associated with this syndrome, i.e., respiratory syncytial virus (RSV), parainfluenza viruses,
adenoviruses, influenza viruses.

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19
Q

Chickenpox (Varicella)

A

Airborne and Contact
Precautions

Airborne droplets and skin lesions are infective

Isolated until all lesions are crusted (at least 5 days after onset of lesions)

Susceptible persons should not enter the room. Persons immune from previous varicella infection may enter the room without a mask. Those immune by vaccination should wear a mask when entering the room. A specially vented room is necessary. The door
to the client’s room should remain closed. The client must wear a mask when leaving their room. Susceptible clients who have been exposed should be placed on Airborne Precautions beginning 10 days after exposure and continuing through day 21 after last
exposure (up to 28 days if VZIG has been given). Clients are
considered infectious 2 days before onset of rash and up to 5 days after onset of lesions. After exposure, use varicella zoster immune
globulin (VSIZ) as recommended by Infectious Diseases Service.

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20
Q

Clostridium difficile enterocolitis

A

Contact Precaution

Spread through feces

Isolated until symptom- free

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21
Q

Common Cold

A

Droplet Precautions (for infants and young children only)

Spread through respiratory secretions

Isolated for duration of illness until symptom free

Rhinoviruses are most frequently associated with the
common cold. Infection is usually mild in adults, but may be severe in infants and young children. Other etiologic agents
such as respiratory syncytial virus (RSV) and parainfluenza
viruses may also cause this syndrome.

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22
Q

Conjunctivitis,

viral (acute hemorrhagic)

A

Contact Isolation

Spread through eye drainage

Isolated until symptom free

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23
Q

Decubitus

ulcer, infected, major

A

Contact Isolation

Spread through Wound drainage

Isolation depends on the extent and condition of the
ulcer.

Major: No dressing or dressing does not adequately
contain drainage.

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24
Q

Diphtheria: Cutaneous

A

Contact precautions - Wound Drainage

Isolation until cultures from infected sites are negative for
Corynebacterium diphtheriae
on two separate days. Collect
cultures > 24 hours apart and
not sooner than 24 hours after
the last dose of antibiotics.
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25
Diphtheria: Pharyngeal
Droplet precautions - Respiratory secretions ``` Isolation until cultures from infected sites are negative for Corynebacterium diphtheriae on two separate days. Collect cultures > 24 hours apart and not sooner than 24 hours after the last dose of antibiotics. ```
26
Ebola
Contact and Droplet Precautions Infective material is Direct contact through broken skin or mucous membranes (eyes, nose and mouth) Blood and body fluids Objects contaminated with Ebola virus (needles/syringes) Infected animals Isolated for duration of the illness Client rooms should have negative pressure and contain their own lab facilities. Those treating clients or entering room should wear PPE: full-body, hazmat suits. Droplet precautions are needed, but health care providers would also wear a special respirator mask that filters airborne particles, such as an N95 mask. Client needs dedicated medical equipment (preferably disposable)
27
Epiglottitis
Droplet Precautions Spread through respiratory secretions Isolated until 24 hours after start of effective therapy Epiglottis is often due to Haemophilus influenzae. Treatment for both systemic infection and carrier state is needed. For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
28
Escherichia coli gastroenteritis eropathogenic, enterotoxigenic, enteroinvasive, entero hemorrahagic
Contact Precautions Spread through feces
29
Fifth’s Disease/ Erythema Infectiosum (Parvovirus B19)
Droplet Precautions Spread through respiratory secretions Isolated until onset of rash (not considered infectious after appearance of rash).
30
German Measles (Rubella)
``` Droplet Precautions (does not require room with negative pressure and external exhaust) ``` Spread through Respiratory secretions and urine Isolated for 7 days after onset of rash Susceptible persons should not enter the room. Persons immune by vaccination or natural illness may enter the room without a mask. Susceptible clients who have been exposed should be placed on Droplet Precautions beginning 7 days after exposure and continuing through day 21 after last exposure. Clients are considered infectious a few days before to7 days after onset of rash
31
German Measles - Congenital Rubella
``` Contact Precautions (does not require room with negative pressure and external exhaust) ``` Spread through Respiratory secretions and urine ``` Isolation is required during any admission for the first year after birth, unless nasopharyngeal and urine cultures after 3 months of age are negative for rubella ``` Susceptible persons should not enter the room. Persons immune by vaccination or natural illness may enter the room without a mask. Susceptible clients who have been exposed should be placed on Droplet Precautions beginning 7 days after exposure and continuing through day 21 after last exposure. Clients are considered infectious a few days before to7 days after onset of rash.
32
Haemophilus influenzae, invasive - Epiglottitis
Droplet Precautions Spread through Respiratory secretion Isolated until 24 hours after start of effective therapy Treatment for both systemic infection and carrier state is needed. For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
33
Haemophilus influenzae, | invasive - Meningitis
Droplet Precautions Spread through Respiratory secretion Isolated until 24 hours after start of effective therapy Treatment for both systemic infection and carrier state is needed. For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
34
Haemophilus influenzae, | invasive - Pneumonia
Droplet Precautions Spread through Respiratory secretion Isolated until 24 hours after start of effective therapy Treatment for both systemic infection and carrier state is needed. For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
35
Hand, foot, and | mouth disease
Contact Precautions Spread through respiratory secretions feces Isolated for 7 days after onset
36
Hepatitis, Viral - Type A
Contact Precautions (for diapered or incontinent clients) Spread through Feces Isolated for duration of the illness
37
Herpes Simplex -Mucocutaneous Disseminated | severe or primary
Contact Precautions Spread through lesion secretions Isolated until symptom free
38
Herpes Simplex - Neonatal
Contact Precautions Isolated until lesions dry and crusted
39
Herpes Zoster (Shingles) - Disseminated
Airborne and Contact Precautions Spread through Lesion and respiratory secretions Isolated until all lesions are crusted Persons susceptible to varicella should not enter the room. Clients who have been exposed should be managed in consultation with Infection Control.
40
Impetigo
Contact Precautions Spread by lesions Isolated for 24 hours after start of effective antibiotic therapy.
41
Influenza
Droplet Precautions Spread through respiratory secretions Isolated until symptom free In the absence of an epidemic, influenza may be difficult to diagnose on clinical grounds. During epidemics, the accuracy of diagnosis increases. Co-horting of clients may be considered during periods of high census. Immunization is strongly encouraged for health care providers and clients at risk for serious complications. Contact Infectious Diseases Service for recommendations regarding the use of prophylaxis for non-immunized persons.
42
Lice
Contact Precautions Spread through infested area Isolated until effective treatment has been completed and room/ personal items adequately disinfected. Employees with direct contact should be examined for infestation. Clothing and bedding may be disinfected by machine washing and drying *use hot cycles). Dry cleaning or storing items in a plastic bag for 10 days is also effective. Use of an environmental insecticide is not needed.
43
Measles ( Rubeola, Red Measles)
``` Airborne Precautions (use a monitored room with negative pressure and external exhaust) ``` Spread through respiratory secretions Isolated for 4 days after onset of rash. For immunocompromised patients, maintain precautions for duration of illness. Promptly notify Infection Control. Susceptible persons should stay out of the room. All other persons should wear a mask upon entry. A specially vented room is necessary. The client must wear a mask when leaving the room. The door to the client’s room should remain closed. Susceptible clients who have been exposed should be placed on Airborne Precautions beginning 5 days after exposure and continuing through day 21 after last exposure. Clients are considered infectious 4 days before to 4 days after onset of rash.
44
Meningococcal pneumonia | Neisseria meningitidis
Droplet Precautions Spread through respiratory secretions Isolated until 24 hours after the start of effective therapy Treatment for both system infection and carrier state is needed. For recommendations regarding prophylaxis after exposure, call infectious Diseases Service (for clients and family) and Occupational Health (for employees).
45
Meningococcemia (meningococcal sepsis) (Neisseria meningitidis)
Droplet Precautions Spread through Respiratory Secretions Isolated until 24 hours after start of effective therapy Treatment for both systemic infection and carrier state is needed. For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
46
Meningitis | Haemophilus influenzae, known or suspected
Droplet Precautions Respiratory secretions Isolated until 24 hours after start of effective therapy Treatment for both systemic infection and carrier state is needed. For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees)
47
Meningitis Neisseria meningitis (meningococcal), known or suspected
Droplet Precautions Respiratory Secretions Isolated until 24 hours after start of effective therapy Treatment for both systemic infection and carrier state is needed. For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees)
48
Meningitis Viral (aseptic or nonbacterial)
Contact Precautions ( For infants and young children only) Feces Isolated for duration of illness until symptom free Enteroviruses are the most common cause of aseptic meningitis.
49
Mumps
``` Droplet Precautions (does not require a room with negative pressure and external exhaust) ``` Feces Isolated for 9 days after onset of swelling. Susceptible personnel who have been exposed should be excluded from work from the 12th day after exposure through the 26th day after exposure, or if symptoms develop until 9 days after the onset of parotitis.
50
Methicillin-resistant Staph. Aureus (MRSA) infection or | colonization
Contact Precautions Wound drainage and/or secretions/ excretions from colonized/infected sites ``` Until 2 cultures obtained after completion of antibiotic treatment are negative on 2 separate days, from all previously colonized/ infected sites (including nasal colonization, if applicable). ``` ``` Previously positive clients must be placed on Contact Precautions when readmitted to the hospital until repeat cultures are negative as per criteria under “Duration of Isolation.” ```
51
Vancomycin resistant | enterococcus (VRE)
Contact Precautions Wound drainage and/or secretions/ excretions from colonized/infected sites ``` Until 2 cultures obtained after completion of antibiotic treatment are negative on 2 separate days, from all previously colonized/ infected sites (including nasal colonization, if applicable). ``` ``` Previously positive clients must be placed on Contact Precautions when readmitted to the hospital until repeat cultures are negative as per criteria under “Duration of Isolation.” ```
52
Necrotizing Fasciitis
Contact Precautions ``` Rarely spread from person to person. Direct contact through broken skin or mucous membranes (eyes, nose and mouth) Blood and body fluids Objects contaminated with bacteria(needles/ syringes) ``` Isolated for duration of illness until symptom free and wounds healed. ``` Group A strep is considered the most common cause, but can also be caused by Klebsiella, Clostridium, E coli, Staph aureaus and Aeromonas hydrophila. Good wound care is the best prevention. Prompt treatment with IV antibiotics is needed. Patients are usually managed in a burn center or surgical ICU setting. ```
53
Pharyngitis
``` Droplet Precautions (for infants and young children only) ``` Respiratory Secretions Isolated until 24 hours after start of effective treatment
54
Plague (Pneumonic)
Droplet Precautions If client requires transport, must have mask on.
55
Pneumonia (Adenovirus)
Droplet and Contact Precautions (for infants and young children only) Respiratory secretions and feces Isolated until symptom free
56
Pneumonia (Bacterial)
Droplet Precautions (for infants and young children only) Respiratory Secretions Isolated until symptom free
57
Pneumonia ( Etiology unknown)
``` Droplet Precautions (for infants and young children only). Use Contact Precautions during RSV season, during an RSV outbreak, or if RSV is in the diagnostic differential. Resume Droplet Precautions if RSV is ruled out. ``` Respiratory Secretions Isolated for duration of illness until symptom free. If respiratory syncytial virus (RSV) antigen positive, refer to RSV.
58
Pneumonia ( Haemophilus influenzae)
Droplet Precautions (for infants and young children only) Respiratory Secretions Isolated until 24 hours after start of effective therapy
59
Pneumonia (Herpes Simplex)
Droplet Precautions Respiratory secretions Isolated until symptom free
60
Pneumonia - Meingococcal
Droplet Precautions Respiratory Secretions Until 24 hours after the start of effective therapy
61
Respiratory syncytial virus (RSV) infection or suspected
Contact precautions Respiratory secretions ``` Until symptom free and nasopharyngeal antigen test is negative for RSV (at least 1 week after positive test) on 2 consecutive days. ``` To avoid the possibility of false-negative test results, the “calgi swab” method should be used to obtain nasopharyngeal specimens.
62
Rotavirus infection
Contact Precautions Feces Duration of illness and stool study negative for rotavirus on 2 separate days
63
SARS
Airborne and contact precautions with goggles over eyes Respiratory droplets
64
Scabies
Contact Precautions Infested area Isolated for 24 hours after start of effective therapy and room/ personal items adequately disinfected. Employee with direct contact should be examined for infestation. Clothing and bedding may be disinfected by machine washing and drying (use hot cycles). Dry cleaning or storing items in a plastic bag for 10 days is also effective. Use of an environmental insecticide is not needed.
65
Scarlet Fever
Droplet Precautions (for infants and young children only) Respiratory Secretions Isolated for 24 hours after effective therapy
66
Smallpox
Airborne and Contact precautions (strict gown/ glove) Spread through large and small respiratory droplets, skin lesions, secretions. Isolated from onset of rash to separation of scabs (approximately 3 weeks) Private rooms preferred. In event of large outbreak, clients with same diagnosis can share respiratory isolation room. Limit client transport, if necessary, client wears mask
67
Syphilis
Skin and mucous membrane, including congenital, primary, and secondary Contact Precautions Lesion secretions, blood, body fluids spread the disease Isolated for 24 hours after start of effective therapy
68
``` Tuberculosis: Pulmonary, confirmed or suspected (sputum smear is AFB positive and/ or chest x-ray appearance strongly suggests active TB, i.e., cavitary lesions; or laryngeal. ```
``` Airborne Precautions (use a monitored room with negative pressure and external exhaust) ``` Spread through Airborne droplet nuclei A specially vented room is necessary. The door to the patient’s room should remain closed. Persons entering the room should wear specially fitted NIOSH approved respiratory protection. The client should leave the room only for essential purposes, particularly if the client has multidrug-resistant TB. When leaving the room, the client should wear a high-filtration surgical mask; for mechanically-supported ventilation, add a bacterial filter to filter the client’’ exhaled air.
69
Typhoid Fever (Salmonella typhi)
Contact precautions (for diapered and incontinent children) Spread through feces Isolated for duration of illness - symptom free
70
Whooping cough (pertussis)
Droplet Precautions Spread through respiratory secretions Isolated for 7 days after start of effective therapy For recommendations regarding prophylaxis after exposure, call Infectious Diseases Service (for clients and family) and Occupational Health (for employees).
71
Zika Virus
Standard/Contact Precautions only - unless in the labor and delivery setting. Apply practices and personal protective equipment (PPE) to prevent exposure as indicated by labor and delivery procedure. Spread through Body fluids (blood, urine, saliva and amniotic fluid). ``` Pregnancy: Men should wait for 6 months after symptoms started (if they get sick) before trying to conceive with their partner. Women should wait at least 8 weeks after travel (or 8 weeks after symptoms started if they get sick) before trying to get pregnant. The waiting period is longer for men because Zika stays in semen longer than in other body fluids. ``` Patients post exposure should protect themselves for 3 weeks from mosquito bites order to prevent further spread of virus. Zika virus is primarily transmitted through the bite of the mosquito, but sexual transmission has also been documented. Zika virus RNA has been detected in body fluids (blood, urine, saliva and amniotic fluid). Zika can also be spread during pregnancy from mother to fetus causing birth defects. There are no reports of transmission through breastfeeding. CDC does not recommend Zika virus testing for asymptomatic men, children, or women who are not pregnant.
72
Aminoglycosides: Tobramycin (Nebcin), Gentamycin (Garamycin), Neomycin, Amikacin (Amikin), Streptomycin*
``` Common Uses: Serious gram (-) infections Given parenterally for systemic use. *Generally restricted to TB treatment. ``` Contraindications: Renal disease Hearing impairment Pregnancy Interactions: Increased risk of ototoxicity with loop diuretics. Increased risk of nephrotoxicity with furosemide. ``` MoA: Interferes with protein synthesis in bacterial cells. DisAdvantages: Can cause irreversible ototoxicity and nephrotoxicity. Poorly absorbed from the GI tract. Baseline hearing test recommended ``` Side Effects: Confusion Depression, Numbness Vertigo Nausea/Vomiting ``` Adverse Effects: Seizures Ototoxicity Nephrotoxicity Renal failure Anaphylaxis ``` ``` Interventions: Monitor peak and trough levels. Monitor BUN and Creatinine levels. Increase fluids to 1500-2000 mL per day. I&O Daily weight ``` Education: Teach to report headache or dizziness. Drink adequate fluids.
73
Antibacterial/Antiprotozoal : Metronidazole
``` H-pylori/GI tract disorders UTI Septicemia Meningitis ``` Contraindication: Pregnancy Hepatic Disease PO/IV/Topical Interactions: Avoid alcohol and alcohol containing medications for at least 48 hours after treatment complete. MoA: Impairs DNA function of susceptible bacteria Advantages: Dual action on bacteria and protozoa (parasites). ``` Side Effects: Dark/reddish brown urine Nausea/vomiting Metallic or bitter taste Headache Dizziness Depression Irritability Insomnia ``` Adverse Effects: Thrombophlebitis Bone marrow suppression Neurotoxicity Interventions: Monitor urine output and color changes Assess ECG and neuro changes during medication administration Proper handwashing and hygiene after bowel cleansing. Education: DO NOT use alcohol or medications with alcohol for 48 hours after treatment complete. Teach that urine may turn dark/reddish brown in color May have metallic or bitter taste in mouth Use proper hygiene with bowel movements and cleansing
74
Vancomycin
``` DOC for MRSA Cellulitis Bone infections Colitis Meningitis ``` Contraindications: Pregnancy Renal disease ``` PO/IV Interactions: Interacts with some vitamins and herbal products. Avoid use when on Amikacin, gentamicin or streptomycin. ``` MoA: It works by killing bacteria or preventing bacterial growth. Best for severe Gram + infections ``` Side Effects: Dry mouth Muscles cramps Diarrhea Nausea/vomiting Abdominal cramping Headache Flushing Hypotension Tachycardia ``` Adverse: Blloody urine - Nephrotoxicity Loss of hearing - Ototoxicity Anaphylaxis ``` Interventions: Monitor peak and trough levels. Infuse over at least 60 minutes on an infusion pump. Monitor BUN and Creatinine levels. Increase fluids to 1500-2000 mL per day. I&O, Daily weight Baseline hearing test recommended ``` ``` Education: Teach to report headache or dizziness. Drink adequate fluids. Report bloody urine or dizziness, ringing in the ears or loss of hearing ```
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``` Antihelminthics: Mebendazole (Vermox) Ivermectin (Stromectol) Pyrantel pamoate (Pin-X) ```
``` Parasites: pinworms, tapeworms, hookworms, roundworms Trichinosis ``` ``` Don't use in children under 2 PO Interactions: Effectiveness decreased by some anticonvulsants. Increased absorption with high fat meal. ``` MoA: Inhibits glucose uptake and degeneration of microtubules in the cell: parasite dies and is excreted. Advantages: Treatment is easy and usually well tolerated by all requiring medication. Side Effects: Diarrhea Abdominal pain Nausea/vomiting Dizziness Headache Adverse: Seizures (rare) Intestinal blockage as parasited die Interventions: Entire family and close contacts must be treated to prevent reinfestation Proper handwashing and hygiene with bowel movements Monitor stools for presence of worms/parasites Monitor CBC, BUN, Creatinie and liver enzymes during treatment EDucation: Teach proper hygiene and cleansing of clothes and linens to prevent reinfestation. Infected person should sleep alone until treatment complete. Teach to wear shoes when out doors Teach proper cleansing of fresh fruits and vegetables
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Antivirals - HIV : Zidovudine or AZT | Retrovir
HIV/AIDS Unlabeled uses: Epstein-Barr virus Hepatitis B Contraindications: Pregnancy PO/IV/30-60mins ``` Interactions: Bone marrow depression with antineoplastics. Decreased platelets and granulocytes ``` MoA: Inhibit viral replication and prevents synthesis of DNA of the HIV virus Disadvantages: Does not cure AIDS but will control symptoms: compliance with treatment required. ``` SIde Effects: Nausea/vomiting Diarrhea Anorexia Flatulence Rash Flushing Headache Dizziness Dyspepsia Insomnia ``` ``` ADverse Effects: Seizures Hepatomegaly Anemia/Granulocytopenia Anaphylaxis ``` Nursing Interventions: Monitor Vital signs and signs of bleeding problems Monitor CBC, BUN and creatinine closely Education: Teach that GI complaints and insomnia resolve after 3-4 weeks of treatment. Report symptoms of suprainfections Teach to not take with OTC products like Tylenol or aspirin.
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Broad Spectrum Antibiotics: Clindamycin
Oral/Skin Infections Contraindications: Pregnancy Breast feeding Hepatic Disease ``` PO/IM/IV/Topical Interactions: Blocked by erythromycin, chloramphenicol. Decreases absorption of kaolin. ``` MoA: Inhibition of bacterial protein synthesis. These drugs are bacteriostatic and suppress bacterial growth. Advatages: Can be used to treat MRSA ``` Side Effects: Dry mouth Muscles cramps Diarrhea Nausea/vomiting Abdominal cramping Headache Flushing Anorexia Rash ``` ``` ADverse Effects: Pseudomembranous colitis Stevens-Johson syndrome Exfoliative dermatitis Suprainfections ``` Interventions: Culture before medication started for accurate results Monitor Vital signs, urine output and stools Monitor AST, ALT if on long term therapy Assess for skin reactions frequently ``` EDucation: Take with food to reduce GI upset Complete entire course of medication Take with full glass of water Report any symptoms of suprainfections and extreme diarrhea ```
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``` Cephalosporins: 4 Generations: 1st: cefazolin sodium (Ancef); cephalexin (Keflex) 2nd: cefaclor (Ceclor) 3rd: cefixime (Suprax); ceftriaxone (Rocephin) 4th: cefepime (Maxipime) ```
Septicemia UTI’s Respiratory infections Skin/bone infections ``` PO/IM/IV Interactions: Some interact with alcohol. Uricosurics increase the excretion rate of uric acid and can decrease the excretion of cephalosporins causing serum level increase ``` ADvantages: Usually well tolerated when other antibiotics cannot be administered Disadvantages: Frequent cross hypersensitivity to penicillins ``` Side Effects: Nausea/vomiting Diarrhea Anorexia Flatulence Rash Flushing Headache Dizziness Dyspepsia ``` ``` Adverse Effects: Increased bleeding Nephrotoxicity Seizures Anaphylaxis Leukopenia/Neutropenia ``` Interventions: Culture the infected area before medications are started. Monitor for adverse reactions and/or super infections Education: Keep drugs out of reach of children Report sign of superinfections like mouth ulcers or anal discharge Advise use of probiotics when taking medications. Take medications with food if GI upset occurs
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``` Fluoroquinolones: Ciprofloxacin (Cipro,Septra) Gatifloxacin (Tequin, Zymar) Levofloxacin (Levaquin) Moxifloxacin (Avelox) ```
``` Common Uses: Broad spectrum antibiotic Anthrax Respiratory infections Cystic Fibrosis ``` Contraindications: Pregnancy Infants and young children PO/IV/Topical Interactions: Antacids, minerals and multivitamins interfere with absorption. Concurrent use with amiodarone, disopyramide. Erythromycin, some antipsychotics and tricyclic antidepressants increases risk of torsade de pointes in susceptible individuals. Concurrent use with corticosteroids may increase risk of tendon rupture. ``` Side Effects: Diarrhea Nausea/vomiting, Abdominal pain Dizziness Drowsiness Sleep problems Headache ``` ``` Adverse Effects: Suprainfection Phototoxicity Cardiotoxicity Tendon/joint toxicity (associated with a small risk of tendon rupture ``` Interventions: Monitor I&O Monitor BUN and creatinine levels Store medication away from heat, moisture, and direct sunlight CLient Education: Take with a full glass of water. Do not take on an empty stomach. Notify primary healthcare provider of swelling of the face and throat, swallowing problems, shortness of breath, rapid heartbeat, tingling of fingers or toes, itching or hives. Stop taking the medicine immediately if swelling in tendon occurs. Avoid being in direct sunlight and use a sunscreen; do not use tanning beds. Do not take antacids that contain aluminum, calcium or magnesium
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Macrolides: Azithromycin (Z-Pak, | Zithromax) Clarithromycin (Biaxin) Erythromycin (Erythrocin)
``` Broad-spectrum Antibiotic for Pneumonia, pertussis, diphtheria, chlamydia, Group A strep infections. ``` ``` Interactions: Increases the plasma levels of theophylline, carbamazepine, and warfarin. Conversely, plasma levels of erythromycin can be reduced when used with verapamil, diltiazem, HIV protease inhibitors and azole antifungal drugs. Contraindicated with astemizole, cisapride, pimozide or terfenadine. ``` MoA: Inhibition of bacterial protein synthesis. These drugs are bacteriostatic and suppress bacterial growth and replication but do not cause microbial death. Advantages: Good alternative for clients with penicillin allergies Side Effects: Nausea/vomiting Diarrhea Abdominal pain ``` Adverse Effects: Suprainfections Hepatotoxicity Dysrhythmias (prolonged Q-T interval) Ototoxicity Anaphylaxis Pseudomembranous colitis ``` Interventions: Administer on an empty stomach -destroyed by gastric acids and acidic fruit juice. Education: Notify primary health care provider if prolonged diarrhea occurs. For capsule administration, take 1-2 hours before meals. Direct sunlight (UV) exposure should be minimized during therapy.
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Non-HIV Antivirals : Rimantacine HCL (Flumadine) Oseltamivir phosophate (Tamiflu) Acyclovir (Zovirax)
Influenza Herpes viruses Cytomegalovirus (CMV) ``` PO/IV Interactions: Decreases effect of phenytoin. Increases nephro-neurotoxicity with aminoglycosides, probenecid and interferon. ``` MoA: Inhibit viral replication by interferring with viral cell synthesis Disadvantages: Cannot stop the viral infection but will reduce the severity of symtoms and length of infection. ``` Side Effects: Nausea/vomiting Anorexia Diarrhea Headache Agitation Lethargy Rash Pruritis ``` ``` Adverse: Anemia Crystalluria Nephrotoxicity Thrombocytopenia Leukopenia ``` Interventions: Monitor Vital signs and urine output closely Monitor CBC, BUN, creatinine and liver enzymes Increase fluid intake to 1500-2000 mL per day Assess gums for bleeding EDucation: Teach proper hydration while taking medications Report changes in urine output or signs of bleeding Report CNS changes and safety related to orthostatic hypotension
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``` Penicillin: Ampicillin (Principen), Amoxicillin (Amoxil, Trimox), Penicillin G (Bicillin), Penicillin V (PenVK), Ampicillin/Sulbactam (Unasyn), Amoxicillin/ Clavulanate (Augmentin), Ticarcillin (Ticar), Peperacillin/ Tazobactam (Zosyn) ```
``` Used in: Meningitis Gram (+) infections Respiratory infections Endocarditis Septicemia Otitis media GI infections GU infections ``` Interactions; Give separately from aminoglycosides: May inactivate medication ``` Side Effects: Mild rash Nausea/vomiting Diarrhea Stomatitis Vaginitis ``` ``` Adverse Effects: Anaphylaxis Glomerulonephritis Bone marrow depression Leukopenia ``` Interventions: Administer with water, not acidic juices. Administer around the clock on empty stomach for better absorption. I&O Monitor CBC EDucation: Take medication with plenty of water 1-2 hours before meals or 2-3 hours after meals). Report sore throat, fever, fatigue, diarrhea as they may indicate superinfection
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Sulfonamides: Trimethoprim/ Sulfamethoxazole (Bactrim, Septra) Sulfisoxazole (Gantrisin)
``` UTI’s Ear infections Newborn eye prophylaxis Respiratory infections ``` ``` PO/IV/topical Interactions: Risk of thrombocytopenia with thiazide diuretics; hyperkalemia with other diuretics ``` MoA: Bacteriostatic - inhibit bacterial synthesis of folic acid which is essential for bacterial growth. Advantages: Good for client with penicillin allergy ``` Side Effects: Nausea/vomiting Diarrhea Anorexia Crystalluria Rash Flushing Headache Dizziness Dyspepsia Photosensitivity ``` ``` Adverse Effects: Nephrotoxicity Hyperkalemia Stevens-Johnson syndrome Anaphylaxis ``` Nursing interventions: Increase fluids to 2000-3000 mL per day Assess I&O, BUN and creatinine regularly Monitor Vital signs closely Assess for early signs of anemia or superinfections Education: Drink lots of fluid daily when taking medications Take 1 hour before or 2 hours after meals Wear sunglasses and avoid direct sunlight Report any excess bruising or bleeding
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Tetracyclines : Doxycycline (Vibramycin) Tetracycline (Sumycin)
Broad spectrum use Respiratory infections Skin infections STD/STI’s Contraindicated in Pregnancy and Hepatic disease Interactions: Do not take with antacids or calcium products ``` Side Effects: Nausea/vomiting Diarrhea Abdominal pain Stains teeth Color vision changes ``` Adverse: ``` Nephrotoxicity Hepatotoxicity Suprainfections Anaphylaxis Severe Photosensitivity Hyperglycemia ``` Interventions: Monitor Vital signs and urine output closely Monitor liver and renal function lab tests Avoid antacids and calcium products when taking medication EDucation: Teach whether medication prescribed should be taken with food or without and time frame for best absorption. Avoid sun and use sunglasses/WEAR LONG SLEEVES Do not take with milk products, iron or antacids Take liquid forms via straw to prevent staining of teeth Do not take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking doxycycline. Absorption will be altered. For instance, iron can bind to doxycycline in the gastrointestinal tract, which may prevent their absorption into the bloodstream and possibly reduce their effectiveness. To avoid or minimize the interaction, iron containing medications and doxycycline should preferably be taken at least three hours apart in most cases. Take on an empty stomach to maximize absorption, although may not be tolerated unless administered with food.
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Antiviral Monoclonal Antibody : Palivizumab (Synagis) RSV Immune globin (RespiGam)
``` Prevents RSV in premature infants and infants born with certain lung disorders or heart disease. ``` Contraindications: Bleeding or clotting disorders Low platelet count IM MoA: A man-made antibody to respiratory syncytial virus (RSV). ``` Side Effects: Fever Crying or fussiness Change in appetite or sleeping patterns ``` Adverse Effects: Cyanosis Black tarry stools Bleeding gums Interventions: Dosage is based on weight of infant and must be calculated with every dose Education: Must take it monthly during the RSV season – November through April Local reactions may occur to injection: tenderness, hives and swelling May interfere with other live vaccines and may need to revaccinated if taken with 10 months after completed
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Biologic: adalimumab | Humira
Crohn’s disease, Psoriatic arthritis Rheumatoid arthritis Sub Q Interactions: Anakinra (Kineret) also used to treat rheumatoid arthritis, vaccines MoA: Biologics work by targeting and blocking the effects of a protein in your body called TNF – alpha. In autoimmune disorders, there is too much of this protein which can cause the body to attack itself. In rheumatoid arthritis, too much of this protein can cause pain, stiffness and swelling in the joints. In ulcerative colitis or Crohn’s, adalimumab can decrease the symptoms and put the client in remission Advantages: Provide very specific targeting of the involved cells Disadvantages: Expensive and not always covered by insurance. Significant adverse symptoms. ``` Side Effects: Headache Nausea Sinus infections Rash at the injection site ``` Adverse Effects: Cancers Sepsis Fungus and other opportunistic infections Interventions: Check for injection site reactions. Assess for TB prior to therapy Assess for blood dyscrasias: CBC, differential periodically Education: Learn proper administration of med in the thigh, abdomen and upper arm Rotate sites at least one inch from old site. Advise no vaccines Report signs of infection immediately
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Immune Serum : Tetanus Immune | Globulin (Baytet)
Exposure to tetanus IM/ 2 days Interactions: These vaccines may not work as well if received shortly after a tetanus injection: Measles, mumps, rubella (MMR), poli MoA: Tetanus immune globulin works by giving your body the antibodies it needs to protect it against tetanus infection. This is called passive protection. This passive protection lasts long enough to protect your body until your body can produce its own antibodies against tetanus. ``` Side Effects: Itching Redness at injection site Anorexia Mild fever Pain at injection site ``` ``` Adverse Effects: Facial edema Difficulty swallowing Tightness of chest Dyspnea ``` Interventions Monitor for signs of significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Education: Reason for medication Educate client about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat).
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Immune System Agents/ Immunosuppressant/ Anti-rejection: tacrolimus (Prograf) cyclosporine (Sandimmune
Autoimmune diseases Prevent organ transplant rejection ``` Contraindications: Hypersensitivity Use cautiously in: Diabetes, HTN Hyperkalemia Hyperuricemia ``` ``` PO/IV Interactions: Aminoglycosides: increased toxicity Antifungals and calcium channel blockers: increase blood levels Vaccines decrease effect ``` ``` Side Effects: Insomnia Back pain Fever UTI’s Nausea/vomiting Muscle spasms ``` ``` Adverse Effects: Infection Hypertension Hepatotoxicity Nephrotoxicity Pulmonary edema ``` Interventions: Monitor liver functions test: AST, ALT, amylase, and bilirubin Monitor serum creatinine and BUN and output - 75% of patients will experience a decrease in urinary output Watch for anaphylaxis Monitor blood studies Education: Advise to report if pregnancy is planned Report fever, rash, severe diarrhea, chills, sore throat, because serious infections can occur. Report clay colored tools or cramping as it may indicate hepatotoxicity. Avoid crowds or persons who are sick to reduce infections. Avoid eating raw shellfish.
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Vaccines - Biologic Response Modifiers (BRMs) : Hepatitis B recombinant viral antigen HPV recombinant viral antigen
Prevention of Hepatitis B which can lead to liver cancer. Prevention of cervical, anal, oropharyngeal cancers; genital warts MoA: Hepatitis B vaccine recombinant is used to prevent infection by the hepatitis B virus. The vaccine works by causing your body to produce its own protection (antibodies) against the disease. It cannot give you the hepatitis B virus (HBV) or the human immunodeficiency virus (HIV). HPV: When a client receives the vaccine, the immune system produces antibodies against these proteins so if the body ever encounters them again in the form of the actual HPV virus it is well equipped to deal with and destroy the virus. Advantages: HPV: Available for both men and women ages 9-26 years of age. HepB : : Does not treat Hep B Intervention: Observe client for s/s of adverse reaction to vaccines. Keep epinephrine readily available for immediate use in case of anaphylactic reaction. Provide client with record of immunizations received. Education: Discuss vaccine-preventable diseases Answer questions regarding vaccine safety and efficacy Advise female clients of childbearing age to avoid pregnancy for 1 month. Provide Vaccine Information Statements from CDC
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Vaccines and Toxoids: | Tetanus Toxoid
Prevention of tetanus ``` Contraindications: Hypersensitivity Active infection Poliomyelitis outbreak Immunosuppression Febrile illness ``` SubQ/IM/2 weeks ``` Interactions: Increased immunosuppression if given with warfarin, corticosteroids, or cancer chemotherapy drugs ``` MoA: Vaccines work by causing the body to produce its own protection (antibodies). Tetanus vaccine is usually first given to infants with 2 other vaccines for diphtheria and whooping cough (pertussis) in a series of 3 injections. This medication is usually used as a “booster” vaccine after this first series. Booster injections may be needed at the time of injury in older children and adults if it has been 5-10 years since the last tetanus vaccine was received. Booster injections should also be given every 10 years even if no injury has occurred. Disadvantages: Do not use the vaccine on children younger than 7 years if it has the preservative thimerosal in it, as this may contain mercury ``` Side Effects: Mild fever Joint pain Muscle aches Nausea Tiredness Pain/itching/redness at injection site ``` ``` Adverse Effects: Tingling of hands/feet Hearing problems Trouble swallowing Muscle weakness Seizures Swelling of face/tongue ``` Interventions: Have epinephrine infection (1:1,000) readily available should an acute anaphylactic reaction occur. Monitor for signs of anaphylactic reaction. Record the date, lot number and manufacturer of the vaccine on the immunization record Education: Make sure the client/parents were fully informed of benefits and risks of immunization by the PHCP. Provide a copy of the immunization record with the date, lot number and manufacturer of the vaccine listed.
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Antitubercular agent: Rifapentine
Rifapentine (Priftin), a derivative of rifampin, is an antitubercular agent used with other drugs (eg, isoniazid) as a combination therapy in active and latent tuberculosis infections. Both rifampin and rifapentine reduce the efficacy of oral contraceptives by increasing their metabolism; therefore, this client will need an alternate birth control plan (non-hormonal) to prevent pregnancy during treatment Clients taking rifampin or rifapentine (Priftin) as part of antitubercular combination therapy should be taught to prevent pregnancy with non-hormonal contraceptives, notify the health care provider of any signs or symptoms of hepatotoxicity (eg, jaundice, fatigue, weakness, nausea, anorexia), and expect red-orange-colored body secretions.