Wounds, Fungal, & Protozoan Infections

Nutrition for wound healing

• High fluids to replace fluid loss in perspiration & exudate

• Protein to correct negative nitrogen balance

• Carbohydrates

  • Due to increased metabolism (including protein)

Who is more at risk for systemic fungal infections?

Immunocompromised people

Fungal infections are often super infections. Describe what this means

• Disruption of normal flora

• Are opportunistic

Describe systemic fungal infections (mycoses)

Typically lungs, brains, & digestive organs

• Affects multiple body systems

• Can be fatal if immune system is suppressed

• Requires aggressive oral or parenteral long-term medications

Describe Amphotericin B

Antifungal— causes breakdown

• used for systemic mycoses for immunocompromised patients

  • Can cause fever, chills, n&v, anorexia, headache, phlebitis

Serious adverse effects of Amphotericin B

• Cardiac arrest, dysrhythmias

• Hypokalemia

• Blood abnormalities

• Ototoxicity

• Nephrotoxicity

• Hepatotoxicity

What should be monitored when giving Amphotericin B

• Troponin

• Potassium

• CBC (WBC)

• Vertigo/hearing loss (symptoms of ototoxicity)

Nursing considerations for those who are on antifungals

• Complete health history

• Baseline

• Culture & sensitivity to determine need for therapy

What can be given to reduce the infusion-related reactions of Amphotericin B

Antipyretic & antihistamine

Drug for both systemic & superficial fungal infections

Fluconazole

Describe fluconazole

Infections by Candida albicans, mycoses (cell breakdown)

• Can cause n&v, diarrhea

• Steven’s-Johnson syndrome

Where do superficial fungal infections commonly occur & who does it affect

• Skin, mucous membranes, mouth, & the vagina

• Can affect anyone, not just those who are immunocompromised

Describe nystatin

Candida infections (cell breakdown)

• Can cause irritation, burning, contact dermatitis, n&v, diarrhea

Nursing considerations for superficial fungal pharmacotherapy

• Complete health history

• Baseline liver function

• Culture & sensitivity

For superficial fungal infections, why is it important to avoid using occlusive dressings?

Will increase the moisture for the fungus

Describe protozoan infections

• Only few are pathogenic, more common in immunosuppressed

• Spread through vectors

Describe metronidazole

For amebiases, trichomoniasis, Crohn’s disease, colitis (causes cell death)

• Can cause n&v, diarrhea, abd pain, dry mouth, metallic taste

• Can affect the peripheral nervous system (seizures, tingling & numbness)

When on metronidazole (Flagyl), what should you warn the patient about?

To not consume alcohol

• Disulfiram-like symptoms

  • Severe discomfort when drinking alcohol