Question

Case Study—The Client With a Bacterial Infection

Gloria Lawton, a 42-year-old secretary, has come to the clinic complaining of a fever, sore throat, and cough, which she has had for the past 24 hours. Her posterior pharynx is reddened, with patches of purulent exudate. She complains of pain with swallowing. Her cervical lymph nodes are enlarged and tender to touch. Based on the client's symptom history and physical examination, the physician suspects a streptococcal infection. After a sample for a throat culture is taken, Ms. Lawson is started on amoxicillin, 500 mg PO every 8 hours for 10 days.

1. Explain the rationale for getting a sample for a throat culture before the first dose of amoxicillin is administered.

2. Before administering the first dose of amoxicillin, what additional assessment data does the nurse need to collect from the client?

3. What should the nurse teach Ms. Lawton about taking the amoxicillin?

4. After the completion of the 10 days of drug therapy, Ms. Lawton's upper respiratory symptoms have resolved. However, she is now complaining of intense perineal itching and a vaginal discharge. How should the nurse respond to Ms. Lawton's questions about these symptoms?

Answer 1

Answer 1:

• This patient is most probably suffering from bacterial pharyngitis. This is a clinical diagnosis.
• This diagnosis needs to be confirmed microbiologically.
• This can be achieved by growing the bacteria in the lab.
• For this, a throat swab needs to be obtained and needs to be sent for bacteria culture.
• The yield of the bacteria culture depends on a number of things.
• If the throat sample is collected after starting antibiotics, then the bacterial population in the throat will reduce.
• This will increase the likelihood of obtaining a negative bacterial culture.
• So it is better to obtain samples prior to starting antibiotics

Answer 2:

• Amoxicillin belongs to the penicillin group of drugs.
• A common side-effect of this group of drug is a hypersensitivity reaction ( allergic reaction )
• The severity of  hypersensitivity reaction can range from mild ( skin reactions ) to severe (anaphylaxis)
• If a patient has had a history of hypersensitivity to amoxicillin, it should be avoided in the future.
• Administration of amoxicillin to a patient who has had a past history of hypersensitivity to amoxicillin can lead to a life-threatening allergic reaction.
• So the nurse should elicit the history of allergy to amoxicillin

Answer 3:

The nurse should teach the patient following things about amoxicillin

• Amoxicillin a drug used for the treatment of bacterial infection.
• It is best to take the medicine within 1 hour of a meal.
• Take the medicine with plenty of water
• Don't chew the tablet.
• Don't break the tablet.
• Take the medicine on time.
• Don't discontinue taking the medicine prematurely. This could lead to the development of antibiotic resistance. Once antibiotic resistance develops, the bacteria can never respond to the same antibiotics
• The common side-effect of amoxicillin was nausea, abdominal distension, heartburn, extensive candidiasis or fungal infection, allergic reaction.

Answer 4:

The patient developed intense perineal itching and vaginal discharge mostly due to the overgrowth of fungus. This overgrowth of fungus gives rise to fungal infections like vaginal thrush and cutaneous fungal infection.

Explanation:

1. Amoxicillin is a broad-spectrum antibiotic.
2. This antibiotic can kills pathogenic and commensal bacteria.
3. These commensal bacteria are good bacteria, they prevent the growth of pathogenic bacteria and fungus.
4. Amoxicillin kills commensal bacteria.
5. This allows the growth of yeast ( candida)

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