Case Studies & Nursing Process

2.1. Is the computed dose of both drugs (Gentamycin and Ampicillin) safe to give and correct?
Justify and support your answer. (4 points)

 No, because base on the video the calculated dose of both drugs is 525mg for ampicillin
which is correct while the gentamicin is 75mg which is wrong because it is computed
through the infants weight especially the usual dose of gentamicin is 7.5 and multiply to
infants weight therefore the results is not exactly correct, because the accepted dose of
gentamicin base on the weight of infant is 80mg, therefore it’s not safe to give for a
patient especially the usual dose of ampicillin is 50mg/kg every 4 hourly and 7.5 mg/kg
of gentamicin every 24 hours, and it’s computed by the registrar through the infant’s
weight.

2.2. Based on the video presented, select and discuss at least three main factors/problems that
lead to the medication error. Support your answer by citing a books/journal. (2 points per
identified problems = 6 points)

Medication errors can occur in:

 Writing the prescription—prescription errors, including illegibility;

 Failures in the administration of a drug, such as giving drugs at the incorrect time and
dose.
 Inaccessibility of patient information, such as information about the current medications,

Reference:

https://academic.oup.com/qjmed/article/102/8/513/1598923

https://journals.lww.com/ajnonline/fulltext/2005/03001/medication_errors__why_they_happ
en,_and_how_they.5.aspx

      2.3. Complete the table below (Drug Study)

Generic Name Ampicillin Gentamicin/ gentamicin sulfate

 Ampicin (CAN), Apo-Ampi
(CAN), Novo-Ampicillin
Brand Name/s Garamycin
(CAN), Nu-Ampi (CAN),
Penbritin (CAN), Principen

Route, Dosage & Frequency Systemic Infections Adult

Adult: PO 250–500 mg
Conventional dosing
q6h IV/IM 250 mg–2 g q6h
Child: PO 25–50 mg/kg/d  3-5 mg/kg/day
divided q6h IV/IM 25–100 intravenously/intramuscularl
mg/kg/d divided q6h
y (IV/IM) divided every 8
Neonate: IV/IM  7 d & 
hours
2000 g, 50 mg/kg/d divided
q12h;  7 d & >2000 g, 75 Extended dosing interval (every 24
mg/kg/d divided q8h; >7 d, 50– hours or more)
100 mg/kg/d divided q6–12h
 Initial: 4-7 mg/kg/dose IV
once/day
Meningitis
Adult/Child: IV 150–200 Children under 5 years: 2.5
mg/kg/d divided q4–6h mg/kg/dose IV/IM every 8 hours
Neonate: IV/IM  7 d & 
2000 g, 100 mg/kg/d divided Infants under 30 weeks' gestation
q12h;  7 d & >2000 g, 150
 0-28 days: 2.5 mg/kg/day
mg/kg/d divided q8h; >7 d,
IV/IM
100–200 mg/kg/d divided q6–
12h  More than 28 days: 3
mg/kg/day IV/IM

Gonorrhea Infants 30-36 weeks' gestation

Adult: PO 3.5 g with 1 g
probenecid times 1 IV/IM 500  0-14 days: 3 mg/kg/day
mg q8–12h IV/IM

 More than 14 days: 5

mg/kg/day IV/IM divided
 every 12 hours.
Classification: Antibiotic,
Pharmacologic classification:
Penicillin aminoglycoside
Drug Classification
Pregnancy Category B Therapeutic classification:
antibiotics

Bactericidal action against

sensitive organisms; inhibits Bactericidal and is a broad spectrum
Therapeutic Action
synthesis of bacterial cell wall, antibiotic
causing cell death.

 Treatment of infections
caused by susceptible
strains of Shigella,
Salmonella,
Escherichia coli,
Haemophilus
influenzae, Proteus
Treatment of
mirabilis, Neisseria
gonorrhoeae, serious infections caused by

enterococci, gram- susceptible strains such as

positive organisms Pseudomonas aeruginosa, Proteus
Indications
(penicillin G–sensitive species (indole-positive and indole-
staphylococci, negative), Escherichia coli,
streptococci, Klebsiella-Enterobacter-Serratia
pneumococci) species
 Meningitis caused by
Neisseria meningitidis

 Unlabeled use:
Prophylaxis in cesarean
section in certain high-
risk patients.

Adverse Effects  CNS: Lethargy,

CNS: headache,
 hallucinations, seizures
lethargy, encephalopathy, confusion,
 CV: CHF dizziness, seizures, numbness,
peripheral neuropathy, fever (with
 GI: Glossitis,
stomatitis, gastritis, injected form).
sore mouth, furry CV: hypotension (with injected
tongue, black “hairy” form).
tongue, nausea, EENT: ototoxicity, blurred vision
vomiting, diarrhea, (with injected form); burning,
abdominal pain, bloody stinging, blurred vision (with
diarrhea, enterocolitis, ophthalmic ointment); transient
pseudomembranous irritation (with ophthalmic solution);
colitis, nonspecific
conjunctival hyperemia (with
hepatitis
ophthalmic form).
 GU: Nephritis GI: vomiting, nausea (with injected
form).
 Hematologic: Anemia,
thrombocytopenia, GU: nephrotoxicity (with injected

leukopenia, form).
neutropenia, prolonged Hematologic: anemia,
bleeding time eosinophilia, leukopenia,
thrombocytopenia,
 Hypersensitivity:
granulocytopenia (with injected
Rash, fever, wheezing,
anaphylaxis form).
Musculoskeletal: muscle twitching,
 Local: Pain, phlebitis,
myasthenia gravis-like syndrome.
thrombosis at injection
Respiratory: apnea (with injected
site (parenteral)
form).
 Other: Superinfections Skin: rash, urticaria, pruritus,
—oral and rectal tingling (with injected form); minor
moniliasis, vaginitis
skin irritation, possible
photosensitivity, allergic contact
dermatitis (with topical
 administration).
Other: anaphylaxis, pain at
injection site (with injected
form); hypersensitivity
reactions, overgrowth of
nonsusceptible organisms (with
ophthalmic form and long-term use).
Nursing Consideration Assessment Special considerations
ALERT Use preservative-free form for
 History: Allergies to
intrathecal route.
penicillins,
• Systemic absorption from excessive
cephalosporins, or
use may cause systemic toxicities.
other allergens; renal
• Monitor serum drug levels. Prolonged
disorders; lactation
peak serum level above 10 mcg/ml and
 Physical: Culture trough serum level above 2 mcg/ml
infected area; skin increases risk of toxicity.
color, lesion; R,
adventitious sounds;
bowel sounds; CBC,
LFTs, renal function
tests, serum
electrolytes, Hct,
urinalysis

Interventions

 Culture infected area

before treatment;
reculture area if
response is not as
expected.

 Check IV site carefully

for signs of thrombosis
or drug reaction.
  Do not give IM
injections in the same
site; atrophy can occur.
Monitor injection sites.

 Administer oral drug

on an empty stomach, 1
hr before or 2 hr after
meals with a full glass
of water; do not give
with fruit juice or soft
drinks.

Patient Education  Take this drug around- Patient education

the-clock. • Inform patient of the proper
administration technique.
 Take the full course of
• Instruct patient to promptly report
therapy; do not stop
worsened lesions or skin irritation.
taking the drug if you
feel better. Reactions may be common,
uncommon, life-threatening,
 Take the oral drug on
or COMMON AND LIFE
an empty stomach, 1
THREATENING.
hour before or 2 hours
◆ Canada only
after meals; do not take
◇ Unlabeled clinical use
with fruit juice or soft
drinks; the oral solution
is stable for 7 days at
room temperature or 14
days refrigerated.

 This antibiotic is
specific to your
problem and should not
be used to self-treat
other infections.
  You may experience
these side effects:
Nausea, vomiting, GI
upset (eat frequent
small meals), diarrhea.

 Report pain or
discomfort at sites,
unusual bleeding or
bruising, mouth sores,
rash, hives, fever,
itching, severe
diarrhea, difficulty
breathing.

TOTAL = 30 points

Reference:
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/A057.html
https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/ampicillin/
https://www.glowm.com/resources/glowm/cd/pages/drugs/g007.html
https://www.rxlist.com/consumer_gentamicin/drugs-condition.htm