Pneumonia with kidney disease

The client with chronic kidney disease is admitted to the medical floor for pneumonia. The admission orders include Zithromax, cyclosporine, and Mylanta. Which question should the nurse ask the client ... 

Traditional use An infusion of the fresh aboveground parts is drank as a hemostatic, analgesic, sedative, and diuretic for people with swelling associated with heart or kidney diseases. A bath or compresses soaked with the infusion are used to treat rheumatism, various skin diseases, scrofula, and furunculosis. The rhizomes are used as to strengthen the libido. In Tibetan medicine, the rhizomes are used to treat pneumonia and Uver diseases (Shreter 1975 Akopov 1990). 

Adverse Effects. The primary adverse effect of systemic pentamidine administration is renal toxicity. Renal function may be markedly impaired in some patients, but kidney function usually returns to normal when the drug is withdrawn. Other adverse effects include hypotension, hypoglycemia, gastrointestinal distress, blood dyscrasias (leukopenia, thrombocytopenia), and local pain and tenderness at the site of injection. Adverse effects are reduced substantially when the drug is given by inhalation, and this method of administration is desirable when pentamidine is used to prevent pneumocystis pneumonia in patients with human immunodeficiency virus (HIV) disease. 

Health consequences of chronic heroin abuse include scarred and collapsed veins, bacterial infections of the blood vessels and heart valves, boils, a variety of soft-tissue infections, kidney problems, and liver disease. Pneumonia, tuberculosis, and other lung diseases are also common among long-term users, which can be attributed to either poor nutrition and depressed respiratory function or both. Many of the additives heroin is cut with do not dissolve in the body and can block blood vessels, translating into higher risk of sudden death from stroke or heart attack. 

Streptomycin (29) have a relatively narrow spectrum of activity which includes both Grampositive and Gram-negative organisms. They are used to control mastitis and enteric disease, and, in the case of streptomycin, calf pneumonia. They are sometimes employed in combination with jS-lactams, to broaden spectrum. The aminoglycosides are quite seriously toxic. Neomycin (27) can cause kidney toxicity, whilst streptomycin (29) has neurotoxicity which can lead to deafness. This toxicity is reflected in the low recommended doses 2-10 mg kg, 10-40 mg kg for streptomycin (29). Resistance to these agents can rapidly be developed. 

In general, most strains of E. coli are avirulent however, there are strains that cause an impressive variety of different types of diseases, including diarrhea, dysentery, hemolytic uremic syndrome, bladder and kidney infections, septicemia, pneumonia, and meningitis. A strain of E. coli associated with a particular disease is due to the fact that the organism has acquired a set of virulence genes. 

Established interactions. With the NRTTs that are actively excreted via the kidneys (e.g. lamivudine, stavudine, and zaicitabine), it is unlikely that dosage alterations are necessary unless the patient has renal impairment. However, when both drugs are needed, patients should be closely monitored for signs of toxicity. Moreover, the UK manufacturer of lamivudine recommends that the use of lamivudine with high-dose co-trimoxazole for the treatment of Pneumocystis pneumonia and toxoplasmosis should be avoided. Since renal clearance represents only 20 to 30% of the total clearance of zidovudine, the authors of two of these reports " suggest that this interaction is unlikely to be clinically important for zidovudine unless the glucuronidation by the liver is impaired by liver disease or other drugs. Didanosine also does not appear to interact to a clinically relevant extent. 

Documented effects The plant is used internally to treat eczema, psoriasis, dermatitis and to normalize metabolism. In combination with other preparations, this species is used to treat gastritis, stomach and duodenal ulcers, enterocolitis, food poisoning, dysentery, kidney inflammation, and urinary incontinence. The preparation Mucaltin, which is prepared from the herb, is used as an expectorant to treat bronchitis and pneumonia (Kurochkin 1998). A methanolic extract and a decoction of the roots inhibited a variety of bacteria known to cause periodontal disease (lauk et al. 2003). An extract of the root has been shown to be a potent inhibitor of calcium mobilization associated with UVB-induced pigmentation of skin (Kobayashi et al. 2002a). 

IVaditional use Fresh fruits, infusion of the dried fruits, syrup or jam, or taken with tea, are widely used to quench the thirst, as a tonic, diaphoretic, diuretic, laxative, and sedative, as a remedy to increase the appetite, and to treat chronic gastritis and enterocolitis, stomach and duodenum ulcers, hver diseases, the flu, sore throats, pneumonia, stomatitis, dysentery, typhoid and fever. Water extracts, infusions or tea of the leaves and roots, is commonly used to treat stomach ulcers, chronic gastritis, and kidney stones (Nuraliev 1989). A decoction of the fruits, leaves, and branches is taken to treat cystitis, pyelitis, bronchitis, diabetes, urinary incontinence, eczema, vitiligo, psoriasis, fungal skin diseases, hair loss, and dnring menopanse (Knrochkin 1998). 

Traditional use An infusion and decoction of the leaves and flowers are used as an expectorant and cough suppressant, to treat bronchial asthma, as well as a diuretic to treat edema and scrofula. It is applied externally as a poultice or wash to treat tumors, abscesses, and furuncles. Juice from fresh leaves and roots is used to treat tuberculosis and malaria, and as a choleretic and diaphoretic (Khatmatov et al. 1984). Leaves are used to treat acute and chronic bronchitis, catarrh of the upper respiratory system, pneumonia, laryngitisis, bronchial pneumonia, and a hoarse voice. Preparations of coltsfoot are used to treat tracheitis, kidney and bladder diseases, the gastrointestinal tract, loss of appetite, fever, erysipelatous skin inflammation, scrofula, hair loss, and abscesses. Fresh juice from the leaves is inhaled into the nostrils to eliminate sinns colds. The juice of leaves is also mixed with powdered sugar to treat tuberculosis (Maznev 2004). 

Infection risk The risk of infections and serious infections with rituximab may be similar to that with the TNT antagonists. To date, there have been no reports from trials of an increased risk of tuberculosis or opportunistic infections with rituximab [162 ]. Some investigators have reported an increase in Pneumocystis jirovecii pneumonia, and increased number of infections has been documented in patients treated with maintenance rituximab for low-grade lymphoma and in patients with concomitant severe immunodeficiency, whether caused by HIV or immunosuppressive agents [152 ]. In rheumatoid arthritis, the susceptibility factors for severe infections include chronic lung and/or cardiac disease, extra-articular involvement, and low IgG before rituximab treatment [163 ]. After kidney transplantation, the off-label use of rituximab is associated with a high risk of infectious disease and death related to infectious disease [164 ]. 

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