1993 Nissan Altima hesitation horrible stumble

i have a 93 altima 5 spd and it seems to have an awful misfire but it will run ok in reverse when cold but not forward and when its warmed up not at all if i give it gas it misses then the rpms drop if i hold the pedal to the floor it misses then the rpms shoot to 2-3k but never higher seems to surge like this : rpm drop rpm rise over and over but never can move any ideas??