A 62-year-old woman is admitted for total knee replacement surgery
CASE STUDY: THE PATIENT WITH HYPERSENSITIVITY: A 62-year-old woman is admitted for total knee replacement surgery. Following surgery,cefazolin sodium (Ancef), 2 g, was ordered to be given intravenous piggyback (IVPB) every 8 hours for 24 hours. She received her first dose when she arrived at the orthopedic unit aftersurgery. Vital signs upon arrival: BP 136/84, P 88, R 12, T 98.8° F. 1.
Before administering the cefazolin sodium (Ancef), the nurse asks the patient about drug allergies.
Which drug allergy causes the nurse to question the administration of the cefazolin sodium and why?
Thirty minutes after the medication was started, the patient calls the nurse and reports “itching all over” and difficulty breathing. The nurse notes facial edema and audible wheezing. The patient’s skin is red with large, swollen blotches over her arms, trunk, and back. Her systolicblood pressure is 118/78, pulse 108, and respirations 24. The IVPB antibiotic bag has infused about three-fourths of the dose.
2. What should the nurse’s first action be?
3. What medications and by what route should the nurse expect the physician to prescribe? Explain the rationale for the medications used in this situation. What other interventions should follow?
4. Below is the documentation of this patient incident recorded by the nurse. What documentation should entry #3 contain?
Initial Entry: VS on arrival to unit BP 136/84, P 88, R 12, T 98.8° F. Patient medication allergies reviewed prior to administration of Ancef 2g IVPB. IVsite clear, without redness or swelling. Ancef IVPB infusing without difficulty.
Entry #2: VS BP 118/78, P 108, R 24. Patient c/o “itching all over.” Patient SOB, with audible wheezing noted, skin reddened with blotches on arms, trunk, and back. IVPB stopped. Dr. X notified. Medications administered as ordered by Dr. X. Entry #3:
a.Reassessment data regarding respiratory status, patient c/o itching and abnormality of skin.
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