Pharmacology Nursing Care Plan

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Cellulitis is a common, potentially serious bacterial skin infection. Cellulitis appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly. The skin on the lower legs is most commonly affected, though cellulitis can occur anywhere on the body or face. Cellulitis may affect only the skin’s surface or cellulitis may also affect tissues underlying the skin and can spread to the lymph nodes and bloodstream. Left untreated, the spreading infection may rapidly turn life-threatening. That’s why it’s important to seek immediate medical attention if cellulitis symptoms occur (Jenkins & Harper, 2011). There are numerous anti-infective medications available, and sometimes a combination of drugs must be given to rid the infection. Regardless, most infections can be controlled and removed. The anti-infective medication highlighted in this paper will be cefazolin better known as Ancef. Cefazolin is a member of the cephalosporins. According to Lilley, Rainforth-Collins, Harrington & Snyder, 2011, “Cephalosporins are semisynthetic antibiotics widely used in clinical practice. They are structurally and pharmacologically related to the penicillins. Like penicillins, cephalosporins are bactericidal and work by interfering with bacterial cell wall synthesis. They also bind to the same penicillin-binding proteins inside bacteria” (p.594). Medication

Trade Name:
Ancef
Generic Name:
cefazolin
Indications and Usage:
Upper, lower respiratory tract, urinary tract, skin infections; bone, joint, biliary, genital infections; endocarditis, surgical prophylazis, septicemia (Skidmore, 2011). Adverse Effects:
CNS- headache, dizziness, weakness, paresthesia, fever, chills, seizures (high doses) GI- nausea, vomiting, diarrhea, anorexia, pail, glossitis, bleeding; increased AST, ALT, bilirubin, LDH, alkaline phosphatase; abdominal pain, pseudomembranous colitis GU-proteinuria, vaginitis, pruritis, candidiasis, increased BUN, nephrotoxicity, renal failure HEMA- leukopenia, thrombocytopenia, anemia, neutopenia, lymphocytosis, eosinophilia, pancytopneia, hemolytic anemia INTEG- rash, uticaria, dermatitis RESP- dyspnea SYST- anaphylaxis, serum sickness, superinfection, Stevens-Johnson syndrome (Skidmore, 2011). Recommended Dosage & Routes:

Life-threatening infections- Adult: IM/IV 1-2 g q6hr, max 12 g/day Child > 1 month: IM/IV 100 mg/kg in 3-4 divided doses, max 6 g/day. Mild/moderate infections- Adult: IM/IV 250 mg- 1 g q8hr. Child > 1 month: IM/IV 25-50 mg/kg in 3-4 equal doses. Renal Dose- Adult: IM/IV following loading dose CCr 35-54 mL/min dose q8hr; CCr 10-34 mL/min 50% of dose q18-24hr. Child: IM/IV CCr > 70 mL/min, no dosage adjustment; CCr 40-70 mL/min following loading dose, reduce dose to 7.5-30 mg/kg q12hr; CCr 20-39mL/min, give 3.125-12.5 mg/kg after loading dose q12hr; CCr 5-19 mL/min, 2.5-10 mg/kg after loading dose q24hr (Skidmore, 2011). Available Forms:

Injections 250, 500 mg, 1, 5, 10, 20 g; infusion 500 mg, 1 g/50 ml vial (Skidmore, 2011). Administration Directions:
IM route: Reconstitute 250-500 mg of product with 2 mL sterile or bacteriostatic water for injection, or 0.9% NaCl; reconstitute 1 g of product with 2.5 mL; give deep in large muscle mass, massage. IV route: Check for irritation extravasation, phlebitis daily, and change site q72hr. For direct IV dilute in 10 mL of sterile water for injection; give over 5 minutes. For intermittent infusion, dilute reconstituted solution (500 mg or 1 mg) in 50-100 mL D5W, D10W, D5/0.25% NaCl, D5/0.45% NaCl, D5/0.9% NaCl, may be refrigerated up to 96 hours or stored 24 hours at room temperature (Skidmore, 2011). Nursing Implications:

As indicated by Skidmore (2011), “Assess patient for previous sensitivity reaction to penicillins or other cephalosporins; cross-sensitivity between penicillins and cephalosporins is common. Assess patient for signs and symptoms of infection including characteristics of wounds, sputum, urine, stool, WBC >...
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