Question

A client was admitted to the hospital with pneumonia. The physician ordered "Zinacef, (a second generation cephalosporin) \(2 \mathrm{~g}\) IV q 8 hour. While preparing to administer the first dose of Znacef, the nurse notices that this client has a penicillin allergy The best action by the nurse is to a. administer the Zinacef as ordered but watch the client carefully for any signs of an allergic reaction. b. ask the pharmacist if another antibiotic can be substituted for the Zinacef. c. administer the Zinacef as ordered. d. hold the Zinacef and notify the physician of the clienc's allergy to penicillin.

Short answer

The best action by the nurse is to hold the Zinacef and notify the physician of the patient's allergy to penicillin.

Step-by-step solution

Identify Cross-Reactivity Concerns

Understand that antibiotics like cephalosporins have a potential for cross-reactivity with penicillin allergies due to similar structures. The nurse must be aware of the heightened risk of an allergic reaction in patients with a penicillin allergy.

Assess Nursing Responsibilities

A nurse's primary responsibility is to ensure the safety of the patient. This means verifying medication orders, particularly when there is a known allergy. It is essential for the nurse to recognize the risk and act accordingly to prevent possible adverse effects.

Take Appropriate Nursing Action

Given the risk of cross-reactivity, the correct course of action is to withhold the medication and promptly notify the physician about the patient's penicillin allergy. This will allow for reevaluation of the medication order and possibly selecting an alternative antibiotic that is safe for the patient.

Key concepts

Cross-Reactivity in Antibiotics

When it comes to antibiotics, the term 'cross-reactivity' refers to the potential for a person who is allergic to one type of antibiotic to also be allergic to another, due to similarities in their chemical structures. For example, penicillins and cephalosporins share a beta-lactam ring in their molecular structure, which can trigger an immune response in individuals with penicillin allergies. Recognizing cross-reactive groups of antibiotics is crucial for healthcare providers to prevent adverse reactions in patients.

It is estimated that about 10% of patients with a penicillin allergy may have a cross-reactive allergic reaction to cephalosporins, especially the earlier generations. However, the risk diminishes with later generations of cephalosporins. Despite this decreased risk, caution is still advised. Alternatives to cephalosporins for treating pneumonia might include macrolides or respiratory fluoroquinolones, depending on the patient's allergy profile and the type of pneumonia being treated.

Nursing Responsibilities

Nurses play an integral role in the healthcare system, one that involves a wide range of responsibilities to ensure patient safety, especially in the context of medication administration. When administering medications, a nurse is responsible for following the 'five rights': the right patient, the right drug, the right dose, the right route, and the right time. Moreover, they are to be vigilant for potential contraindications such as allergies.

When a patient has a documented allergy, nurses must take additional steps to confirm whether the prescribed medication poses a risk. This means reviewing the patient’s allergy history, understanding the potential for cross-reactivity, and consulting with a pharmacist or physician when there is uncertainty. If a nurse encounters a situation where the prescribed medication could potentially harm the patient, they must withhold the treatment and alert the prescribing physician for a reevaluation, thus embodying the principle of non-maleficence, a key element of clinical practice.

Patient Safety in Medication Administration

Patient safety is the paramount concern when it comes to medication administration. Healthcare professionals must take all precautions to prevent medication errors that can cause patient harm. This includes correct labeling, dosage calculations, and monitoring for side effects. It's important for professionals to stay up-to-date with the latest practices and to communicate effectively among the healthcare team.

In the scenario of the patient with penicillin allergy, it's crucial to ensure that such concerns are documented and communicated to every healthcare provider involved in the patient's care. Creating a culture of safety within healthcare institutions also promotes vigilance in identifying and addressing potential risks before they result in patient harm. Adequate patient education on medications, including why they are receiving them and what adverse reactions to watch for, further enhances patient safety and engagement in their own care.