Introduction to Cefazolin and Nursing's Role
Cefazolin is a widely used first-generation cephalosporin antibiotic effective against many gram-positive and some gram-negative bacteria [1.3.3]. It is commonly administered intravenously (IV) or intramuscularly (IM) for treating infections of the skin, bone, joint, urinary tract, and respiratory tract, and is a mainstay for perioperative prophylaxis to prevent post-surgical infections [1.7.1, 1.9.3]. Given its broad application, nurses play a pivotal role in ensuring its safe administration and monitoring for potential adverse effects. A foundational aspect of this responsibility involves a thorough initial assessment, including a detailed history of allergies, particularly to penicillin or other cephalosporins, as cross-sensitivity can occur [1.4.1]. Before starting therapy, baseline vital signs and laboratory values, such as a complete blood count (CBC) and renal function tests, should be documented to track any changes during treatment [1.2.2].
Monitoring for Hypersensitivity and Anaphylaxis
Vigilance for allergic reactions is paramount. While generally considered safe, cefazolin can cause hypersensitivity reactions ranging from mild rashes to life-threatening anaphylaxis [1.3.6]. In fact, it is a common cause of perioperative anaphylaxis [1.5.1].
Key signs and symptoms to monitor include:
- Skin Reactions: Urticaria (hives), pruritus (itching), and generalized rash are common signs [1.2.1]. Nurses must frequently assess the patient's skin. The appearance of a rash should prompt immediate discontinuation of the drug and notification of the healthcare professional, as it could be a precursor to severe conditions like Stevens-Johnson syndrome (SJS) [1.3.6].
- Anaphylaxis: This is a medical emergency. Nurses should observe for rapid onset of symptoms such as tightness in the throat or chest, wheezing, dyspnea (difficulty breathing), hypotension, and angioedema (swelling of the face, lips, or tongue) [1.2.1, 1.7.3]. Emergency equipment, including epinephrine and antihistamines, should be readily available whenever administering cefazolin [1.4.1].
- Serum Sickness-Like Reactions: This can manifest as fever, muscle aches, and joint pain (arthralgia) and may occur with or without skin reactions [1.2.1].
Renal Function Assessment
Cefazolin is substantially excreted by the kidneys, making renal function a critical monitoring parameter [1.2.6]. Impaired renal function can lead to drug accumulation and an increased risk of toxicity, including seizures at high doses [1.4.6, 1.6.3].
Nursing monitoring includes:
- Laboratory Values: Regularly monitor blood urea nitrogen (BUN) and serum creatinine levels throughout therapy [1.2.2]. Increases in these values may indicate nephrotoxicity [1.2.5, 1.6.2].
- Urine Output: Track intake and output to detect any significant decrease in urination, which could signal renal impairment [1.2.3, 1.8.3].
- Dosage Adjustment: For patients with pre-existing renal impairment, dosage adjustments are necessary. Nurses must confirm that the ordered dose aligns with the patient's creatinine clearance rate [1.6.1, 1.6.3]. Elderly patients are more likely to have decreased renal function and require careful dose selection [1.2.6].
Gastrointestinal and Superinfections
Like many antibiotics, cefazolin can disrupt normal gut flora, leading to gastrointestinal side effects.
- Common Effects: Nausea, vomiting, and diarrhea are common but are typically mild [1.3.1].
- Clostridioides difficile-Associated Diarrhea (CDAD): A more severe complication is CDAD, which can range from mild diarrhea to fatal colitis. It's caused by the overgrowth of C. difficile bacteria [1.7.1]. The nurse must monitor for and report persistent watery or bloody stools, abdominal cramps, and fever. These symptoms can occur during therapy or even up to two months after discontinuation [1.3.5, 1.7.2].
- Superinfection: Prolonged use can lead to the overgrowth of non-susceptible organisms, such as fungi. Nurses should assess for signs of superinfection, including oral thrush (white patches in the mouth), vaginal itching or discharge, or loose, foul-smelling stools [1.4.2].
| Parameter | Key Nursing Assessments | Rationale |
|---|---|---|
| Hypersensitivity | Assess for rash, urticaria, pruritus, wheezing, laryngeal edema [1.4.1]. Check allergy history for penicillin/cephalosporins [1.4.1]. | Early detection of mild reactions and life-threatening anaphylaxis [1.5.1]. Cross-sensitivity is possible. |
| Renal Function | Monitor BUN, serum creatinine, and urine output [1.2.2, 1.2.3]. Verify correct dosage for patients with renal impairment [1.6.1]. | Cefazolin is renally excreted; accumulation can cause toxicity, including seizures [1.2.6, 1.4.6]. |
| Gastrointestinal | Monitor for diarrhea, especially if watery, bloody, or accompanied by fever/cramps [1.3.6]. Assess for oral thrush or vaginal candidiasis [1.4.2]. | Risk of C. difficile-associated diarrhea (CDAD) [1.7.1]. Risk of fungal superinfection with prolonged use [1.4.6]. |
| Hematologic | Observe for signs of bleeding (bruising, bleeding gums) or infection (fever, sore throat) [1.2.1]. Monitor CBC for neutropenia or thrombocytopenia [1.2.2]. | Can cause leukopenia, neutropenia, and thrombocytopenia [1.2.5]. May alter prothrombin time, especially with anticoagulants [1.2.2, 1.4.6]. |
Hematologic and IV Site Monitoring
Nurses must also be aware of potential hematologic changes and ensure the integrity of the intravenous access.
- Hematologic Effects: Although rare, cefazolin can cause blood dyscrasias like leukopenia (low white blood cell count), neutropenia, and thrombocytopenia (low platelet count) [1.2.5, 1.8.5]. The nurse should instruct the patient to report signs of infection (fever, sore throat) or bleeding (easy bruising, nosebleeds) [1.2.1]. Prothrombin time should be monitored in at-risk patients, such as those with renal or hepatic impairment or those on anticoagulants like warfarin [1.2.2, 1.4.6].
- IV Site Assessment: When administered intravenously, the IV site must be monitored frequently for signs of phlebitis (pain, redness, swelling) or irritation [1.9.1, 1.9.2]. To prevent this, it's recommended to change IV sites every 48-72 hours [1.9.1]. The nurse should also assess for pain and induration at IM injection sites [1.3.1].
Conclusion
In answering, "What should the nurse monitor with cefazolin?" a multi-system approach is essential. Diligent monitoring is the cornerstone of safe cefazolin administration. This includes baseline and ongoing assessment of hypersensitivity reactions, renal and hepatic function, gastrointestinal disturbances like CDAD, hematologic changes, and IV site integrity. Through careful observation, timely intervention, and thorough patient education on reportable symptoms, nurses can mitigate risks and ensure optimal therapeutic outcomes for patients receiving this common antibiotic.
For more in-depth information, you can review the FDA's prescribing information for Cefazolin.
