A client is scheduled for surgery and has a prescription for cefazolin 1 gram IV to be administered 30 minutes prior to incision. The nurse notes the client reports a penicillin allergy with a rash. What is the nurse's PRIORITY action?
- ANotify the surgeon and the pharmacy of the allergy.
- BDocument the allergy and hold the medication.
- CAdminister the cefazolin as prescribed and monitor for a reaction.
- DAdminister an antihistamine prior to the cefazolin.
Show answer & explanationAnswer & explanation
Correct answer: A. Notify the surgeon and the pharmacy of the allergy.
Cefazolin is a cephalosporin, which has a cross-reactivity risk with penicillin, especially if the penicillin allergy involves a rash (Type I hypersensitivity). Giving cefazolin could trigger an allergic reaction. The priority is to notify the surgeon and pharmacy to discuss an alternative antibiotic or to determine if the benefits outweigh the risks and if desensitization or close monitoring is warranted. This involves collaboration and ensuring client safety before administering a potentially harmful medication.
Why the other options are wrong
- B. While documenting and holding are important, the priority is to communicate with the team to find a safe and effective alternative for surgical prophylaxis, as delaying antibiotics can increase surgical site infection risk.
- C. Administering without further clarification risks a severe allergic reaction.
- D. Administering an antihistamine does not prevent a severe allergic reaction and should not be done without a provider's order or a clear plan to administer the medication safely.
Penicillin-Cephalosporin Cross-Reactivity
Penicillins and cephalosporins (like cefazolin) share a similar chemical structure, leading to a risk of cross-reactivity. If a client has a penicillin allergy, especially a Type I (IgE-mediated) reaction like a rash, caution is warranted with cephalosporins. Provider notification is crucial to determine a safe alternative or management plan.
- Penicillins and cephalosporins related.
- Cross-reactivity risk.
- Rash indicates Type I allergy.
- Notify provider for alternative/plan.
Memory trick: Penicillin rash? Cefazolin clash! Tell the doc!