Clinical Medications WorksheetsGeneric NamePiperacillin/tazobactam

Trade NameZosyn

ClassificationAnti-infectives

Dose2.25gm

RouteIVPB

Time/frequencyQ 6 hrs

PeakEnd of infusion

Onsetrapid

Duration4-6 hrs

Normal dosage range3.375-4.5 g q 6 hrRate: Administer over at least 30 min

Why is your patient getting this medicationSkin and skin structure infections

For IV meds, compatibility with IV drips and/or solutionsReconstitute with 5 ml of 0.9% NaCl, sterile or bacteriostatic water for injection, or D5W. Do not use LR--incompatible. Shake well until dissolved. Dilute further in at least 50 ml of diluent. Discard any unused solution after 24 hr at room temperature or 48 hr if refrigerated.

Mechanism of action and indications(Why med ordered)Piperacillin: Binds to bacterial cell wall membrane, causing cell death. Spectrum is extended compared with other penicillins.Tazobactam: Inhibits beta-lactamase, an enzyme that can destroy penicillins.

Nursing Implications (what to focus on) Contraindications/warnings/interactionsHypersensitivity to penicillins, betalactams, cephalosporins, or tazobactam (cross-sensitivity may occur). Renal impairment (dosage reduction or increased interval recommended if CCr <40 ml/min).Common side effectsSEIZURES (HIGHER DOSES), PSEUDOMEMBRANOUS COLITIS, rashes, hypokalemia, phlebitis at IV site, HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS AND SERUM SICKNESS

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)None for this patient

Lab value alterations caused by medicineEvaluate renal and hepatic function, CBC, serum potassium, and bleeding times prior to and routinely during therapy, May cause positive direct Coombs' test result, May cause ↑ BUN, creatinine, AST, ALT, serum bilirubin, alkaline phosphatase, and LDH, May cause leukopenia and neutropenia, especially with prolonged therapy or hepatic impairment, May cause prolonged prothrombin and partial thromboplastin time, Piperacillin may cause ↑ serum sodium and ↓ serum potassium concentrations, Piperacillin/tazobactam may also cause ↓ hemoglobin and hematocrit and thrombocytopenia, eosinophilia, leukopenia, and neutropenia. It also may cause proteinuria; hematuria; pyuria; hyperglycemia; ↓ total protein or albumin; and abnormalities in sodium, potassium, and calcium levelsBe sure to teach the patient the following about this medicationAdvise patient to report signs of superinfection (black furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy. Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication.

Nursing Process- Assessment(Pre-administration assessment)Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy, Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response, Obtain specimens for culture and sensitivity prior to initiating therapy. First dose may be given before receiving results.

AssessmentWhy would you hold or not give this med?Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care professional immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.

EvaluationCheck after givingResolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.