Cefepime Nursing Implications
Cefepime Nursing Pharmacology
Cefepime belongs to the fourth-generation cephalosporin antibiotic, commonly given to treat infections like pneumonia, urinary tract infections, and skin infections. It is more effective than third-generation antibiotics against both gram-positive and gram-negative bacteria.
Cefepime injection is also given as treatment to patients who have a fever and are at high risk of infection due to a low white blood cell count. Cefepime appears to be well tolerated; however, patients taking this antibiotic, especially those with other medical conditions, must be closely monitored to avoid further complications.
Cefepime is administered through an injection into a muscle or vein as instructed by the doctor. The dosage is determined by the patient’s medical condition and treatment response. The dosage for children is also determined by their weight.
Indications of Cefepime
- Pneumonia. Cefepime is indicated for the treatment of moderate to severe pneumonia caused by susceptible Streptococcus pneumoniae strains, including cases associated with concurrent bacteremia, Pseudomonas aeruginosa, Klebsiella pneumoniae, or Enterobacter species.
- Urinary tract infections. Cefepime is used to treat uncomplicated and complicated urinary tract infections (including pyelonephritis) caused by susceptible strains of Escherichia coli or Klebsiella pneumoniae, or caused by Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis, if the infection is mild to moderate, such as infections are associated with consistent bloodstream infections with these organisms.
- Skin infections. Cefepime is used to treat simple skin and skin structure infections caused by Staphylococcus aureus (only methicillin-susceptible strains) or Streptococcus pyogenes.
- Intra-abdominal infection. Cefepime is used to treat complicated intra-abdominal infections in adults spread by Escherichia coli, viridans group streptococci, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter species, or Bacteroides fragilis
- Neutropenic fever. Cefepime is indicated as an empiric treatment for patients with neutropenic fever. Antimicrobial monotherapy may not be appropriate in patients at high risk of severe infection (including those with a history of current bone marrow transplantation, hypotension at presentation, a latent hematologic malignancy, or serious and long-term neutropenia).
Mechanism of Action of Cefepime
Cefepime works in a similar manner to other beta-lactams. Cefepime prevents bacterial cell wall synthesis by reversibly binding enzymes involved in the final transpeptidation step of peptidoglycan wall synthesis. The said action causes defects in the cell wall, which results in autolysis and the organism’s death.
Due to a few mechanisms, cefepime has expanded gram-negative protection and is more dependable against beta-lactamases than third generation cephalosporins. Penicillin-binding enzymes, for example, have a lower affinity for cefepime.
Another difference is that the chemical structure differs from previous generations due to the substitution of a side chain, which increases its action against staphylococcal species. Cefepime is also a zwitterion, which gives it an advantage for faster cell wall penetration by gram-negative bacteria and explains why it has a wider scope of gram-negative protection than the third generation.
Pharmacokinetics of Cefepime
Absorption. Intramuscular infusion results in rapid and complete absorption. The peak plasma time for intravenous administration is 0.5 to 1.5 hours, while intramuscular injection takes 1 to 2 hours.
Distribution. Cefepime enters into the inflammatory fluid at 80% of serum concentrations and bronchial mucosa at 60% of plasma concentrations; crosses the blood-brain barrier. Cefepime’s serum protein binding is approximately 16-19%.
Volume of distribution. Cefepime’s average sustained volume of distribution in adults is 16 to 20 L and in pediatric patients is 0.3 L/kg.
Metabolism. In the liver, less than 1% of cefepime is metabolized.
Elimination. Cefepime is primarily excreted by the kidneys, and the majority of it is unchanged.
Half-life. Average half-life of cefepime is 2 hours.
Side effects of Cefepime
A medicine may have some unintended consequences in addition to its intended effects. Even though not all of the following side effects are probable, they may require proper medical care if they happen. If any of the following side effects occur, stop taking cefepime and contact the doctor or nurse right away.
- Pain and tenderness at the site of injection
In some cases, side effects become serious. If the patient experience any of these symptoms, get medical attention right away:
- Bloody stool
- Unusual tiredness
- Abdominal cramps
- Fever (During the treatment or after stopping treatment)
- Itchiness of the skin
- Trouble breathing or swallowing
- Decreased alertness
- Difficulty speaking
- Sore throat
- Changes in the amount of urine
- Loss of appetite
- Yellowish-colored sclera or skin
- Dark-colored urine
Cefepime may cause a serious intestinal condition in rare cases due to a bacteria called C. difficile. This can develop during medical therapy or weeks to months after it has ended. Inform the doctor as soon as possible if the patient develops the following:
- Continuous diarrhea
- Abdominal pain or cramps
- Blood or mucus in stool
Do not give any anti-diarrhea or opioid medicine as it may worsen the symptoms.
If a Cefepime overdose is suspected, the doctor should discontinue the drug and emergency treatment should be started. The symptoms of Cefepime overdose include:
- Muscle spasms and shakes
Adverse Effects of Cefepime
Cefepime is generally well tolerated by both adults and kids. In adults, the most possible adverse effects are diarrhea and rash. Fever, diarrhea, and rash are often adverse effects in children.
According to the system affected, listed below are the adverse effects:
- Neurological: Headache, fever, neurotoxicity, encephalopathy, hallucination, seizures,
- Gastrointestinal: Nausea, vomiting, stomach pain, liver injury, colitis including pseudomembranous colitis, and oral candidiasis.
- Genitourinary: kidney injury, vaginitis, renal failure
- Dermatological: irritation at the injection site, pruritus, urticaria, steven-johnson syndrome, and erythema multiforme.
- Hematological: positive coomb’s test without hemolysis, pancytopenia, aplastic anemia, eosinophilia, hemolytic anemia, neutropenia, thrombocytopenia
- Locale: Pain at injection site, phlebitis.
- Miscellaneous: Allergic reactions, anaphylaxis, superinfection
Cautions and Contraindications Against Cefepime
- Cefepime is contraindicated in patients with diarrhea caused by C. difficile infection.
- Observe the patient for any symptoms of pseudomembranous colitis, such as loose bowel movement, stomach pain, fever, presence of pus or mucus in the stools, and other persistent Gastrointestinal problems including nausea, vomiting, and heartburn. Notify the doctor right away if these symptoms are present.
- Kidney function should be checked with blood urea nitrogen and serum creatinine, particularly in the elderly or patients with history of kidney dysfunction. Furthermore, signs of neurological changes must be examined, especially in the geriatric patients with renal impairment, and patients with febrile neutropenia.
- Keep track of the patient’s INR. Cefepime may cause an increase in the international normalized ratio (INR) with long – term treatment, particularly in nutritionally deficient patients.
- Monitor the patient for encephalopathy symptoms such as reduction in alertness, lethargy, and incoordination. Inform the doctor if any of these symptoms are present before they develop to more serious decline in mental status, such as dementia, seizures, or coma.
- Implement safety precautions to secure the patient’s safety if his or her mental status deteriorates.
- Observe for signs of blood dyscrasias, such as Eosinophilia (tiredness, loss of strength, muscle pain), hemolytic anemia (malaise, dizziness, yellowish discoloration of the skin, stomach discomfort), neutropenia (fever, sore throat, mucosal lesions, and other signs of infection), and thrombocytopenia (bruising, nose bleeds, bleeding gums, other uncommon bleeding). Inform the physician about these symptoms.
- If the patient is pregnant or intends to become pregnant, advise them to consult their doctor before using this medication. Cefepime passes in small amounts into breast milk and is likely to affect a breastfeeding infant. Inform the patient that she should consult a doctor before breast-feeding.
Drug Interactions with Cefepime
- Aminoglycosides. Aminoglycoside antibacterial drugs have a higher risk of nephrotoxicity and ototoxicity when combined with Cefepime. Renal function should therefore be monitored.
- Diuretics. Nephrotoxicity has been observed when cefepime is combined with diuretics. Renal function should be monitored when cefepime is combined with diuretics,
- Live bacterial vaccine. Cefepime may reduce the efficacy of live bacterial vaccines, such as typhoid vaccine.
- Hormonal birth control. Cefepime has the potential to interfere with birth control because it can change the body’s levels of hormones.
Nursing Considerations for Patients on Cefepime
- Before starting Cefepime for injection therapy, it is important to determine whether the patient has ever had an immediate allergic response to cefepime, cephalosporins, penicillin’s, or other beta-lactams.
- Perform a detailed physical examination before beginning drug therapy to establish baseline data, identify therapy effectiveness, and assess the incidence of any adverse effects related to drug therapy.
- Instruct the patient to inform the doctor about their medical history, particularly of kidney disease and stomach/intestinal diseases such as colitis, before using this medication.
- Inform patients that antibacterial medications, such as cefepime, are only used for treating bacterial infections. Antibiotics do not deal with viral infections.
- Cefepime may impair the effectiveness of live bacterial vaccines (including typhoid vaccine). Before receiving any immunizations or vaccinations, advise the patient to inform their doctor that they are taking cefepime.
- Instruct the patient to talk to their doctor or dentist first about all of the products they use before having surgery (including prescription drugs, over the counter drugs, herbal and nutritional products).
- Instruct the patient not to begin, discontinue, or adjust the dosage of any medications without first consulting with their doctor.
- Inform patients that while it is normal for their symptoms to improve quickly at the start of treatment, the medication must be taken exactly as prescribed. Skipping or failing to finish the entire treatment may reduce the efficacy of the immediate treatment. It may also increase the risk of the bacteria developing resistance and becoming untreatable in the future by cefepime or other antibiotics.
- Cefepime injection is available as a powder that must be mixed with liquid or as a premixed product that must be injected into a vein (intravenously) over a 30-minute period. Cefepime injection can also be administered into a muscle (intramuscular). It is typically administered every 8 to 12 hours for 7 to 10 days.
- It is critical to take this medication exactly as prescribed. If the nurse misses a dose, contact the attending doctor as soon as possible to get a new dosing schedule. Do not double the dose.
- Inform the patient that it is essential that they keep a written record of all prescription and nonprescription (over-the-counter) medications they are taking, and also any vitamins, minerals, or other nutritional supplements. They should keep this list with them whenever they go to the doctor or are admitted to the hospital. It is also important data to have on hand in case of an emergency.
- Keep an eye out for seizures and notify the doctor right away if the patient begins or increases seizure attack.
- Only if the doctor tells the patient otherwise, the patient may proceed in a normal diet.
- Pain at the injection site, inflammation, and irritation should be monitored. Inform the doctor about any long-term or excessive injection-site reactions.
- To help prevent the spread of infection, washing of hands thoroughly all the time and disinfection of equipment. Implement universal safety or isolation techniques as directed based on the patient’s category.
- Giving Cefepime via certain methods may result in false-positive results for glucose in the urine. Inform the client that they must notify the laboratory staff if they are taking cefepime on the day of the urine test.
- A decrease in prothrombin action has been linked to many cephalosporins, including cefepime. Patients with kidney or liver disorder, as well as those in poor nutritional condition, are at risk, and so are patients on a long course of antibiotic treatment. Prothrombin time must be monitored in high-risk patients taking cefepime.
- Watch out for any symptoms of drug overdose. If the patient experiences these symptoms, discontinue cefepime immediately and seek emergency medical attention.
- Instruct the patient that watery and bloody stools (with or without abdominal discomfort and fever) may occur while on treatment and may last for up to two months after treatment is completed. Diarrhea is a known side effect of antibiotics like cefepime, but it usually goes away once the antibiotic is stopped or finished. In this case, advise patients to contact their doctor as soon as possible.
- Explain with the patients the potential neurological side effects of cefepime. Advise patients or their relatives to notify their healthcare provider immediately if the patient experience any neurological signs and symptoms such as encephalopathy (disruptions of consciousness including confusion, hallucinations, stupor, and coma), aphasia (disturbance of speaking and understanding spoken and written language), myoclonus, seizures, or nonconvulsive status epilepticus, in order to have immediate medical intervention, adjustment in the dosage, or discontinuation of cefepime.
- Inform the patient that they must keep all of their doctor’s and laboratory schedules. The doctor may order certain lab tests to assess the patient’s body response to cefepime injection.
- For more information on storage, consult the product instructions or the facility’s pharmacist. Keep cefepime out of the reach of children and pets.
- Before using, visually check this product for particle sizes or discoloration. If either of these conditions exists, do not use and discard immediately.
- Know how to safely store and dispose of medical supplies. When using the frozen pre-mixed solution. Thaw the bag at room temperature or in the refrigerator. Allow the bag to settle at room temperature for at least 1 hour after it has been thawed in the refrigerator. Thaw using a water bath or in the microwave. After thawing, shake the bag properly and squeeze it to check for any leaks. If the bag leaks, throw the solution. Remember, do not re-freeze the solution.
- Administer cefepime at evenly spaced time intervals for optimal outcomes.
- Keep on giving cefepime for the full time prescribed by the doctor, even if the condition improves after several days. Stopping the medication too soon may result in the infection returning. Inform the doctor if the patient’s condition persists or worsens.
- Long-term or repeated use of this cefepime may lead to oral thrush or a new yeast infection. If white patches in the patient’s mouth are observed, an alteration in vaginal discharge, or any other new symptoms, inform the doctor immediately.
- Keep Cefepime out of the reach of children and pets. Unless otherwise directed, do not flush Cefepime down the toilet or pour it down the drain. When this product has expired or is no longer needed, observe proper disposal techniques.
- Clostridioides difficile-associated diarrhea (CDAD) can occur in patients who are taking cefepime and should be regarded in all patients who have continuous diarrhea after treatment. Obtain a thorough medical history, as CDAD has been noted to happen up to 2 months after taking cefepime.
- Fluid and electrolyte management, protein supplementation, antibiotic drug treatment of C. difficile, and surgical evaluation should be started as soon as medically necessary.
- Shake well until the drug is dissolved in sterile water or normal saline. Over 3-5 minutes, inject into a large vein or a free flowing IV solution.
- Assess patient understanding of drug treatment by asking the patient to name the drug, why it is given, and potential side effects.
- Instruct the patient not to drink alcoholic beverages while on treatment with Cefepime.
- Discuss with the patient that prescribing a drug without a validated or strongly suspected bacterial infection or a prophylactic indication is unlikely to improve the patient’s condition and raises the chances of drug-resistant bacteria development.
- Inform the patient not to share cefepime with anyone else. This medication has been advised specifically for their present condition. Tell the patient not to use it again for another infection only if the doctor prescribed it. In that situation, other kind of medication may be required.
- Though some antibiotics are unlikely to interfere with hormonal birth control methods such as pills, patches, or rings, some antibiotics, such as cefepime, may reduce their efﬁcacy. This could result in pregnancy. Tell the patient to consult their doctor or pharmacist first to determine whether they may need additional reliable birth control techniques while taking this medication.
Nursing Diagnosis for Patients on Cefepime
Possible Nursing Diagnosis
- Nausea related to the possible side effect of Cefepime
- Acute Pain (Abdominal) related to the side effect of Cefepime
- Risk for Imbalanced Nutrition: Less Than Body Requirements related to loss of appetite secondary to Cefepime
- Risk for Anaphylactic Reaction related to drug allergy to Cefepime
- Risk for Bleeding secondary to adverse reaction of Cefepime
|Cefepime Nursing Interventions||Rationale|
|Assess the patient for signs and symptoms of bacterial infection.||To confirm the indication for administering Cefepime.|
|Assess if the patient has hypokalemia, C.difficile infection, a bleeding disorder, seizures, or stage 3A (moderate) chronic kidney disease or CKD.||Patients with diarrhea due to C.difficile infection are not recommended to have Cefepime, because cephalosporins like this drug increase the risk of developing the said infection. Cefepime is generally contraindicated in patients with bleeding disorder, seizures, or stage 3A (moderate) chronic kidney disease or CKD as it may worsen these health conditions.|
|Check the patient’s allergy status.||Previous allergic reactions to Cefepime or other cephalosporins may render the patient unable to take them. Alternatives to Cefepime should therefore be considered in case of allergy.|
|Assess if the patient is pregnant or lactating.||Cefepime can be prescribed to a pregnant woman as this drug is under pregnancy category B which means it does not impose known harm to humans. However, cefepime must only be administered under the direction of the physician and with caution.|
|Perform a focused gastrointestinal assessment of the patient.||Cefepime may cause gastrointestinal side effects which include nausea, vomiting, and diarrhea.|
|Assess the patient’s veins in preparation for administering Cefepime.||To ensure that there is a good venous access before Cefepime is given.|
|Collect blood for a kidney function check.||Cefepime may cause adverse effects on the kidneys if not dosed properly.|
Nursing Planning and Intervention
|Cefepime Nursing Interventions||Rationale|
|Administer Cefepime via a peripheral or central venous line.||To ensure optimal absorption and therapeutic action by Cefepime, as well as reduce possible side effects.|
|Monitor the venous access after administration. Ask the patient to report any pain or discomfort during and after administration of the drug.||To check for any infiltration or phlebitis around the IV site.|
|Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking Cefepime.||To inform the patient on the basic information about Cefepime.|
|Monitor the patient’s input and output and commence a stool chart.||Cefepime may cause diarrhea. Early detection of diarrhea can help institute a bowel program and relieve them effectively.|
|Discourage alcohol intake when on Cefepime.||Alcohol can increase the possible GI side effects of Cefepime, such as nausea and vomiting.|
|Inform the patient that Cefepime may cause nausea and vomiting, and this should be reported to any healthcare professional once noticed.||To inform the patient of the possible side effect of Cefepime on the gastrointestinal system, and to be able to administer antiemetics as soon as the patient reports the symptom.|
|Perform daily weight checks, start a food chart, and refer to the dietitian as needed.||Cefepime may cause nausea, vomiting, and/or diarrhea which may cause the patient to have an unintentional weight loss. Weighing the patient daily can help monitor any weight loss. Food charting will show the oral food intake of the patient and can help the dietitian and the healthcare team to create a nutrition plan for the patient.|
|Cefepime Nursing Interventions||Rationale|
|Ask the patient to repeat the information about Cefepime.||To evaluate the effectiveness of health teaching on Cefepime.|
|Check for any signs of allergic reaction to Cefepime, such as shortness of breath, skin rash, or swelling.||To ensure the patient’s safety after the initial dose of Cefepime and to be able to reverse anaphylaxis quickly.|
|Monitor the patient’s full blood count and kidney function.||To ensure that the Cefepime did not cause any anemia or thrombocytopenia, as well as damage to the kidney function.|
|Monitor the patient for any signs of bleeding such as bruising.||To check for any adverse effect of Cefepime which is the risk for bleeding.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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