Patient Care and Monitoring

• Conduct a thorough medication history including prescription and nonprescription medications, as well as herbals and vitamins.

• Verify the patient's allergy history and the type of reaction experienced. Attempt to discern between true allergy and adverse event. P-Lactam-allergic patients may receive clindamycin, vancomycin, or other antimicrobials. Cross-reactivity between penicillin allergy and cephalosporins is low but cephalosporins should be avoided in patients with a history of anaphylaxis to penicillins.

• Document the type of operation the patient is undergoing. Verify the surgical procedure with the patient.

• Prophylactic antimicrobials should be started within an hour of the first incision to optimize patient outcomes. Exceptions to this include vancomycin and fluoroquino-lones.

• The patient should be monitored for signs of an allergic reaction during the operation. These include rash, hives, difficulty breathing, or substantial drops in blood pressure.

• Major breaks in surgical technique may cause the classification of the operation to change and require adjustments in antimicrobial prophylaxis.

• The patient should be monitored for signs and symptoms of infection postoperatively. These could include pus, erythema, and fever. If signs consistent with SSI appear, cultures should be taken and additional antimicrobial therapy should be considered.

• Patients being discharged should be counseled on recognizing signs and symptoms of SSI. An SSI can appear up to 30 days after an operation is completed.

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