A nurse who works at a nursing home notices that a client's hearing has diminished significantly over the past couple of days. The client has been receiving gentamicin IV for an infection. Which action by the nurse is the most appropriate?
1. Continue gentamicin IV and check the peak level in a week.
2. Suggest checking the client's peak gentamicin level and immediately report the loss in hearing in the chart and to the health care provider.
3. Tell the client that she is going to need a hearing aid.
4. Continue gentamicin IV and suggest adding vancomycin IV to improve the ototoxicity.
Correct Answer: 2
Rationale 1: Gentamicin is a narrow-therapeutic-window drug, and levels should be assessed sooner.
Rationale 2: Gentamicin is a narrow-therapeutic-window drug that can cause ototoxicity and nephrotoxicity. A peak level can help determine the likelihood that it is the drug causing the hearing loss.
Rationale 3: It would be inappropriate to notice a sudden change in hearing and not consider that it might be drug related. Also, all adverse effects should be documented..
Rationale 4: Both vancomycin and gentamicin have the ability to cause nephrotoxicity and ototoxicity. Giving both together would not help the ototoxicity.
Global Rationale: Gentamicin is a narrow-therapeutic-window drug that can cause ototoxicity and nephrotoxicity. A peak level can help determine the likelihood that it is the drug causing the hearing loss. Gentamicin is a narrow-therapeutic-window drug, and levels should be assessed sooner. It would be inappropriate to notice a sudden change in hearing and not consider that it might be drug related. Also, all adverse effects should be documented. Both vancomycin and gentamicin have the ability to cause nephrotoxicity and ototoxicity. Giving both together would not help the ototoxicity.
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