While reviewing the electronic health record of a client diagnosed with a severe infection, a practical nurse observes a significant change in the client's laboratory results. The morning serum creatinine has increased to 2.9 mg/dL (reference range: 0.6–1.2 mg/dL) from a baseline of 1.0 mg/dL upon admission. The client is prescribed intravenous gentamicin, and the next dose is scheduled to be administered in 15 minutes. Which action should the nurse take?
- AProceed with the medication administration to maintain therapeutic blood levels and document the laboratory results.
- BIncrease the rate of the client's primary intravenous fluids to protect the kidneys before giving the dose.
- CBypass the electronic barcode scanning system to ensure the medication is given exactly at the scheduled time.
- Withhold the upcoming dose of the medication and immediately communicate the laboratory findings to the registered nurse.Answer
Answer
The correct action is to withhold the upcoming dose of the medication and immediately communicate the laboratory findings to the registered nurse.
The correct action is to withhold the medication and report the findings. Gentamicin is an aminoglycoside antibiotic that is notoriously nephrotoxic. The client's serum creatinine level has abruptly increased from 1.0 mg/dL to 2.9 mg/dL, strongly indicating acute kidney injury. Giving another dose of gentamicin could cause further, potentially irreversible, renal damage. Within the scope of practice, the practical nurse must recognize this critical change, withhold the harmful agent, and escalate the information to the registered nurse or provider for a change in the treatment plan.
Step-by-Step Solution
Key Concept
Recognizing nephrotoxicity and escalating critical laboratory values prior to medication administration.