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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer intermittent intravenous (IV) vancomycin to a client diagnosed with a severe methicillin-resistant Staphylococcus aureus (MRSA) infection. Which of the following actions by the nurse are appropriate? Select all that apply.

  1. Assess the peripheral intravenous insertion site for erythema and edema prior to initiating the infusion.Answer
  2. Program the electronic infusion pump to deliver the medication over a minimum of 60 minutes.Answer
  3. Ensure a trough serum concentration level is drawn immediately before administering the next scheduled dose.Answer
  4. D
    Instruct the unlicensed assistive personnel to perform the initial vital sign assessment 15 minutes after the infusion begins.
  5. E
    Administer a scheduled dose of intravenous push metoclopramide through the active Y-site without consulting a compatibility chart.
  6. F
    Convert the client's body weight from pounds to kilograms by multiplying the weight by 2.2 before calculating the dose.

Answer

The appropriate actions are to assess the IV site prior to the infusion, administer the medication over at least 60 minutes, and ensure a trough level is drawn before the next dose.
Appropriate actions for administering intravenous vancomycin include verifying the patency and safety of the IV site, administering the medication slowly over a minimum of 60 minutes to prevent Red Man Syndrome, and monitoring trough levels to ensure therapeutic dosing and prevent nephrotoxicity.

Step-by-Step Solution

1
Analyze the prescribed therapy.
Identify vancomycin as a high-alert antibiotic requiring specific administration, monitoring protocols, and weight-based dosing.
Understanding the drug's properties is required to determine the necessary safety interventions.
2
Evaluate each action for safety and adherence to pharmacological principles.
Select actions that prevent complications (e.g., slow infusion to prevent Red Man Syndrome, site assessment for phlebitis, trough monitoring for toxicity) and reject unsafe practices.
Safe parenteral therapy requires avoiding improper math conversions, lack of compatibility checking, and inappropriate delegation of assessments.

Key Concept

Safe Administration and Monitoring of Intravenous Vancomycin
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Topics

Pharmacological and Parenteral Therapies

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