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Zorluk: ZorPharmacological Therapies

An 82-year-old client is admitted to the medical-surgical unit with a severe systemic infection and is prescribed scheduled doses of intravenous (IV) piggyback gentamicin and oral levofloxacin. During the morning assessment, the practical nurse (PN) observes that the client, who was alert and oriented the previous evening, is now highly agitated and disoriented to time and place. The client's morning laboratory results reveal a serum creatinine of 2.8 mg/dL (baseline was 0.9 mg/dL on admission). Which action should the PN take first regarding the client's care and scheduled medications?

  1. Withhold both the gentamicin and levofloxacin, and immediately notify the supervising registered nurse (RN) of the acute neurological changes and elevated creatinine level.Cevap
  2. B
    Administer the scheduled antibiotics, attributing the sudden disorientation to expected age-related cognitive changes, and initiate strict fall precautions.
  3. C
    Document the abnormal creatinine level in the electronic health record, but proceed with the medication administration since treating the severe infection is the clinical priority.
  4. D
    Administer a prescribed as-needed dose of intravenous (IV) push lorazepam to safely calm the client before attempting to give the oral levofloxacin.

Cevap

The correct action is to withhold both the gentamicin and levofloxacin, and immediately alert the RN to the client's acute confusion and critical laboratory values.
The correct action demonstrates an understanding of pharmacology, gerontology, and safe scope of practice. The client is exhibiting signs of acute kidney injury, evidenced by a significantly elevated serum creatinine level. Gentamicin is highly nephrotoxic, and levofloxacin requires adequate renal clearance. Administering these medications during an acute kidney injury can lead to severe systemic toxicity. Furthermore, the sudden onset of confusion and agitation in an older adult indicates acute delirium, likely secondary to the infection or impending toxicity, which is a medical emergency. The practical nurse must advocate for client safety by withholding the potentially harmful medications and urgently escalating these critical findings to the registered nurse for provider intervention.

Adım Adım Çözüm

1
Analyze the client's morning laboratory results in the context of their prescribed medications.
The serum creatinine has increased from a baseline of 0.9 mg/dL to 2.8 mg/dL, indicating acute kidney injury (AKI). Gentamicin is a highly nephrotoxic aminoglycoside, and levofloxacin is renally cleared.
Administering nephrotoxic or renally cleared medications during an acute kidney injury can lead to severe, irreversible systemic toxicity.
2
Evaluate the client's sudden change in neurological status.
The client exhibits new-onset agitation and disorientation to time and place.
Acute, sudden confusion in an older adult is a hallmark sign of delirium, which is a medical emergency often triggered by infection, medication toxicity, or acute metabolic disturbances (such as AKI).
3
Determine the safest and most appropriate intervention within the practical nurse scope of practice.
The PN must hold the potentially harmful medications and immediately escalate these critical clinical findings to the supervising RN.
The PN is responsible for recognizing life-threatening changes, withholding contraindicated therapies, and reporting critical labs to the RN or provider for immediate intervention.

Anahtar Kavram

Pharmacokinetics, Geriatric Delirium, and Practical Nurse Scope of Practice in Medication Safety
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Konular

Pharmacological Therapies

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