Pharmacology Antibiotics #8

Question

An 82-year-old patient with heart failure is admitted to the intensive care unit. The health care provider suspects urosepsis in addition to the heart failure and orders intravenous furosemide 40 mg and gentamicin 4mg/kg. Which action by the nurse is a priority while caring for the patient on both medications?

Answers

  1. Assess the IV site every 2 hours.
    • Rationale:

      This answer is not correct because although assessment of the IV site is very important, it is not the priority over monitoring the BUN and creatinine for kidney injury associated with nephrotoxicity of the medications.

  2. Assess skin every 2 hours.
    • Rationale:

      This answer is not correct because although assessment of the skin is very important, it is not the priority over monitoring the BUN and creatinine for kidney injury associated with nephrotoxicity of the medications.

  3. Administer hearing test every 6 hours.
    • Rationale:

      This answer is not correct because although gentamicin may cause ototoxicity along with nephrotoxicity, the patient may be too critical for hearing tests. It is a priority to monitor serum blood urea nitrogen (BUN) and creatinine levels every 24 hours.

  4. Monitor serum BUN and creatinine levels every 24 hours.
    • Rationale:

      This answer is correct because furosemide and gentamicin both can cause kidney injury. Administering furosemide with gentamicin, a known highly nephrotoxic antibiotic can further increase kidney damage. Therefore, it is a priority to monitor serum BUN and creatinine levels every 24 hours.

Overview

Furosemide and gentamicin both can cause kidney injury. Therefore, it is a priority to monitor serum blood urea nitrogen (BUN) and creatinine levels every 24 hours.

Explanation

Learning Outcomes

Furosemide is a loop diuretic and gentamicin is an aminoglycoside antibiotic. Furosemide can cause urine to become more acidic which could cause nephrotoxicity in the patient. Administering furosemide with gentamicin, a known highly nephrotoxic antibiotic can further increase kidney damage. Blood urea nitrogen (BUN) and creatinine levels should be monitored closely to determine if kidney injury is beginning. This should be completed every 24 hours.

Test Taking Tip

BUN and creatinine levels reflect kidney health. Be sure to know that levels of BUN greater than 20 mg/dL and creatinine levels of 1.3 or greater need to be investigated unless the patient is dehydrated.

Video Rationale