— 藥理與非經腸給藥 · HARD · MCQ —
病人服用萬古黴素（vancomycin），下列哪項發現護理師應立即回報？
A client is prescribed vancomycin. Which assessment finding should the nurse report to the provider immediately?
- AClient reports slight itching病人報告輕微搔癢
- BMild flushing of the neck and face頸部和臉部輕微潮紅
- CSerum creatinine increase from 0.8 to 1.5 mg/dL✓ 正解血清肌酸酐從 0.8 上升至 1.5 mg/dL
- DUrine output of 60 mL/hr尿量為 60 mL/hr
— Explanation · 中文詳解 —
萬古黴素具有高度腎毒性。肌酸酐從 0.8 升至 1.5 mg/dL 代表急性腎功能惡化，必須立即停藥並通知醫師調整劑量。B 與 A 為紅人症候群（Red Man Syndrome），通常與輸注速度過快有關，可藉由減慢速度改善；D 為正常尿量。
Vancomycin is highly nephrotoxic. A rise in serum creatinine from 0.8 to 1.5 mg/dL represents acute deterioration of renal function and requires immediate discontinuation of the drug and notification of the provider for dose adjustment. Options B and A are consistent with Red Man Syndrome, which is usually related to a too-rapid infusion rate and can be addressed by slowing the infusion; option D represents a normal urine output.
✦ 台美臨床差異
兩地對於 Vancomycin 監測指引均嚴格，但美國現多強調 Trough level 的監測以預防毒性。