病患因 MRSA 感染醫囑使用靜脈注射 vancomycin。護理師應執行哪些措施以確保給藥安全？（選所有適合的）
A client is prescribed intravenous vancomycin for a MRSA infection. Which actions should the nurse implement to ensure safe administration? (Select all that apply.)
- AInfuse the medication over at least 60 minutes✓ 正解以至少60分鐘之時間輸注藥物
- BMonitor the infusion site for signs of phlebitis✓ 正解監測輸注部位是否有靜脈炎跡象
- CCheck the peak serum level 30 minutes after the first dose在第一劑給藥後30分鐘檢查血清峰值濃度
- DAssess the client for a rash on the face and neck during infusion✓ 正解在輸注期間評估病人是否有臉部和頸部皮疹
- EMonitor blood urea nitrogen (BUN) and creatinine levels✓ 正解監測血液尿素氮（BUN）和肌酸酐濃度
Vancomycin 的安全管理核心在於預防輸注反應與器官毒性。為何 A/D 正確：快速輸注會引起「紅人症候群」（Red Man Syndrome），表現為臉頸部潮紅，故須緩慢輸注（至少 60 分鐘）。為何 B 正確：該藥物具刺激性，極易導致血栓性靜脈炎，需密切監測部位。為何 E 正確：Vancomycin 具有腎毒性，需監測 BUN/Cr。為何 C 錯誤：臨床現在多監測「最低濃度」（Trough level），通常在第四劑給藥前 30 分鐘採血，而非第一劑後的巔峰值。臨床思路：安全優先在於控制給藥速度與監測排泄器官功能，避免不可逆損傷。
The core of safe vancomycin management lies in preventing infusion reactions and organ toxicity. Why A and D are correct: rapid infusion can cause "Red Man Syndrome," manifesting as flushing of the face and neck, so infusion must be slow (over at least 60 minutes). Why B is correct: the drug is irritating and easily causes thrombophlebitis, so the IV site must be closely monitored. Why E is correct: vancomycin is nephrotoxic, requiring monitoring of BUN/creatinine. Why C is wrong: current clinical practice favors monitoring trough levels, typically drawn 30 minutes before the fourth dose, rather than peak levels after the first dose. Clinical reasoning: safety first lies in controlling infusion rate and monitoring excretory organ function to prevent irreversible damage.
美國藥劑師在醫院中常主導 Vancomycin 的劑量調整（Pharmacy-led dosing），護理師需精準配合採血時間；台灣多由醫師依據檢驗數值下醫囑調整，護理師在抽 Trough level 的時間點掌握上需更主動提醒醫師或執行。