護理師準備對嚴重葡萄球菌感染病人給予萬古黴素，計畫在 90 分鐘內輸注完畢。護理師首要採取哪項行動？
A nurse is preparing to administer Vancomycin to a client with a severe staphylococcal infection. The nurse plans to infuse the dose over 90 minutes. What is the priority nursing action?
- AObtain a trough level before the infusion✓ 正解在輸注前取得谷濃度
- BMonitor the infusion site for phlebitis監測輸注部位是否有靜脈炎
- CAssess the client's BUN and Creatinine評估個案的 BUN 和 Creatinine
- DCheck the client's peak level during infusion在輸注期間檢查個案的峰濃度
Vancomycin 具腎毒性與耳毒性，治療窗狹窄。對於已建立 maintenance therapy 的病人，**下次劑量給藥前 30 分鐘**抽 trough level（A）是標準監測項目，可確保藥物濃度於治療範圍（通常 15-20 mg/L）並避免毒性。注意：(1) 第一劑時應先評估 baseline 腎功能（BUN/creatinine）作為 dosing 依據；(2) 現代趨勢採用 AUC-guided monitoring。本題情境為持續治療下的下次劑量，A 為優先動作。
Vancomycin is nephrotoxic and ototoxic and has a narrow therapeutic window. For a client already on maintenance therapy, drawing a trough level 30 minutes before the next dose (A) is the standard monitoring practice; it ensures the drug concentration is within the therapeutic range (usually 15-20 mg/L) and helps prevent toxicity. Notes: (1) before the first dose, baseline renal function (BUN/creatinine) should be evaluated to guide dosing; (2) modern practice increasingly uses AUC-guided monitoring. In this scenario the client is on ongoing therapy, so A is the priority action.
美國醫院藥師常協助計算 dose，台灣則高度依賴醫囑系統，護理師需確認血中濃度報告是否已更新。