— 藥理與非經腸給藥 · HARD · MCQ —
一位病人因嚴重 MRSA 感染使用 Vancomycin，護理師應優先回報下列哪項發現？
A client is prescribed vancomycin for a severe MRSA infection. Which finding should the nurse prioritize reporting to the healthcare provider?
- AElevated BUN and serum creatinine levels✓ 正解BUN 和血清肌酸酐值升高
- BOral temperature of 38.2°C口腔溫度 38.2°C
- CMild flushing of the neck and face頸部和臉部輕微潮紅
- DUrine output of 50 mL/hour尿量 50 mL/小時
— Explanation · 中文詳解 —
Vancomycin 具有腎毒性，當血中 BUN 與 creatinine 上升時，代表腎功能受損，需調整劑量或監測藥物濃度。頸部潮紅（紅人症候群）可透過減慢滴速改善，非最嚴重；尿量 50 mL/h 正常，體溫略高可能是感染過程反應。
Vancomycin is nephrotoxic, so elevated BUN and creatinine levels indicate renal impairment requiring immediate dose adjustment to prevent toxicity. While mild fever and flushing (Red Man Syndrome) are common, they are less critical than potential kidney damage, and a urine output of 50 mL/hr is within normal limits.
✦ 台美臨床差異
台灣醫院 Vancomycin 監測多由藥師介入計算藥物動力學，美國則更強調護理師在給藥時的腎功能評估與數據監測。