Question

A client has taken several doses of intravenous gentamicin for a severe infection and is scheduled for another dose this morning. The client is unsteady while walking to the bathroom this morning and complains of having some trouble hearing the nurse. The nurse notes that this is new behavior from what was shared in shift report. What action should the nurse implement?

A. Administer the scheduled dose on time to help maintain a steady state of the gentamicin

B. Contact the health care provider and request trough level before giving the scheduled dose

C. Contact the health care provider and request an order for the gentamicin to be discontinued

D. Request a physical therapy consultation to help with balance and gait training

Answer 1

Gentamicin is an antibiotic used in patients to treat severe bacterial infections. It is administered intravenously (IV). It is very important to ensure the level of medication of Gentamicin. This is because; Gentamicin may produce free radicals after binding with iron in the blood, in case it becomes toxic. These free radicals have a tendency to attack the hair cells in the inner portion of the ears which may result in inability to transmit sound impulses to nerve and brain. Further the damage to the vestibular system may also result in dizziness, vertigo and difficulty in walking.

In the present case, as the patient complains of difficulty in walking and hearing loss, this may be a case of Gentamicin toxicity. Hence, the nurse should contact the health care provider for this case. The nurse should get the trough level blood test to assess the amount of medication in the patient’s bloodstream. This will help in further analysis of the case. All this should be performed before giving any scheduled dose.

Answer: B

(Contact the health care provider and request trough level before giving the scheduled dose)