Question

NUR219 MRSA

A nursing home resident K.W., had a hip replacement 6 months ago and consequently developed an infection with methicillin resistant Staphylococcus aureus and then osteomyelitis. He has a history of diabetes.

Medication Questions

K.W. receives vancomycin IVPB ordered at 15 mg/kg/day. K.W. weighs 220 lb. What daily dose would the patient receive?

What nursing considerations are essential when giving this medication?

What are the signs and symptoms and treatment the nurse would be alert for if K.W. developed the red man syndrome?

Answer 1

1) Daily dose of vancomycin

220 pounds = 99.79kg

Dose in mg= 99.79 x 15mg/kg/day = 1496.85 mg/day (daily vancomycin dose)

This value would be divided by vancomycin clearance. The result obtained is the AUC 24, which would be again divided by MIC or minimum inhibition concentration.

2) Nursing considerations:

• The serum concentration of the drug must be checked
• Renal function test must be performed
• Check rights of drug administration such right patient, correct drug, correct dose, route and frequency
• Check for IV complications such as infiltration, extravasation or necrosis
• Monitor for side efefcts such as diarrhea, chills, increased body temperature and red man syndrome
• Ask the patient to notify if in case of side effects

3) Signs and symptoms of red man syndrome:

• Erythema of the upper body and extremities including face and neck
• Flushing
• Pruritis
• Back and chest pain
• Muscle spasm

Treatment

• Stop the infusion immediately
• Provide blanket for the patient
• Administer antihistamine drug such as diphenhydramine as per organization policy
• Continuous monitoring is required
• Assess vital parameters