100%(6)6 out of 6 people found this document helpful
This preview shows page 1 - 3 out of 4 pages.
4What supportive treatment do you expect for Ms. L? Why?
IV fluids and hydration status since the patient will be having profuse diarrhea which is a great manifestation of this diagnosis.You have been assigned to care for Mr. E, a 60-year-old with septicemia. He is on gentamicintherapy intravenous (IV) once daily. You are developing a care plan for him. Your clinical instructor has asked you to answer the following questions and to incorporate the answers into Mr. E’s plan of care.1How is the gentamicin dosage best determined and why is this method preferred?Gentamicin is an aminoglycoside antibiotic commonly used for the treatment of infections and surgical prophylaxis. It is not absorbed from the gut when administered orally, and is therefore predominantly administered via intramuscular or intravenous injection. Gentamicin can cause serious dose-related side effects including nephrotoxicity and irreversible hearing loss, so it is important to ensure patients receive the correct dose and are monitored regularly.2In your plan of care, when do you expect peak and trough levels to be drawn and what is the reasoning behind this timing?Monitoring of serum drug levels provides the best basis for adjusting the aminoglycoside dosage. To produce bacterial kill, peak levels must be sufficiently high. To minimize ototoxicity and nephrotoxicity, trough levels must be sufficiently low.3If Mr. E’s gentamicin is to be administered at 9:00 AM, when do you expect the trough level to be drawn?Bactericidal activity persists for several hours afterserum levels have dropped below the minimal bactericidal concentration; this phenomenon is known as the postantibiotic effect.Gentamicin peak and trough guidelinesGoalsWhen to draw levelInitial trough0.3-1.0Just prior to 2nd doseLate troughs0.3-1.0Obtain on day 7 if continuing therapy >7 days and then weekly thereafter. Draw earlier and/or more frequent if there is decreased urine output or other changes in renal function.Peaks5-12IV: 30 minutes after the end of the infusionMs. K, who is 19 years old, comes to the clinic complaining of burning and urgency on urination.You have been assigned to follow her through the clinic visit. In your interview with her, you learn that Ms. K is a college student who works as a lifeguardat the college pool as her work-study job. Ms. K tells you that she knows this is a urinary tract infection, because she has gotten them a lot since she became a teenager. Ms. K then goes in to see the primary care provider.