Question

The nurse is administering medication to four clients. Which client should be most closely monitored for signs of ototoxicity? A. A 20-year-old receiving ciprofloxacin (Cipro) for a urinary tract infection B. A 75-year-old receiving amikacin sulfate (Amikin) for pneumonia C. A 46-year-old receiving cefazolin sodium (Ancef) for sinusitis D. A 6-month-old receiving amoxicillin/clavulanate potassium (Augmentin) for otitis media

Short answer

Answer: Client B, a 75-year-old receiving amikacin sulfate (Amikin) for pneumonia, should be most closely monitored for signs of ototoxicity.

Step-by-step solution

Understanding Medications and Ototoxicity

The first thing to do in this exercise is to understand which medications are known to cause ototoxicity. Based on the available options, the medications are: 1. Ciprofloxacin (Cipro) 2. Amikacin sulfate (Amikin) 3. Cefazolin sodium (Ancef) 4. Amoxicillin/clavulanate potassium (Augmentin) A basic understanding of pharmacology shows that amikacin sulfate (Amikin) is an aminoglycoside antibiotic, and aminoglycosides are well-known for their potential to cause ototoxicity.

Evaluating Client Age and Condition

Now that we understand which medication is known for its ototoxic effects, let's consider the client's age and medical conditions: A. 20-year-old receiving ciprofloxacin (Cipro) for a urinary tract infection B. 75-year-old receiving amikacin sulfate (Amikin) for pneumonia C. 46-year-old receiving cefazolin sodium (Ancef) for sinusitis D. 6-month-old receiving amoxicillin/clavulanate potassium (Augmentin) for otitis media Obviously, client B is receiving Amikin, which is known to cause ototoxicity. Furthermore, elderly clients (in this case, the 75-year-old) are more susceptible to the side effects of medications, as their bodies are generally less efficient at metabolizing and eliminating drugs.

Identifying the Client at Highest Risk

Based on the information provided, client B, a 75-year-old receiving amikacin sulfate (Amikin) for pneumonia, is the most likely candidate to be closely monitored for ototoxicity. This is due to the combination of the drug's known ototoxic potential and the client's advanced age, which makes them more susceptible to the side effects of medications.

Key concepts

Medication Administration

Administering medication involves the careful process of preparing and giving medicine to patients. It's a responsibility primarily handled by healthcare professionals like nurses. Understanding the right procedures and protocols is crucial to ensure patient safety.
There are several critical steps in medication administration:

• Verification of the patient's identity using at least two identifiers.
• Verification of the correct medication and dosage.
• Checking the correct route and time for medication delivery.
• Observing for effects and documenting the administration process.

These steps aim to prevent errors and enhance the positive outcomes of treatment. For example, when administering a drug that potentially causes ototoxicity, like amikacin, nurses must be particularly vigilant in ensuring the correct procedures are followed.

Ototoxicity

Ototoxicity refers to drug-induced damage to the ear, primarily affecting the inner ear and leading to hearing loss or balance disorders. It's an important consideration in pharmacology, especially with medications like aminoglycosides and certain chemotherapy agents.
Understanding ototoxic agents is essential:

• Classification: Drugs known for ototoxic effects include aminoglycosides (e.g., amikacin), specific loop diuretics, and certain antibiotics.
• Symptoms: Patients may present with tinnitus, hearing loss, or balance issues.
• Monitoring: Regular auditory assessments and vestibular function tests can detect early signs of damage.

Proactive monitoring and timely intervention can prevent long-term effects. For a medication like amikacin, healthcare providers need to weigh the benefits of its antibacterial effects against the risks of ototoxicity.

Pharmacology

Pharmacology is the study of how drugs interact with the body. It covers a broad spectrum including how drugs are used, the effects they have, and the mechanisms by which they act.
Important pharmacological concepts include:

• Drug Classifications: Understanding the classes, such as antibiotics and their subclasses like aminoglycosides.
• Mechanism of Action: Each class has a unique way they work at the molecular or cellular level.
• Adverse Effects: Knowledge of potential side effects, like ototoxicity, is critical for patient safety.
• Drug Interactions: How different medications can affect each other's effectiveness.

Through pharmacology, healthcare providers acquire knowledge to ensure safe and effective drug use, as well as manage drugs’ potential side effects, including those considered ototoxic.

Patient Monitoring

Monitoring patients who are receiving medications is essential to ensure their safety and the effectiveness of the therapy. This process involves regular checks on the patient’s response to the medication to identify any adverse effects early.
Considerations in patient monitoring include:

• Regular Assessments: Checking vital signs and conducting specific tests related to the drug being administered.
• Patient Interviews: Engaging with patients to understand their experience of the medication and any side effects.
• Documentation: Keeping accurate records of the patient’s response and any changes observed.
• Tailored Plans: Adjusting the course of treatment based on the findings from ongoing monitoring.

In contexts like monitoring for ototoxicity, healthcare practitioners must be diligent. For elderly patients, this means being especially observant due to their increased physiological sensitivity to drugs like amikacin.