Question

A client with an infectious process is receiving IV vancomycin (Vancocin). When will the nurse instruct the laboratory to draw blood for a 30-minute trough level if the Vancomycin IVPB is scheduled to be hung at 2000? ? A. 1900 ? B. 1930 ? C. 2000 ? D. 2030

Short answer

Answer: B. 1930

Step-by-step solution

Understand trough levels

Trough levels refer to the lowest concentration of a medication in the bloodstream, usually measured just before the next scheduled dose. Monitoring trough levels helps ensure proper dosing and avoid potential side effects caused by excessively high or low blood concentrations of the medication.

Identify the time of the IVPB administration

The IV vancomycin (Vancocin) is scheduled to be hung at 2000 (8:00 PM). This is the time when the medication administration will begin.

Determine the time for a 30-minute trough level

In this case, the laboratory should draw blood for a 30-minute trough level. Since trough levels are usually measured just before the next scheduled dose, we need to subtract 30 minutes from the scheduled administration time of 2000 (8:00 PM).

Calculate the time for blood sample collection

To find the time for blood sample collection, subtract 30 minutes from the scheduled administration time: 2000 - 0030 ------ 1930 So the nurse should instruct the laboratory to draw blood at 1930 (7:30 PM).

Identify the correct answer

Based on the calculation, the correct answer is: ? A. 1900 ? B. 1930 (Correct) ? C. 2000 ? D. 2030

Key concepts

Trough levels

When administering certain medications, it is crucial to monitor their concentration in the body to ensure effectiveness and reduce the risk of side effects. Trough levels refer to the lowest concentration of a drug in the patient's bloodstream. These levels are typically measured just before a person receives their next dose of medication.
For example, if a drug is given every 24 hours, the trough level is checked right before the new dose is administered. Checking trough levels helps healthcare providers ensure that the drug remains in a therapeutic range, but not too high, which could lead to toxicity, or too low, which might be ineffective.
This process is particularly important for medications with a narrow therapeutic index, such as vancomycin, where there is only a small range between an effective dose and a toxic one. Regular monitoring through trough levels ensures safe and effective treatment.

Vancomycin administration

Vancomycin is an antibiotic used to treat severe bacterial infections caused by gram-positive bacteria, like MRSA. Due to its potency and potential side effects, vancomycin requires precise dosing and monitoring.
It is often administered intravenously, ensuring the medication reaches high levels directly in the bloodstream. The dosage and frequency of vancomycin administration depend heavily on factors including the patient's weight, kidney function, and the severity of the infection.
This medication has a narrow therapeutic window, meaning the dosage must be just right—too much can cause toxicity, while too little may not effectively treat the infection. Thus, healthcare providers rely on laboratory tests to measure trough levels and make necessary dosage adjustments.

Nursing interventions

Nursing interventions play a critical role in the safe administration of medications like vancomycin. Nurses must be vigilant in timing, dosing, and monitoring to ensure patient safety and therapeutic efficacy.
Some essential nursing interventions when administering vancomycin include:

• Timing the Doses: Ensuring medication is administered on schedule and coordinating with lab tests to monitor trough levels accurately.
• Monitoring for Side Effects: Watching for potential side effects, such as nephrotoxicity (kidney damage) or red man syndrome, a reaction that can occur with rapid infusion.
• Patient Education: Informing the patient about the importance of medication adherence and potential signs of adverse effects.
• Documentation: Accurately documenting administration times, patient responses, and lab values.

Each of these tasks is crucial for preventing complications and ensuring the best possible outcomes for the patient. Nurses are pivotal in the management of vancomycin therapy, helping to adapt the treatment to the patient's changing needs. Hand-in-hand with physicians and pharmacists, they maintain the proper medication balance for effective treatment.