Which condition would the nurse monitor for in the client on aminoglycoside?
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Aminoglycosides are a potent broad spectrum of antibiotics that are useful for treating severe infections. Many aminoglycosides are poorly absorbed in the GI tract; therefore, the majority are given IV or IM. Aminoglycosides are potentially nephrotoxic and neurotoxic. They should be administered cautiously. Blood peak and trough levels should be performed to titrate a safe dose for each patient. Indications: Streptomycin is used for streptococcal endocarditis and a second line treatment for tuberculosis. Neomycin is used in the treatment of hepatic encephalopathy as adjunct therapy to lower ammonia levels and is also used as a bowel prep for colon procedures. Mechanism of Action: Aminoglycosides are bactericidal and bind with the area of the ribosome known as the 30S subunit, inhibiting protein synthesis in the cell wall and resulting in bacterial death (see Figure 3.9).[1] Aminoglycosides may be given with beta-lactam medications to facilitate transport of aminoglycoside across the cellular membrane, resulting in a synergistic effect and increasing drug effectiveness. Special Administration Considerations: Aminoglycosides can result in many adverse effects for the patient and, therefore, the nurse should monitor the patient carefully for signs of emerging concerns. Peak and trough levels are used to titrate this medication to a safe dose. Aminoglycosides can be nephrotoxic (damaging to kidney), neurotoxic (damaging to the nervous system), and ototoxic (damaging to the ear). Nurses should monitor the patient receiving aminoglycosides for signs of decreased renal function such as declining urine output and increasing blood urea nitrogen (BUN), creatinine, and declining glomerular filtration rate (GFR). Indications of damage to the neurological system may be assessed as increasing peripheral numbness or tingling in the extremities. Additionally, the patient should be carefully assessed for hearing loss or hearing changes throughout the course of drug administration. Patient Teaching & Education: Patients receiving aminoglycosides should be advised to monitor for signs of hypersensitivity and auditory changes. This may include tinnitus and hearing loss. Patients may also experience accompanying vertigo while on the medication. Patients should be advised to drink plenty of fluids while taking the medication. Female patients should notify their provider if pregnancy is planned or if they are actively breastfeeding.[2] Now let’s take a closer look at the medication grid for streptomycin and gentamycin in Table 3.12.[3] Table 3:12 Streptomycin and Gentamycin Medication GridClass/SubclassPrototype/GenericAdministration ConsiderationsTherapeutic EffectsSide/Adverse EffectsAminoglycosidesstreptomycingentamicin Check for allergiesObtain culture before administering IM: Blood sample for peak level should be obtained 1 to 2 hours after IM injection; obtain blood for trough level just before next dose Inject in a large muscle Handle carefully; use gloves to prepare Monitor peak and trough levels – WBCs – Fever Monitor actual site of infection Monitor culture results GI upsetRash Report diarrhea immediately SAFETY: Nephrotoxicity: monitor renal function closely Risk for severe neurotoxic reactions, especially with renal impairment. Can result in respiratory paralysis if given soon after anesthesia or muscle relaxant Risk for ototoxicity, especially if administered with a loop diuretic Can cause harm to fetus and breastfed infants Critical Thinking Activity 3.12aUsing the above grid information, consider the following clinical scenario question: A patient is admitted with streptococcal endocarditis and the nurse is preparing the morning dose of streptomycin. The lab has not yet arrived to obtain the trough level, and the drug is now overdue to be given. What is the nurse’s next best response? Note: Answers to the Critical Thinking activities can be found in the “Answer Key” sections at the end of the book.
This page titled 3.12: Aminoglycosides is shared under a CC BY 4.0 license and was authored, remixed, and/or curated by Ernstmeyer & Christman (Eds.) (OpenRN) via source content that was edited to the style and standards of the LibreTexts platform; a detailed edit history is available upon request. What are the nursing implications of aminoglycosides?Aminoglycosides come with a boxed warning for serious risk of neurotoxicity, possibly leading to hearing loss, vertigo, ataxia, and loss of balance; as well as nephrotoxicity, which may progress to kidney failure.
What are the two major side effects of aminoglycosides?The major side effects of aminoglycosides are kidney injury, hearing impairment and vestibular toxicity.
Which body systems may experience toxic effects from the administration of aminoglycosides?Aminoglycosides are associated with serious toxic side effects, including damage to hearing and/or balance (ototoxicity) and acute kidney damage (nephrotoxicity). Though kidney damage caused by aminoglycosides is usually reversible, hearing and/or balance loss is frequently permanent.
Which adverse effect should the nurse be alert for in a patient who is taking tobramycin?Tobramycin can damage nerves and may cause hearing loss that may be permanent. Tell your doctor right away if you have: numbness, tingling, muscle stiffness or uncontrolled twitching; dizziness, spinning sensation, seizure (convulsions); or.
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