Mechanism of Action
Vancomycin works by inhibiting cell wall synthesis in bacteria, leading to cell lysis and death. It binds to the D-alanyl-D-alanine terminus of cell wall precursors, which prevents the cross-linking of peptidoglycan chains, a crucial step in bacterial cell wall synthesis.Administration and Dosage
Vancomycin can be administered intravenously for systemic infections or orally for gastrointestinal infections such as
C. difficile. The dosage depends on the type and severity of the infection, as well as the patient’s renal function and weight. Nurses must closely monitor the patient's
serum vancomycin levels to ensure therapeutic efficacy while avoiding toxicity.
Side Effects and Adverse Reactions
Common side effects of vancomycin include
nephrotoxicity,
ototoxicity, and "red man syndrome," a reaction characterized by flushing, rash, and itching. Nurses should be vigilant in monitoring for these side effects and manage them appropriately. For instance, slowing the infusion rate can help mitigate red man syndrome.
Nursing Considerations
Monitor
renal function (e.g., serum creatinine, blood urea nitrogen) regularly to detect any signs of nephrotoxicity.
Assess for signs of ototoxicity, such as tinnitus or hearing loss, especially in patients receiving high doses or prolonged therapy.
Ensure accurate dosing by calculating the dose based on weight and renal function, and verify serum levels according to protocol.
Educate patients about potential side effects and the importance of reporting any unusual symptoms immediately.
Administer the drug over at least 60 minutes to reduce the risk of red man syndrome.
Monitoring and Laboratory Tests
Regular monitoring of
serum vancomycin levels is crucial to avoid toxicity while ensuring therapeutic effectiveness. Trough levels are typically measured just before the next dose, with target levels generally ranging from 10 to 20 mcg/mL, depending on the infection being treated. Additionally, routine blood work to monitor renal function is essential.
Patient Education
Nurses play a pivotal role in educating patients about their treatment. Patients should be informed about the importance of completing the entire course of vancomycin, even if they start feeling better. They should also be advised to report any symptoms of side effects promptly, such as changes in urine output, hearing issues, or severe itching and rash.Conclusion
Vancomycin is a critical antibiotic in the fight against severe bacterial infections, particularly those resistant to other treatments. Proper administration, vigilant monitoring, and patient education are essential components of nursing care to maximize the drug's effectiveness while minimizing potential risks.
