Comprehensive Nursing Pharmacology Q 163

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Which of the following nursing diagnoses might occur when administering large parenteral doses of amphotericin B with vancomycin (Vancocin)?

  

     A. Decreased cardiac output

     B. Ineffective airway clearance

     C. Ineffective breathing pattern

     D. Fluid volume excess

    

    

Correct Answer: D. Fluid volume excess

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These two drugs are both nephrotoxic, so this nursing diagnosis may result from renal problems. Renal toxicity correlates with conventional amphotericin B use and can lead to renal failure and requirement for dialysis. But the azotemia often stabilizes with therapy and renal damage is reversible after discontinuation of amphotericin B. Avoiding concomitant use of other nephrotoxic agents, and appropriate hydration with normal saline may significantly decrease the likelihood and severity of azotemia associated with amphotericin B.

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Option A: Amphotericin exhibits infusion-related toxicity, which accounts for its extended administration times. Infuse slowly over 3 hours; rapid infusion can cause cardiotoxicity. Other potential uncommon side effects include demyelinating encephalopathy in patients with bone marrow transplants with total body irradiation or who are receiving cyclosporine.

Option B: Monitoring is a recommendation to evaluate for the presence of side effects. Initially, a daily electrolyte panel, including potassium and magnesium concentrations until the dose increases to its therapeutic level, and after that, weekly electrolyte concentrations are sufficient.

Option C: The monitoring of amphotericin B concentrations in the serum or CSF is of little value because the relationships between plasma and tissue concentrations and clinical efficacy or toxicity have not had adequate research performed.

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