A patient receiving aminoglycoside antibiotics needs to undergo which investigation positively?

BCCL kharkhanda Staff Nurse - 2015

Pharmacology

Easy

Appeared in: BCCL kharkhanda Staff Nurse - 2015

Explanation

Aminoglycoside antibiotics (e.g., gentamicin, amikacin, tobramycin) are well-known for causing nephrotoxicity, which is damage to the kidneys.
Serum creatinine is the most direct and sensitive laboratory marker for monitoring kidney (renal) function.
A rising serum creatinine level indicates that the kidneys are not filtering waste products effectively, which is a key sign of drug-induced nephrotoxicity.
Monitoring creatinine allows for early detection of kidney injury, enabling dose adjustments or discontinuation of the drug to prevent permanent damage.

Option A: Serum sodium primarily reflects the body's fluid balance and is not a direct or early indicator of aminoglycoside-induced kidney damage.
Option B: While severe kidney failure can lead to hyperkalemia (high potassium), serum potassium is not the initial test used to monitor for the onset of aminoglycoside nephrotoxicity.
Option C: The red blood cell count is used to assess for anemia or polycythemia and has no direct relationship with the known toxic effects of aminoglycosides.

Clinical Relevance

Nursing practice connection: Use the key finding related to Monitoring for adverse effects of aminoglycoside antibiotics to guide bedside assessment, documentation, and the next nursing action.
Nurses play a vital role in preventing aminoglycoside toxicity by ensuring that baseline and periodic serum creatinine levels are checked as ordered and by reporting any upward trend to the prescriber immediately.
Patient education should include reporting symptoms of ototoxicity (ringing in ears, dizziness) and nephrotoxicity (decreased urine output, swelling).
What if? If the patient was elderly or also taking another nephrotoxic drug (like vancomycin or furosemide), the risk of kidney injury would be significantly higher, necessitating more frequent serum creatinine monitoring.

How to Approach the Question

First, identify the drug class mentioned in the question: 'aminoglycoside antibiotics'.
Recall the two major, well-known toxicities associated with this class: nephrotoxicity (kidney damage) and ototoxicity (ear damage).
Scan the options to find a test that directly measures kidney or ear function.
Recognize that 'Serum creatinine' is the standard laboratory test for assessing kidney function.
Eliminate the other options: 'Serum sodium' and 'potassium' are electrolytes, and 'Red blood cell count' relates to hematology, neither of which is the primary test for this specific drug toxicity.
Conclude that monitoring serum creatinine is the essential investigation.

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 2 p. 316-318

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