The nurse prepares to administer IV vancomycin to an 80-year-old client with a methicillin-resistant Staphylococcus aureus infection. The nurse should notify the health care provider about which serum laboratory results before administering the drug? Select all that apply.

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Vancomycin is a glycopeptide antibiotic that is excreted by the kidneys. It is used to treat serious infections with gram-positive microorganisms (Staphylococcus aureus [methicillin-resistant Staphylococcus aureus]) and diarrhea associated with Clostridium difficile. Serum vancomycin trough level is monitored before the 4th dose (15-20 mg/L [10.4-13.8 µmol/L] is optimal). Blood urea nitrogen (BUN) and creatinine levels are monitored regularly (usually 2-3 times/week) in clients receiving the drug due to increased risk of nephrotoxicity, especially in those with impaired renal function, receiving aminoglycosides, and who are >60 years old. The health care provider (HCP) can lower the dose, decrease the drug administration frequency, or discontinue vancomycin. It is important to know the baseline values of BUN and creatinine to monitor trending and identify if there is an increase. Before administering this drug, the nurse should notify the HCP that the client's BUN (60 mg/dL [21.4 mmol/L]) and creatinine (2.1 mg/dL [185.6 µmol/L]) are both increased. The normal range for BUN is 6-20 mg/dL (2.1-7.1 mmol/L) and creatinine is 0.6-1.3 mg/dL (53-115 µmol/L). (Option C) An elevated glucose level (>110 mg/dL [6.1 mmol/L]) is expected in a client with an infection due to physiological stress and gluconeogenesis; this does not need to be reported to the HCP. (Option D) A hemoglobin level of 15 g/dL (150 g/L) is normal (13.2-17.3 g/dL [132-173 g/L] in adult men; 11.7-15.5 g/dL [117-155 g/L] in adult women) and does not need to be reported to the HCP. (Option E) A magnesium level of 1.5 mEq/L (0.75 mmol/L) is normal (1.5-2.5 mEq/L [0.75-1.25 mmol/L]) and does not need to be reported to the HCP. (Option F) A white blood cell count of 14,000/mm³ (14.0 × 10⁹/L) is elevated and expected in a client with a serious infection; this does not need to be reported to the HCP. Educational objective: As nephrotoxicity can occur, monitoring of vancomycin trough level to maintain optimal drug level and renal function is indicated in clients receiving vancomycin, especially in those with impaired renal function and who are >60 years old.

The Nurse Prepares to Administer IV Vancomycin to an 80-Year-Old