Question

The nurse is caring for a client who has been prescribed vancomycin intravenous infusion for the treatment of methicillin-resistant staphylococcus aureus. Which of the following laboratory values should be immediately reported to the healthcare provider?

Vancomycin trough of 15 mcg/dl

Blood urea nitrogen level of 18 mg/dl

Creatinine level of 1.1 mg d/l

White blood cell count of 11,500 per microliter

Answer 1

The vancomycin trough level of 15 mcg/dl should be immediately reported due to potential toxicity concerns, especially if the patient has renal impairment. The BUN level of 18 mg/dl and creatinine level of 1.1 mg/dl are within normal ranges, while the WBC of 11,500 per microliter is slightly elevated but not urgent.

Step-by-step explanation:

The nurse should immediately report the vancomycin trough of 15 mcg/dl, as it can be indicative of a high level that might cause toxicity. Vancomycin therapeutic trough levels are usually aimed to be between 10-20 mcg/ml, depending on the severity of the infection and the patient's specific situation, but if the patient has preexisting renal issues or is at risk for toxicity, this value may be concerning.

The blood urea nitrogen (BUN) level of 18 mg/dl is within the normal range of 8-20 mg/dl and does not need immediate reporting. The creatinine level of 1.1 mg/dl is within the normal range for males (0.8-1.2 mg/dl) and slightly elevated for females (0.6-0.9 mg/dl), so it should be interpreted based on patient gender and history. A white blood cell count (WBC) of 11,500 per microliter is slightly elevated as the normal range is 4,500-11,000 per microliter, which could be due to infection or inflammation but is not as critical to report immediately as the vancomycin trough.