Vancomycin, Nursing Diagnosis, and Collaborative Problems - Pharmacology

Nursing Care Plan for Vancomycin

Patients who receive vancomycin may also experience nephrotoxicty (kidney). Monitor urine output for kidney function.

Here are the common nursing diagnoses that are related to a patient who is receiving vancomycin.

  • Risk for injury related to histamine release if administered too rapidly
  • Fluid volume deficit related to nausea and vomiting
  • Impaired tissue integrity
  • Sensory-perceptual disturbance related to ototoxicity (loss of hearing and tinnitus [ringing in the ears])


Aminogylcosides are potent antibiotics used to kill bacteria that cause serious or life-threatening infections. They are very effective against many bacteria (gram-positive and gram-negative) but are generally used for gram-negative infections.


Safer and less toxic agents are available to treat the majority of gram-positive infections. Since the patient is experiencing a life-threatening infection, pre¬scribes combine animoglycosides with penicillin, cephalosporins, or ancomycin to give a one-two punch knockout to the bacteria.

There are significant side effects to using aminogylcosides. These are nephrotoxicity, neurotoxicity, hyersensitivity, and ototoxicity (problems with hearing and balance). Assess the patient according to the guidelines for all antibiotics as described previously in this chapter for penicillin. Infants with botulism and patients with myasthenia gravis or Parkinsonism will experience more muscle weakness than other patients who are treated with animoglycosides. You must also assess if the patient has hearing or kidney problems or allergies.

Before administering aminoglycosides, obtain a baseline assessment for the patient including audiogram, renal function, and vestibular function studies.

When administering aminoglycosides intravenously, dilute the medication in solution as per the package insert and infuse it over a 30- to 60-minute period. Use a smaller than normal dose for elderly patients who are at greater risk for kidney toxicity and ototoxicity.

If aminoglycides are given IM, then give the injection deep into the upper outer quadrant of the gluteal muscle.

After administering aminoglycides, keep the patient well hydrated and monitor the patient’s intake and output to determine if there is nephrotoxicity. Monitor the patient’s temperature, cultures, and WBC to determine if the infection is resolving. A daily urinalysis should be obtained for signs of kidney irritation.

The patient should be provided with the same instructions as those given to a patient who is receiving penicillin (see Penicillin and Patient Education). Advise the patient to report any hearing problem including ringing or buzzing in the ears as well as dizziness, numbness, tingling, twitching, or changes in urinary patterns especially blood in the urine.

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