Vancomycin nursing considerations
Vancomycin's nursing considerations are to infuse it slowly over at least 60 minutes to prevent the red man (vancomycin flushing) reaction, monitor the trough level to keep it safe and effective, and watch kidney function and hearing because it is nephrotoxic and ototoxic.
What vancomycin does, and why the NCLEX tests it
Vancomycin inhibits cell-wall synthesis and is a go-to for MRSA and other resistant gram-positive infections (IV), and for C. difficile (oral). The exam tests the infusion-rate reaction and trough monitoring.
Key nursing considerations for vancomycin
Give IV over at least 60 minutes to prevent vancomycin flushing (red man) syndrome, which is flushing and rash of the face, neck, and upper body from a fast infusion.
Check the trough level (about 10 to 20 mcg/mL) to keep therapy safe and effective.
Monitor kidney function (BUN and creatinine) and report ringing in the ears or hearing changes.
If flushing or itching starts during the infusion, slow or stop it and notify.
Oral vancomycin stays in the gut to treat C. difficile.
How the NCLEX turns vancomycin into a question
Report flushing or rash during the infusion (rate too fast), ringing in the ears, and decreased urine output.
Priority slow the infusion to at least 60 minutes and monitor the trough, kidney function, and hearing.
Lab vancomycin trough (about 10 to 20 mcg/mL), BUN and creatinine.
Teach tell the nurse if you feel flushing or itching during the IV, and report any ringing in the ears or hearing changes.
Flushing and redness of the face and neck partway into a rapid vancomycin infusion. Slow the rate and notify.
Quick answers
What is red man syndrome?
Vancomycin flushing syndrome: flushing and a rash of the face, neck, and upper body caused by infusing vancomycin too fast. Prevent it by infusing over at least 60 minutes.
Why monitor the vancomycin trough?
The trough level (about 10 to 20 mcg/mL) keeps the drug in a range that is effective without being nephrotoxic or ototoxic.
Is vancomycin hard on the kidneys?
Yes. It is nephrotoxic and ototoxic, so kidney function and hearing are monitored during therapy.
Keep studying
These pages build on each other. Work through the related classes, then pressure-test yourself against the free cheat sheet and the full guide.
Gentamicin
Ototoxic and nephrotoxic: ears, kidneys, peaks and troughs.
Read the guide →Cephalosporins
Penicillin cross-allergy and the alcohol reaction.
Read the guide →All high-yield drug classes
The seven most-tested classes on one page, each decoded the same way.
Open the overview →Antidotes & lab values cheat sheet
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Every high-yield class, decoded the same way
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