A nurse is caring for a patient who is receiving intravenous vancomycin for a severe infection. The patient complains of itching and flushing of the face, neck, and chest.
The nurse recognizes these symptoms as indicative of what?

A red man syndrome is a reaction to the antibiotic vancomycin that causes flushing, itching, and sometimes hypotension and tachycardia. It is not a true allergic reaction, but rather a pseudoallergic or anaphylactoid reaction caused by the release of histamine from mast cells. It is more likely to occur when vancomycin is infused rapidly or at high doses.The symptoms usually resolve with slowing or stopping the infusion, and can be prevented by premedicating with antihistamines or extending the infusion time

Choice A is wrong because an allergic reaction to vancomycin would involve IgE-mediated hypersensitivity, which can cause urticaria, angioedema, bronchospasm, and anaphylaxis.An allergic reaction would not be dependent on the infusion rate or dose of vancomycin, and would require immediate discontinuation of the drug and treatment with epinephrine and other supportive measures

Choice B is wrong because a superinfection is a secondary infection that occurs when the normal flora of the body is disrupted by antibiotics, allowing opportunistic pathogens to proliferate. Common examples of superinfections are Clostridioides difficile colitis, oral or vaginal candidiasis, and methicillin-resistant Staphylococcus aureus infections. Superinfections do not cause flushing or itching, but rather symptoms related to the site of infection, such as diarrhea, abdominal pain, oral thrush, or skin lesions.Superinfections may require treatment with different antibiotics or antifungals

Choice C is wrong because a disulfiram-like reaction is a reaction that occurs when alcohol is consumed while taking certain drugs that inhibit the enzyme acetaldehyde dehydrogenase, which is responsible for metabolizing alcohol. This leads to the accumulation of acetaldehyde, which causes nausea, vomiting, headache, flushing, palpitations, and hypotension. Vancomycin does not cause a disulfiram-like reaction, but some other antibiotics such as metronidazole and cephalosporins do.A disulfiram-like reaction can be avoided by abstaining from alcohol while taking these drugs

Gentamicin is an aminoglycoside antibiotic that can cause nephrotoxicity, which is the damage of the kidney.Gentamicin induces nephrotoxicity by inhibiting protein synthesis in renal cells that specifically causes necrosis of cells in the renal proximal tubule, resulting in acute tubular necrosis, followed by acute renal failure.The nurse monitors the patient’s serum creatinine level as an indicator of nephrotoxicity because serum creatinine reflects the glomerular filtration rate (GFR) and kidney function.

Choice A is wrong because hepatotoxicity is the damage of the liver, not the kidney.

Gentamicin is not known to cause hepatotoxicity.

Choice C is wrong because neurotoxicity is the damage of the nervous system, not the kidney.

Gentamicin can cause neurotoxicity by affecting the neuromuscular junction and causing muscle weakness or paralysis, but this is not related to serum creatinine level.

Choice D is wrong because ototoxicity is the damage of the ear, not the kidney.

Gentamicin can cause ototoxicity by damaging the hair cells in the inner ear and causing hearing loss or balance problems, but this is not related to serum creatinine level.

Normal ranges for serum creatinine are 0.6 to 1.2 mg/dL for men and 0.5 to 1.1 mg/dL for women.