A nurse is caring for a client who is receiving vancomycin by IV infusion over 30 min. Which of the following findings indicate the clien experiencing a vancomycin infusion reaction?

1. A) Extravasation: Extravasation, or the leaking of IV medication into surrounding tissues, is a potential complication of IV therapy. However, it does not indicate a need to increase the rate of dopamine infusion. Instead, the priority is to stop the infusion, assess the site for damage, and provide appropriate interventions to minimize tissue injury.

   B) Hypotension: Hypotension, or low blood pressure, is a common indication for administering dopamine in septic shock to improve cardiac output and increase blood pressure. If the client's blood pressure remains low despite the’current rate of dopamine infusion, it may be necessary to increase the infusion rate to achieve the desired therapeutic effect and improve perfusion to vital organs. Therefore, hypotension is the correct finding that indicates the need to increase the rate of infusion.

   C) Headache: While headache can occur as a side effect of dopamine infusion, it is not typically an indication to increase the infusion rate. Headache may warrant further assessment and management, but it does not directly correlate with the need for a higher dose of dopamine.

   D) Chest pain: Chest pain may occur as a side effect of dopamine infusion or could be indicative of other cardiac or pulmonary issues. However, like headache, it is not a specific indicator for increasing the rate of dopamine infusion. Further assessment and appropriate interventions are needed to address chest pain, but it does not directly relate to the need for a higher infusion rate of dopamine.
   

B) Melena: Melena refers to black, tarry stools and is indicative of upper gastrointestinal bleeding. Warfarin is an anticoagulant medication that works by inhibiting the synthesis of vitamin K-dependent clotting factors, thereby prolonging the time it takes for blood to clot. While anticoagulation is intended to prevent thrombosis, it also increases the risk of bleeding, including gastrointestinal bleeding. Melena is a concerning sign of significant bleeding and requires prompt medical attention. The nurse should prioritize reporting melena to the provider to facilitate further evaluation and management, which may include adjusting the warfarin dosage or investigating the underlying cause of the bleeding.

A) Hair loss: Hair loss, or alopecia, is a known side effect of warfarin but is generally not considered a priority finding compared to signs of active bleeding. While hair loss can be distressing for clients, it is typically not life-threatening and may resolve spontaneously or with discontinuation of the medication.

C) Abdominal cramping: Abdominal cramping can occur for various reasons, including gastrointestinal upset or other gastrointestinal issues, but it is not typically associated with warfarin use. While the nurse should assess and address the client's abdominal cramping, it is not as urgent as reporting signs of active bleeding such as melena.

D) Fever: Fever may indicate the presence of an infection or inflammatory process but is not directly related to warfarin therapy. However, if the fever is accompanied by signs of bleeding or other concerning symptoms, it should be reported to the provider for further evaluation. Nonetheless, in the absence of other significant symptoms, fever alone may not be as urgent as reporting melena, which suggests active bleeding.