A nurse is preparing to administer ampicillin and gentamicin sulfate via IV infusion. Which of the following resources should the nurse consult first regarding medication compatibility?

Choice A: Type and match for 2 units of packed RBCs

This option is not typically part of the initial management of sepsis. Typing and matching for blood transfusion is generally reserved for patients who are experiencing significant blood loss or severe anemia. In this case, the patient’s hemoglobin and hematocrit levels are within normal ranges, indicating that a blood transfusion is not immediately necessary. The primary focus in the first hour of sepsis management is to stabilize the patient through fluid resuscitation, infection control, and monitoring vital signs.

Choice B: Rapidly administer 30 mL/kg of normal saline

Rapid fluid resuscitation is a critical component of sepsis management. Administering 30 mL/kg of normal saline helps to restore intravascular volume, improve tissue perfusion, and prevent organ failure. This intervention is particularly important in patients with hypotension or elevated lactate levels, as it helps to maintain adequate blood pressure and oxygen delivery to tissues. The Surviving Sepsis Campaign guidelines recommend this approach to stabilize patients and prevent further complications.

Choice C: Measure lactate level

Measuring lactate levels is essential in the early management of sepsis. Elevated lactate levels indicate tissue hypoperfusion and anaerobic metabolism, which are hallmarks of sepsis and septic shock. Monitoring lactate levels helps to assess the severity of the condition and guide further treatment decisions. The Surviving Sepsis Campaign guidelines emphasize the importance of measuring lactate levels within the first hour of sepsis recognition. If the initial lactate level is elevated, it should be remeasured to evaluate the effectiveness of the interventions.

Choice D: Obtain blood cultures

Obtaining blood cultures before administering antibiotics is crucial for identifying the causative pathogen and tailoring antibiotic therapy. Blood cultures help to determine the source of infection and guide appropriate antimicrobial treatment. Early identification and targeted therapy are essential for improving patient outcomes in sepsis. The Surviving Sepsis Campaign guidelines recommend obtaining blood cultures as part of the initial management of sepsis.

Choice E: Obtain a wound culture

Obtaining a wound culture is important in this case because the patient has a wound with purulent drainage, which could be a potential source of infection. Identifying the specific pathogen responsible for the wound infection allows for targeted antibiotic therapy, which is more effective than broad-spectrum antibiotics. This intervention helps to control the source of infection and prevent further complications. The Surviving Sepsis Campaign guidelines support source control measures, including obtaining wound cultures, as part of the initial management of sepsis.

Choice A reason:

Health care provider: While health care providers, such as doctors, have extensive knowledge about medications and their uses, they may not always have the most up-to-date information on specific drug compatibilities. Pharmacists specialize in medications and are more likely to have immediate access to detailed compatibility data.

Choice B reason:

Hospital pharmacist: Pharmacists are the primary resource for information on drug compatibility. They have access to comprehensive databases and resources that provide detailed information on drug interactions and compatibility. Consulting the hospital pharmacist ensures that the nurse receives accurate and current information regarding the safe administration of ampicillin and gentamicin sulfate.

Choice C reason:

Nurse manager: Nurse managers oversee nursing staff and ensure that patient care standards are met. While they have a broad knowledge of clinical practices, they may not have the specific expertise or resources to provide detailed information on drug compatibility.

Choice D reason:

Medication sales representative: Medication sales representatives are knowledgeable about the products they promote, but their primary role is to market medications. They may not have the comprehensive and unbiased information needed to determine drug compatibility. It is always best to consult a pharmacist for this type of information.