An 8-year-old (30 kg) with MRSA bacteremia is prescribed IV vancomycin 15 mg/kg every 6 hours. Which set of nursing actions is most appropriate?

Pediatric vancomycin dosing for serious MRSA infections is weight-based: 15 to 20 mg/kg per dose every 6 hours IV is typical, with maximum total daily dose adjusted for renal function and not to exceed institutional caps. For a 30 kg child at 15 mg/kg, the calculated dose is 450 mg every 6 hours. Key administration and monitoring: (1) infuse over at least 60 minutes for doses of 1 g or less, longer for higher doses, to reduce red man syndrome; (2) central venous access is preferred for prolonged therapy and high doses because of vesicant potential and the need for repeated draws; peripheral IV is acceptable for short-term with strict site monitoring; (3) trough goal 15 to 20 mg/L for serious MRSA with sampling 30 minutes before the fourth dose at steady state; AUC-guided dosing is the new standard; (4) renal function — daily creatinine and urine output, hold or adjust if rising; (5) ototoxicity monitoring — assess hearing changes, tinnitus, balance; in younger children rely on caregiver report and audiology consult for prolonged therapy; (6) accurate weight documentation because pediatric dosing changes with weight; (7) IV site assessment for infiltration; vancomycin extravasation can cause tissue damage. Adult dose flat conversion, IV push, and IM all wrong. The child should be in a monitored unit with sepsis management and ID consultation.

Pediatric vanco is weight-based, infused slowly, monitored for trough/red man/AKI/ototoxicity, given via reliable IV. Round to mg/kg, not to adult-flat dose.