Rising creatinine and oliguria indicate possible gentamicin nephrotoxicity, while tinnitus, vertigo, and gait instability indicate auditory or vestibular toxicity. The nurse should hold the drug, notify the prescriber promptly, protect the client from falls, and anticipate renal testing, drug concentrations, and hearing or balance evaluation. Additional gentamicin, symptom masking, and delayed reassessment can worsen potentially irreversible ototoxicity and kidney injury.
In-depth explanation
Clinical reasoning
Gentamicin accumulates when renal clearance falls. Aminoglycosides can injure both the kidney and the vestibular or cochlear branches of cranial nerve VIII.
Decision rule
New renal dysfunction or tinnitus, vertigo, or hearing change during gentamicin therapy requires the dose to be held and the prescriber to reassess exposure urgently.
For study reference only. Always follow current clinical guidelines and your institution’s protocols.