A rising tobramycin trough, increasing creatinine, and oliguria indicate accumulation and nephrotoxicity. Concurrent nephrotoxic or ototoxic drugs and diuretics can increase risk. The nurse should hold tobramycin, notify the prescriber and pharmacist, and anticipate renal-function, electrolyte, serum-level, fluid-status, and medication-plan reassessment. Extra tobramycin, delayed evaluation, and adding an NSAID can worsen kidney injury.
In-depth explanation
Clinical reasoning
Tobramycin is cleared by the kidneys. A rising trough indicates accumulation, while vancomycin and a diuretic add medication-related renal or ototoxic risk that requires coordinated review.
Decision rule
Hold the next aminoglycoside dose and escalate when the trough rises with renal dysfunction; reassess interacting drugs, hydration, renal function, electrolytes, and hearing or balance symptoms.
For study reference only. Always follow current clinical guidelines and your institution’s protocols.