Assignment task:
A nurse is assisting in the care of a female older adult client on a medical-surgical unit. Two days ago, the client was alert and oriented to person, place, and time. Lung sounds clear to auscultation. S1S2 present, no extra heart sounds. Peripheral pulses 2+ in all extremities. Client reported flank pain and dysuria. Client had an outpatient urine culture done with was positive for Escherichia coli. Client was admitted for intravenous antibiotic therapy. One day ago, medication adjusted by pharmacy. Client's 24-hr urinary output 1,000 ml, intake 800 ml. Client reports one loose stool. Today client's 24-hr urinary output 750 ml, intake 500 ml. Client reports two loose stools. Two days ago: Gentamicin 500 mg every 8 hr IV. One day ago: Gentamicin 500 mg every 8 hr IV. Today, 0800: Gentamicin 300 mg every 8 hr IV, Furosemide 20 mg once daily PO, Cefazolin 1 g every 8 hr IV. Two days ago: Gentamicin trough 1.5 mcg/ml. One day ago: Gentamicin trough 2 mcg/ml. Today: BUN 20 mg/dl, Creatinine 1.2 mg/dl, Gentamicin peak 6.2 mcg/ml, Gentamicin trough 4.2 mcg/ml. Complete the sentence by using the list of options. The client is at greatest risk for developing ___ as