Challenges for Advanced Practice Nurse

Challenges for advanced practice nurse in medical-surgical unit

Advanced practice nurses in medical-surgical unit practice mainly on hospital units to provide care to patients with a variety of acute medical problems and patients recuperating from surgery. Friese et al (2015) argue that advanced medical nurses are challenged to offer high quality care to complex patients within a demanding environment. Nurses play a crucial role in contributing to the restructuring of care delivery in a clinical setting so as to enhance patient outcomes. However, practice environments are deprived, burnout is greater and satisfaction with job is lesser on medical surgical unites compared to specialty settings. Challenges for Advanced Practice Nurse


Amikacin, its adverse effects and black box warning

Amikacin and its side effects an aminoglycoside used in treating a wide range of bacterial infections of the blood, skin, abdomen and lungs. Amikacin side effects include loss of appetite vomiting, nausea, drug fever, skin rash, increased thirst and irritation, pain and redness at injection site. The drug is administered as an intramuscular or intravenous drug and the prescribed amount is determined by body weight of the patient (Comerford, 2016)

A black box warning alerts medical professionals that Amikacin and other aminoglycosides are ototoxic and nephrotoxic and must be utilized with a lot of caution if patients have impaired renal function. Amikacin can cause neurotoxicity, ototoxicity and neuromuscular blockade( Frandsen & Pennington, 2015).Toxicity may happen due to higher than the recommended dose or may even occur with correct doses in patients with impaired renal function or prerenal azotemia (Comerford, 2016). Challenges for Advanced Practice Nurse

According to Comerford (2016), evidence of ototoxicity or impairment of renal function needs discontinuation of the drug or correct dosage. If possible, serum drug concentrations should be monitored and the drug should not be used other nephrotoxic, ototoxic or ototoxic drugs. Amikacin may cause harm to the fetus when given to pregnant women. Respiratory paralysis and neuromuscular blockade may occur after parenteral injection and consideration should be made if Amikacin is administered in patients being treated with neuromuscular blocking agents or anesthetics (Comerford, 2016).


Comerford, K. (2016). Nursing 2015 Drug Handbook. Philadelphia: Wolters Kluwer Health.

Frandsen, G., & Pennington, S. (2015). Abrams’ Clinical Drug: Rationales for Nursing Practice. Philadelphia: Wolters Kluwer Health.

Friese, C., Grunawalt, J., & Bhullar, S et al. (2015). Pod Nursing on a Medical/Surgical Unit: Implementation and Outcome Evaluation. Journal of Nursing Administration, 44(4): 207-211.

Challenges for Advanced Practice Nurse

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