A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if a health concern occurs?
A. Impaired color discrimination
B. Increased urinary frequency
C. Decreased hearing acuity
D. Increased appetite
Correct Answer: C. Decreased hearing acuity
Decreased hearing acuity indicates ototoxicity, a serious adverse effect of streptomycin therapy. The client should notify the physician immediately if it occurs so that streptomycin can be discontinued and an alternative drug can be prescribed. Ototoxicity and vestibular impairment are often thought to be the hallmark of streptomycin toxicity. In extreme cases, deafness may occur due to ototoxicity, thus caution must be exercised when combining streptomycin with other potentially ototoxic drugs. The other options aren’t associated with streptomycin.
Option A: Impaired color discrimination indicates color blindness. There are also reports of neuromuscular blockade with streptomycin use in association with installation into body cavities, use during anesthesia involving the use of neuromuscular blocking agents, and overdose in children. Neurotoxic effects can lead to optic nerve dysfunction, peripheral neuritis, and encephalopathy.
Option B: Increased urinary frequency accompanies diabetes mellitus. Monitoring for streptomycin toxicity is especially important in the young and patients with renal impairment, as streptomycin occurs via glomerular filtration. Renal impairment can lead to a prolonged half-life of 50 to 100 hours.
Option D: Increased appetite is not associated with streptomycin. Monitoring is based on the limited therapeutic index of aminoglycosides and known toxicities, particularly nephrotoxicity and ototoxicity. In general, clinicians should avoid concomitant use of additional medications with possible ototoxic or nephrotoxic effects.
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