Decreased urine output, flank pain, or rising creatinine may signal nephrotoxicity and must be reported.
Before you read
Test yourself first: 2 questions
Question 1 of 2
A client with herpes zoster is prescribed oral acyclovir. Which instruction should the nurse include in the teaching?
Answer: A. Adequate hydration is important with acyclovir because the drug can crystallize in the renal tubules and cause nephrotoxicity, especially with IV use. Clients should maintain a generous fluid intake. Acyclovir does not cure the latent virus, is most effective when started early in the outbreak, and does not require avoiding sunlight specifically.
Question 2 of 2
A client is started on IV acyclovir for a severe herpes simplex infection. Which intervention is most important to prevent the drug's primary adverse effect?
Answer: A. IV acyclovir can crystallize in the renal tubules and cause acute kidney injury. Ensuring adequate IV hydration and infusing the drug slowly over at least one hour helps prevent nephrotoxicity. Restricting fluids, giving a rapid bolus, or warming the solution would not prevent this and could worsen renal risk.
Keep the streak going with more questions like these, each with a full rationale.
What is acyclovir?
It does not cure these viruses but shortens outbreaks and reduces severity, working best when started early. The key safety concern is nephrotoxicity from crystal formation, prevented by adequate hydration, especially with IV use.
Key points to remember
- Acyclovir is an antiviral that inhibits viral DNA replication but does not eradicate the latent virus.
- It is most effective when started at the earliest sign of an outbreak.
- IV acyclovir can crystallize in the kidneys and cause nephrotoxicity if the patient is dehydrated.
- It is infused slowly over at least 1 hour to reduce kidney injury risk.
- Doses are reduced in patients with renal impairment.
- It reduces transmission and outbreak frequency but does not prevent spread entirely.
Nursing priorities
- Maintain adequate hydration before and during IV therapy to prevent crystalluria.
- Infuse IV acyclovir slowly over at least 1 hour and never as a rapid bolus.
- Monitor renal function and urine output during treatment.
- Teach the patient to start oral therapy at the first sign of an outbreak.
- Use standard and contact precautions and good hand hygiene when handling lesions.
Labs & values
Patient teaching
- Start the medication at the first sign of tingling, itching, or blistering.
- Drink plenty of fluids while taking this medication.
- This drug controls outbreaks but does not cure the infection, and you can still transmit it.
- Use barrier protection and avoid contact with lesions to prevent spreading the virus.
Red flags: report now
- Decreased urine output, flank pain, or rising creatinine may signal nephrotoxicity and must be reported.
- Confusion, tremors, or hallucinations may indicate CNS toxicity, more common in renal impairment.
- Never give rapid IV bolus acyclovir because it increases kidney injury risk.
References
Clinical references for this topic
