A client with a history of seizure disorder is receiving continuous enteral nutrition via … — NCLEX-PN

A client with a history of seizure disorder is receiving continuous enteral nutrition via a gastrostomy tube. The healthcare provider prescribes liquid phenytoin to be administered via the gastrostomy tube every $12\text{ hours}$ . Which action by the practical nurse (PN) demonstrates safe and effective pharmacological management?

Pause the continuous enteral feeding for $1$ to $2\text{ hours}$ prior to and following the administration of the medication.Answer
B
Add the prescribed volume of the liquid medication directly into the hanging enteral nutrition formula bag.
C
Delegate the administration of this scheduled liquid medication to an unlicensed assistive personnel (UAP).
D
Proceed with administering the scheduled dose after noting a morning serum phenytoin level of $28\text{ mcg/mL}$ .

Answer

The correct action is to pause the continuous enteral feeding for

1

2\text{ hours}

before and after administering the liquid phenytoin.

Enteral feeding formulas contain high amounts of proteins that strongly bind to phenytoin, significantly decreasing its absorption in the gastrointestinal tract. To prevent subtherapeutic serum drug levels and subsequent breakthrough seizures, the practical nurse must pause the continuous feeding for

1

2\text{ hours}

before and after administering the scheduled medication dose. The tube must also be flushed adequately with water before and after the dose.

Step-by-Step Solution

Identify the prescribed medication and the client's current method of nutritional support.

The client is receiving liquid phenytoin and continuous enteral nutrition formula via a gastrostomy tube.

Understanding the concurrent therapies is the essential first step in identifying potential drug-nutrient interactions.

Evaluate potential interactions between oral phenytoin and enteral feeding formulas.

Enteral nutrition formulas significantly decrease the gastrointestinal absorption of phenytoin.

Phenytoin binds strongly to the proteins present in the enteral formula, which can lead to subtherapeutic serum drug levels and poor seizure control.

Determine the appropriate nursing intervention to prevent the drug-nutrient interaction.

The continuous enteral feeding must be stopped for a specific window of time (

1

2\text{ hours}

) before and after the medication is given.

This time window allows the stomach to empty, preventing the formula from binding to the medication and ensuring adequate drug absorption.

Key Concept

Drug-Nutrient Interactions and Safe Enteral Medication Administration

Question

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Step-by-Step Solution

Key Concept

Common Mistakes

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