A client who is experiencing frequent seizure activity has a single peripheral intravenous (IV) catheter infusing 5% dextrose in water (D5W) continuously. The healthcare provider prescribes a stat dose of IV phenytoin. Which of the following actions should the nurse perform to safely administer this medication? (Select all that apply)
- Pause the primary D5W infusion and flush the IV line with 0.9% sodium chloride before the injection.Answer
- BAdminister the phenytoin via a secondary Y-site port while the continuous D5W infusion is running.
- CInject the medication rapidly over 30 to 45 seconds to quickly achieve therapeutic serum levels.
- Flush the IV catheter with 0.9% sodium chloride immediately after completing the medication injection.Answer
- Monitor the client's cardiac rhythm and blood pressure continuously during the medication administration.Answer
- FDilute the phenytoin dose in a syringe with sterile water for injection to minimize vein irritation.
Answer
The correct actions include pausing the D5W infusion to flush with normal saline before the injection, flushing with normal saline after the injection, and continuously monitoring the client's cardiac rhythm and blood pressure.
Phenytoin is physically incompatible with any dextrose-containing solution and requires a dedicated line or thorough flushing with 0.9% sodium chloride before and after administration to prevent precipitation. Due to its potential to cause severe hypotension, bradycardia, and arrhythmias, continuous cardiovascular monitoring is mandatory during administration.
Step-by-Step Solution
Key Concept
Phenytoin Intravenous Administration Safety and Compatibility