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Difficulty: MediumPharmacological and Parenteral Therapies

A young adult is brought to the emergency department experiencing sustained, continuous tonic-clonic seizures. The healthcare provider prescribes a loading dose of intravenous phenytoin. The patient currently has a peripheral venous catheter with a continuous infusion of 5% dextrose in water (D5W) running at 75 mL/hr. Which nursing action is essential for the safe administration of this prescribed medication?

  1. A
    Connect the phenytoin preparation as a piggyback to the lowest port of the continuous 5% dextrose in water infusion.
  2. B
    Push the total calculated dose intravenously over 60 seconds to rapidly arrest the seizure activity.
  3. Flush the intravenous catheter with 0.9% sodium chloride immediately before and after the medication is given.Answer
  4. D
    Delegate the continuous monitoring of the patient's vital signs during the infusion to the unlicensed assistive personnel.

Answer

Flush the intravenous catheter with 0.9% sodium chloride immediately before and after the medication is given.
Phenytoin is compatible only with 0.9% sodium chloride (normal saline). Because the primary infusion is 5% dextrose in water, the nurse must adequately flush the line with normal saline before and after administration to prevent drug precipitation and ensure safe delivery.

Step-by-Step Solution

1
Identify the prescribed medication and the current continuous intravenous fluid.
The medication is phenytoin, and the continuous fluid is 5% dextrose in water (D5W).
Establishing the baseline therapy is required to evaluate compatibility.
2
Recall the compatibility profile for intravenous phenytoin.
Phenytoin is only compatible with 0.9% sodium chloride (normal saline) and will crystallize in dextrose solutions.
Preventing drug precipitation in the intravenous line is a critical safety measure.
3
Determine the appropriate intervention to safely administer the medication.
The line must be thoroughly flushed with 0.9% sodium chloride before and after the phenytoin is administered.
Flushing clears the line of the incompatible dextrose solution, preventing adverse reactions or catheter occlusion.

Key Concept

Intravenous phenytoin is incompatible with dextrose solutions and requires a 0.9% sodium chloride flush before and after administration.
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Topics

Pharmacological and Parenteral Therapies

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