A nurse is preparing to administer an intravenous (IV) infusion of amphotericin B deoxycholate to a client diagnosed with a severe systemic fungal infection. Which of the following nursing actions are appropriate when managing this parenteral therapy? Select all that apply.
- Administer prescribed prophylactic acetaminophen and diphenhydramine 30 minutes prior to the infusion.Answer
- BReconstitute and dilute the medication exclusively with 0.9% sodium chloride.
- CInfuse the medication rapidly over 30 to 45 minutes to minimize peripheral vein irritation.
- Monitor the client's serum creatinine and blood urea nitrogen (BUN) levels closely throughout therapy.Answer
- EAssess the client's baseline and ongoing serum potassium levels for the development of hyperkalemia.
- Evaluate the intravenous insertion site frequently for signs of phlebitis and extravasation.Answer
Answer
The correct actions are to administer prescribed prophylactic medications prior to the infusion, monitor renal function (BUN and creatinine) closely, and evaluate the IV site frequently for complications.
Amphotericin B is associated with severe infusion reactions (fever, chills, rigors), making pre-medication with acetaminophen and diphenhydramine a standard safety practice. Because it is highly nephrotoxic, meticulous monitoring of BUN and creatinine levels is required to prevent acute kidney injury. Furthermore, it is a known vesicant and chemical irritant, requiring frequent assessment of the IV site to prevent severe tissue necrosis from extravasation.
Step-by-Step Solution
Key Concept
Amphotericin B is a highly toxic antifungal medication requiring strict administration protocols: dilution in D5W only, slow infusion over 2-4 hours, pre-medication to prevent infusion reactions, and vigilant monitoring for nephrotoxicity, hypokalemia, and phlebitis.