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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer intravenous (IV) phenytoin to a client who recently experienced status epilepticus. Which actions should the nurse include in the plan of care to ensure safe parenteral administration? (Select all that apply.)

  1. Flush the intravenous catheter with 0.9%0.9\% sodium chloride before and after the medication is given.Answer
  2. B
    Dilute the prescribed dose in a primary intravenous fluid bag of 5%5\% dextrose in water (D5W).
  3. Ensure the intravenous administration rate does not exceed 50 mg/min50\text{ mg/min}.Answer
  4. D
    Instruct the unlicensed assistive personnel (UAP) to assess the intravenous site every 15 minutes15\text{ minutes} for signs of infiltration.
  5. Monitor the client's blood pressure and electrocardiogram (ECG) rhythm continuously during the infusion.Answer

Answer

The correct actions are to flush the IV catheter with 0.9% sodium chloride, limit the administration rate to a maximum of 50 mg/min, and continuously monitor the client's blood pressure and ECG.
Intravenous phenytoin is a high-alert medication that requires strict adherence to safety protocols. It is highly alkaline and only compatible with 0.9%0.9\% sodium chloride (normal saline); mixing it with other solutions like dextrose causes immediate precipitation. The line must be flushed with normal saline before and after the infusion. Because rapid administration can precipitate severe hypotension and cardiac arrhythmias, the infusion rate must never exceed 50 mg/min50\text{ mg/min} in adults, and the client requires continuous hemodynamic and electrocardiogram (ECG) monitoring throughout the procedure.

Step-by-Step Solution

1
Analyze the pharmacological properties and compatibility of intravenous phenytoin.
Phenytoin is highly alkaline, irritating to veins, and precipitates easily when mixed with non-saline solutions.
Understanding compatibility prevents life-threatening complications like microemboli.
2
Identify safe administration rates and necessary cardiovascular monitoring.
The medication must be administered slowly (maximum 50 mg/min) while the client is on continuous ECG and blood pressure monitoring.
Rapid infusion is known to cause severe hypotension and potentially fatal cardiac arrhythmias.
3
Determine appropriate delegation for site monitoring.
The RN must retain the responsibility of assessing the IV site for extravasation or infiltration.
Site assessment requires clinical judgment and cannot be legally or safely delegated to unlicensed assistive personnel (UAP).

Key Concept

Safe parenteral administration of high-alert medications (IV Phenytoin)
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Topics

Pharmacological and Parenteral Therapies

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