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Difficulty: MediumPharmacological and Parenteral Therapies

A client admitted with septic shock is receiving a continuous intravenous (IV) infusion of norepinephrine through a single peripheral IV line. The client's mean arterial pressure (MAP) is currently 68 mmHg68 \text{ mmHg}. The healthcare provider prescribes a scheduled dose of IV push pantoprazole. Which of the following actions is the most appropriate for the nurse to take?

  1. Establish a second peripheral IV line to administer the pantoprazole.Answer
  2. B
    Administer the pantoprazole via the Y-site closest to the client's IV insertion site.
  3. C
    Pause the norepinephrine infusion, flush the line with normal saline, administer the pantoprazole, and restart the infusion.
  4. D
    Calculate the safe IV push rate for the pantoprazole and administer it concurrently through the norepinephrine line.

Answer

The most appropriate action is to establish a second peripheral IV line to administer the pantoprazole.
Establishing a second peripheral IV line is the safest and most appropriate action because continuous vasoactive infusions, such as norepinephrine, must remain strictly uninterrupted to maintain the client's hemodynamic stability. Administering an IV push medication through the same line—even via the lowest Y-site—risks altering the vasopressor's delivery rate, which can lead to life-threatening fluctuations in blood pressure.

Step-by-Step Solution

1
Analyze the client's current continuous therapy.
The client is receiving norepinephrine, a critical, life-sustaining vasoactive medication used to maintain blood pressure in septic shock.
Understanding the nature of the continuous infusion dictates how secondary medications can be safely administered.
2
Identify the risks associated with the existing single IV line.
Pushing medications or flushing a dedicated vasopressor line can alter the delivery rate, causing either a dangerous interruption in therapy or a life-threatening bolus of the residual vasopressor.
Norepinephrine requires a dedicated line to ensure precise, uninterrupted delivery.
3
Determine the safest intervention for administering the newly prescribed medication.
The nurse must initiate a separate, second peripheral IV line.
This allows for the safe administration of the IV push medication without interfering with the continuous vasoactive infusion.

Key Concept

Safe administration of intravenous medications alongside continuous vasoactive infusions.
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Topics

Pharmacological and Parenteral Therapies

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