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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer an intravenous (IV) dose of phenytoin 300 mg300\text{ mg} to a client with a seizure disorder. The client has a continuous IV infusion of 5%5\% dextrose in water (D5W) infusing at 75 mL/hr75\text{ mL/hr} through a single peripheral IV catheter. Which of the following is the most appropriate action by the nurse?

  1. Stop the D5W infusion, flush the line with 0.9%0.9\% sodium chloride, administer the phenytoin, and flush again with 0.9%0.9\% sodium chloride.Answer
  2. B
    Connect the medication syringe to the lowest Y-site port and administer it while the D5W continues to infuse.
  3. C
    Administer the 300 mg300\text{ mg} dose via intravenous push rapidly over 11 to 22 minutes to quickly achieve therapeutic serum levels.
  4. D
    Withhold the phenytoin dose until the primary D5W infusion is completely finished to prevent a chemical reaction.

Answer

Stop the D5W infusion, flush the line with 0.9%0.9\% sodium chloride, administer the phenytoin, and flush again with 0.9%0.9\% sodium chloride.
Phenytoin precipitates when mixed with dextrose solutions. To safely administer phenytoin through an IV line infusing 5%5\% dextrose in water (D5W), the nurse must first pause the continuous infusion, flush the line with a compatible solution such as 0.9%0.9\% sodium chloride (normal saline), administer the medication at the appropriate rate, and then flush the line again with normal saline before restarting the primary infusion.

Step-by-Step Solution

1
Identify the compatibility of the prescribed medication (phenytoin) with the current continuous infusion (D5W).
Phenytoin is highly incompatible with dextrose-containing solutions and will precipitate.
To prevent a potentially life-threatening chemical reaction and embolism in the IV line.
2
Determine the correct procedure for administering an IV push medication through an incompatible continuous IV line.
The continuous infusion must be paused, and the line must be flushed with a compatible solution (0.9%0.9\% sodium chloride) before and after medication administration.
This clears the tubing of the incompatible fluid and ensures safe delivery of the medication to the client.
3
Evaluate the appropriate rate of administration for IV phenytoin.
Phenytoin must be administered slowly, not exceeding 50 mg/min50\text{ mg/min}.
Rapid administration of phenytoin can cause severe cardiovascular collapse, including hypotension and bradycardia.

Key Concept

Safe administration of intravenous phenytoin (incompatibility with dextrose and rate limits)
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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