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Difficulty: MediumPharmacological and Parenteral Therapies

A hospitalized client requires an intravenous dose of phenytoin for seizure management. The client's continuous intravenous fluids consist of 5% dextrose in water infusing at 100 mL/hr100\text{ mL/hr} through a single-lumen peripheral catheter. Which action represents the safest method for the nurse to administer this medication?

  1. A
    Connect the medication syringe to the lowest Y-site port on the primary tubing and administer it concurrently with the active infusion to dilute the drug.
  2. B
    Dilute the prescribed dose in a 50 mL50\text{ mL} bag of 5% dextrose in water and administer it as a secondary piggyback infusion over thirty minutes.
  3. Pause the continuous intravenous fluids, flush the catheter with 0.9% sodium chloride, administer the medication at a maximum rate of 50 mg/min50\text{ mg/min}, and flush again with 0.9% sodium chloride.Answer
  4. D
    Flush the catheter with sterile water, inject the medication rapidly over one minute to quickly halt seizure activity, and follow with a final sterile water flush.

Answer

Pause the continuous intravenous fluids, flush the catheter with 0.9% sodium chloride, administer the medication at a maximum rate of 50 mg/min50\text{ mg/min}, and flush again with 0.9% sodium chloride.
The correct action involves pausing the dextrose infusion and flushing the line with 0.9% sodium chloride (normal saline) before and after administration. Phenytoin is highly incompatible with dextrose solutions and will form a precipitate if they come into contact. Furthermore, intravenous phenytoin must be administered slowly, not exceeding 50 mg/min50\text{ mg/min}, to prevent cardiovascular toxicity such as severe hypotension and arrhythmias.

Step-by-Step Solution

1
Identify the primary intravenous fluid currently infusing.
The client is receiving 5% dextrose in water.
Compatibility must be established before administering any intravenous medication.
2
Determine the compatibility of phenytoin with the infusing fluid.
Phenytoin is incompatible with dextrose solutions and will form a precipitate.
Mixing incompatible drugs can cause crystal formation, leading to catheter occlusion or emboli.
3
Determine the correct administration protocol for the medication.
The line must be flushed with normal saline before and after the dose, and the medication must be pushed slowly (max 50 mg/min50\text{ mg/min}).
Normal saline clears the line of dextrose, and a slow administration rate prevents cardiovascular toxicity.

Key Concept

Phenytoin is highly incompatible with dextrose solutions and must be administered slowly (no faster than 50 mg/min50\text{ mg/min}) using 0.9% sodium chloride to prevent precipitation and cardiovascular adverse effects.
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Topics

Pharmacological and Parenteral Therapies

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