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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is providing care for several clients who require pharmacological and parenteral therapies. Which of the following nursing actions demonstrate the correct application of critical safety principles for intravenous (IV) administration? Select all that apply.

  1. Administering an intermittent IV infusion of vancomycin over 90 minutes to a client with a systemic infection.Answer
  2. Aspirating for a brisk blood return from an implanted central venous port prior to administering an intravenous vesicant medication.Answer
  3. Flushing a peripherally inserted central catheter (PICC) with a 10 mL syringe using a pulsatile (push-pause) technique after medication delivery.Answer
  4. D
    Administering an IV push dose of phenytoin into a continuous running infusion of 5% dextrose in water (D5W).
  5. E
    Pausing a continuous infusion of norepinephrine to administer a scheduled IV piggyback antibiotic through the same single-lumen peripheral catheter.
  6. F
    Calculating a continuous weight-based heparin infusion rate using a documented estimated weight provided by the client's family.

Answer

The correct safe actions are: administering vancomycin over 90 minutes, aspirating for blood return before giving vesicants, and flushing a central line with a push-pause technique using a 10 mL syringe.
The correct actions adhere to foundational safety standards for parenteral therapy. Vancomycin must be infused slowly to avoid histamine release. Vesicant administration demands verified catheter patency via brisk blood return to prevent tissue necrosis. Lastly, central lines must be flushed with large-barrel syringes (10 mL) to reduce pressure, utilizing a push-pause method to create turbulence that clears the lumen.

Step-by-Step Solution

1
Evaluate each parenteral administration action for adherence to infection control, medication compatibility, and hemodynamic safety.
Identify actions that prevent complications like precipitation, extravasation, and speed shock.
Safe IV therapy requires verifying all physiological and pharmacological parameters before administration.
2
Identify the correct safety principles.
Vancomycin requires slow infusion, central lines require pulsatile flushing with a 10 mL syringe, and vesicants require confirmation of blood return.
These specific actions prevent red man syndrome, catheter occlusion or rupture, and tissue necrosis.
3
Identify the incorrect actions and their associated safety risks.
Recognize that phenytoin precipitates in D5W, pausing vasopressors causes hemodynamic shock, and estimating weight for heparin risks fatal hemorrhage.
These represent critical errors in IV compatibility, clinical prioritization, and medical math.

Key Concept

Safe administration of parenteral therapies requires strict adherence to medication-specific compatibility, infusion rate limits, accurate calculation parameters, and catheter patency verification to prevent life-threatening complications.
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Topics

Pharmacological and Parenteral Therapies

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