A practical nurse is preparing to administer a scheduled dose of liquid phenytoin suspension via a percutaneous endoscopic gastrostomy (PEG) tube to a client who is receiving continuous enteral feedings. To ensure therapeutic drug levels and maintain tube patency, arrange the following actions in the correct chronological order.
- 1Stop the continuous enteral feeding pump.
- 2Allow 1 to 2 hours to elapse to prevent a drug-nutrient interaction.
- 3Verify enteral tube placement and flush with 30 mL of water.
- 4Administer the liquid phenytoin suspension by gravity.
- 5Flush the tube with 30 mL of water and delay restarting the feeding for 1 to 2 hours.
Cevap
The correct sequence is to first stop the feeding pump, wait 1 to 2 hours, verify placement and flush, administer the phenytoin, and finally flush again while delaying the restart of the feeding for another 1 to 2 hours.
Phenytoin has a significant drug-nutrient interaction with enteral feeding formulas. The proteins and calcium in the formula bind tightly to phenytoin, significantly reducing its gastrointestinal absorption and potentially leading to subtherapeutic serum levels and breakthrough seizures. Therefore, the continuous feeding must be stopped 1 to 2 hours prior to administration. After this waiting period, standard safe medication administration requires verifying tube placement and flushing the tube to confirm patency and clear any residual formula. The liquid phenytoin is then administered by gravity, followed by another flush to ensure the full dose reaches the stomach and to prevent tube occlusion. Finally, the feeding must remain paused for an additional 1 to 2 hours to allow the drug to be fully absorbed before the formula is reintroduced.
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Anahtar Kavram
Phenytoin has a significant drug-nutrient interaction with enteral feeding formulas. The feeding must be stopped 1 to 2 hours before and 1 to 2 hours after administration to ensure adequate absorption and maintain therapeutic drug levels.