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Zorluk: ZorPharmacological and Parenteral Therapies

During the night shift, a nurse is monitoring a client admitted with acute decompensated heart failure and rapid atrial fibrillation. The client has a single 22-gauge peripheral intravenous catheter infusing continuous diltiazem. Assessment reveals a blood pressure of 92/60 mmHg, an irregular heart rate of 118 beats/min, and a respiratory rate of 28 breaths/min with audible crackles bilaterally. The provider orders a stat dose of intravenous furosemide. Upon checking the compatibility matrix, the nurse notes that furosemide is physically incompatible with diltiazem. What is the priority nursing action?

  1. A
    Pause the diltiazem infusion, flush the line with normal saline, administer the furosemide, flush again, and restart the diltiazem.
  2. B
    Connect the furosemide to the Y-site port closest to the client to minimize contact time between the medications.
  3. Initiate a second peripheral intravenous catheter to administer the furosemide.Cevap
  4. D
    Contact the healthcare provider to request changing the order to oral furosemide to avoid the intravenous incompatibility.

Cevap

Initiate a second peripheral intravenous catheter to administer the furosemide.
The correct action is to initiate a second peripheral intravenous catheter. While standard nursing practice for incompatible medications often involves pausing the primary infusion and flushing the line before and after the secondary medication, this rule strictly does not apply to critical continuous infusions. Diltiazem is a short-acting rate-control medication; pausing it in a client with a rapid heart rate of 118 beats/min and borderline hypotension will lead to rapid loss of rate control and further hemodynamic compromise. Because the medications are physically incompatible and cannot be mixed in the same line, establishing independent intravenous access is the only way to safely deliver the urgent furosemide without interrupting the essential diltiazem drip.

Adım Adım Çözüm

1
Analyze the client's current clinical stability and the purpose of the ongoing therapy.
The client is hemodynamically borderline (BP 92/60, HR 118) and relies on the continuous diltiazem infusion to prevent the ventricular rate from accelerating further.
Understanding the physiological necessity of the current continuous infusion is critical before altering its delivery.
2
Identify the pharmacological conflict presented in the scenario.
Diltiazem and furosemide are physically incompatible and cannot share the same intravenous line or Y-site without precipitating.
Mixing incompatible medications can cause crystallization, leading to loss of drug efficacy and fatal embolus formation.
3
Evaluate standard compatibility protocols against the client's specific acuity.
The standard protocol of pausing the primary fluid, flushing, administering the secondary drug, and restarting cannot be applied here because interrupting the diltiazem will cause dangerous rebound tachycardia.
Continuous antiarrhythmic and vasoactive medications have very short half-lives and must not be interrupted in unstable clients.
4
Determine the safest and most effective intervention.
The only safe action is to establish a new, independent intravenous access line to administer the furosemide.
This ensures the client receives the life-saving diuretic immediately without compromising the critical rate-control infusion.

Anahtar Kavram

Management of Intravenous Incompatibilities with Critical Continuous Infusions
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Konular

Pharmacological and Parenteral Therapies

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