Examkin

Soru

Zorluk: Çok zorPharmacological and Parenteral Therapies

An adult client with acute decompensated heart failure is admitted to the cardiac intensive care unit. The client is currently receiving a continuous intravenous (IV) infusion of dobutamine at 10 \mug/kg/min10 \text{ \mu g/kg/min} via a dedicated single-lumen peripheral IV catheter. During the shift, the client suddenly develops severe dyspnea, and the nurse auscultates coarse bilateral crackles. The healthcare provider immediately prescribes a stat dose of furosemide 40 mg40 \text{ mg} IV push. Which of the following is the most appropriate action by the nurse?

  1. Establish a second peripheral IV access immediately to administer the furosemide.Cevap
  2. B
    Pause the dobutamine infusion, flush the IV line with normal saline, administer the furosemide, and restart the dobutamine.
  3. C
    Administer the furosemide IV push through the Y-site port closest to the insertion site while the dobutamine continues to infuse.
  4. D
    Contact the healthcare provider to request changing the furosemide to an oral or intramuscular route to preserve the dedicated IV line.

Cevap

Establish a second peripheral IV access immediately to administer the furosemide.
The correct action is to establish a second peripheral IV line. Dobutamine is a critical vasoactive medication with a very short half-life (approximately 2 minutes). Pausing the infusion can lead to rapid hemodynamic deterioration. More importantly, flushing the existing line would inadvertently force a concentrated bolus of dobutamine into the client's bloodstream, risking severe tachycardia and hypertension. Furthermore, furosemide is highly alkaline and physically incompatible with acidic solutions like dobutamine, meaning they cannot be administered simultaneously through a Y-site without causing precipitation. Given the emergent nature of the pulmonary edema, a second IV line is the only safe and effective way to administer the diuretic.

Adım Adım Çözüm

1
Analyze the client's current clinical status and existing therapies.
The client has acute pulmonary edema requiring immediate diuresis with IV furosemide, but only has one IV line currently infusing continuous dobutamine.
Understanding the urgency and the limitations of current access is the first step in prioritization.
2
Evaluate the pharmacological properties of the continuous infusion.
Dobutamine is a short-acting vasoactive inotrope. The infusion cannot be paused without causing hemodynamic instability, and the line cannot be flushed without delivering an unsafe bolus to the client.
Vasoactive medications require dedicated lines and strict administration protocols to prevent adverse cardiovascular events.
3
Check the physical compatibility of the two medications.
Furosemide and dobutamine are physically incompatible and will precipitate if mixed in the same line.
Administering incompatible medications concurrently can cause crystal formation, leading to catheter occlusion or embolism.
4
Determine the safest method of administration.
Because the primary line cannot be paused, flushed, or used for concurrent administration, a new peripheral IV line must be initiated.
A secondary access site ensures the rapid delivery of the emergent diuretic without compromising the life-sustaining inotropic support.

Anahtar Kavram

Administration Safety for Vasoactive Infusions and IV Incompatibilities

İpuçları

1
Consider the characteristics of continuous vasoactive infusions. What happens if they are suddenly stopped, or if the tubing is flushed?
2
Think about the physical space inside the IV tubing. If you flush the line with normal saline, where does the dobutamine that was sitting in the tubing go?
3
Because the dobutamine line cannot be flushed (it would cause a dangerous bolus) and the medications are incompatible to mix, you must find an entirely different route to administer the IV push medication safely.

Daha Fazla Pratik

Review facility protocols regarding dedicated IV lines for high-alert vasoactive medications and memorize common IV incompatibilities.

Alternatif Yöntem

N/A
Tahmini Süre:1m 15s
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Konular

Pharmacological and Parenteral Therapies

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