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Zorluk: OrtaPharmacological and Parenteral Therapies

While working in the emergency department, a registered nurse receives a prescription for a stat dose of intravenous phenytoin for a client experiencing seizure activity. The client's only venous access is a peripheral catheter currently infusing 5%5\% dextrose in water (D5WD_5W) at 100 mL/hr100 \text{ mL/hr}. Which protocol must the nurse implement to safely administer this medication?

  1. A
    Introduce the medication directly into the running dextrose infusion to promote steady systemic absorption.
  2. B
    Deliver the medication rapidly over a 60-second60\text{-second} period to promptly achieve therapeutic serum levels.
  3. Flush the intravenous catheter with normal saline both prior to and following the medication injection.Cevap
  4. D
    Delegate the task of checking the client's vital signs every 5 minutes5 \text{ minutes} to an unlicensed assistive personnel.

Cevap

The nurse must clear the intravenous line by flushing it with normal saline before and after the phenytoin administration.
Phenytoin is highly incompatible with dextrose-containing solutions such as D5WD_5W. If mixed, the medication will rapidly form a solid precipitate. To prevent this dangerous crystallization and ensure safe delivery, the nurse must clear the tubing by flushing it with a compatible solution—specifically normal saline—both before and after the medication is administered.

Adım Adım Çözüm

1
Identify the prescribed medication and the fluid currently infusing in the client's intravenous line.
The prescribed medication is phenytoin, and the continuous fluid is 5%5\% dextrose in water (D5WD_5W).
Recognizing both components is necessary to evaluate drug-solution compatibility before administration.
2
Determine the compatibility between intravenous phenytoin and dextrose solutions.
Phenytoin is highly incompatible with dextrose and will quickly form a solid precipitate if the two mix.
Administering incompatible substances can lead to catheter occlusion and potential embolic events.
3
Select the appropriate intervention to safely administer the medication through the existing access.
The nurse must stop the dextrose, flush the line with normal saline, administer the phenytoin, and flush with normal saline again.
Normal saline is compatible with phenytoin and clears the incompatible dextrose from the tubing, ensuring safe delivery.

Anahtar Kavram

Phenytoin is physically incompatible with dextrose-containing solutions and requires flushing the intravenous line with normal saline to prevent dangerous precipitation.
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