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Zorluk: ZorPharmacological and Parenteral Therapies

A registered nurse is preparing to administer a prescribed intravenous (IV) loading dose of phenytoin to an adult client experiencing recurrent generalized seizures. Which of the following nursing actions are necessary during the preparation and administration of this parenteral medication? (Select all that apply.)

  1. Administer the medication via an infusion pump at a continuous rate not exceeding 50 mg/min50\text{ mg/min}.Cevap
  2. B
    Dilute the medication with 5%5\% dextrose in water (D5WD_5W) to minimize vascular irritation.
  3. Attach a 0.220.22-micron in-line filter to the intravenous tubing prior to starting the infusion.Cevap
  4. D
    Delegate the continuous monitoring of the client's electrocardiogram and blood pressure to the unlicensed assistive personnel (UAP).
  5. Assess the intravenous insertion site frequently for localized tissue swelling, pain, or discoloration.Cevap
  6. F
    Calculate the infusion pump settings to deliver a 1,000 mg1,000\text{ mg} loading dose continuously over a 1010-minute period.

Cevap

The correct actions are to administer the medication at a rate not exceeding 50 mg/min50\text{ mg/min}, attach a 0.220.22-micron in-line filter, and frequently assess the IV insertion site for signs of extravasation.
Phenytoin is a high-alert anti-seizure medication with strict administration parameters. It must be administered slowly (maximum 50 mg/min50\text{ mg/min}) to prevent life-threatening cardiovascular collapse, requires an in-line filter to catch micro-crystals, and necessitates close IV site monitoring because it is a vesicant that can cause severe tissue necrosis if extravasation occurs.

Adım Adım Çözüm

1
Identify the specific administration requirements and compatibilities for intravenous phenytoin.
Phenytoin precipitates in dextrose and requires normal saline (0.9%0.9\% NaCl) and an in-line filter.
To prevent crystallization and embolization in the vascular system.
2
Determine the maximum safe administration rate for IV phenytoin in an adult.
The maximum safe continuous rate is 50 mg/min50\text{ mg/min}.
Rapid administration of phenytoin can cause severe hypotension, bradycardia, and cardiovascular collapse.
3
Recognize the tissue toxicity risk associated with phenytoin extravasation.
The nurse must continuously and closely monitor the IV insertion site.
Phenytoin is highly alkaline and a potent vesicant that can cause Purple Glove Syndrome and severe tissue necrosis if it leaks into surrounding tissues.
4
Evaluate the safety of delegating client monitoring during high-risk intravenous infusions.
The registered nurse must retain direct responsibility for assessing hemodynamics and cardiac rhythms.
Assessing a client's physiological response to a high-alert medication requires specialized nursing knowledge and clinical judgment that cannot be delegated to unlicensed assistive personnel.

Anahtar Kavram

Safe Intravenous Administration of Phenytoin
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Konular

Pharmacological and Parenteral Therapies

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