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Zorluk: Çok zorPharmacological and Parenteral Therapies

A nurse is caring for a client who exhibits sudden carpopedal spasms, facial twitching, and a prolonged QT interval on the electrocardiogram. The client's serum calcium level is 6.4 mg/dL6.4\text{ mg/dL} (1.6 mmol/L1.6\text{ mmol/L}). The healthcare provider urgently prescribes '1 gram1\text{ gram} Calcium Chloride IV piggyback over 10 minutes10\text{ minutes}'. The client's only vascular access is a 22-gauge22\text{-gauge} peripheral intravenous (PIV) catheter located in the dorsum of the right hand. Which of the following is the PRIORITY action by the nurse?

  1. Contact the healthcare provider to request changing the prescription to intravenous calcium gluconateCevap
  2. B
    Administer the calcium chloride as prescribed while remaining at the bedside to monitor the IV site for extravasation
  3. C
    Dilute the calcium chloride in an additional 250 mL250\text{ mL} of 5%5\% Dextrose in water and infuse it over 2 hours2\text{ hours}
  4. D
    Hold the medication and request a stat order for central venous catheter placement prior to administration

Cevap

The nurse should contact the healthcare provider to request changing the prescription to intravenous calcium gluconate, which is safe for peripheral administration.
The correct answer recommends requesting a prescription change to calcium gluconate. Calcium chloride is highly hyperosmolar and a severe vesicant. If extravasation occurs, especially from a small fragile vein like a 22-gauge22\text{-gauge} in the hand, it causes catastrophic tissue necrosis and sloughing. Therefore, calcium chloride is generally restricted to central venous administration. Calcium gluconate provides the same therapeutic cation but is significantly less irritating, making it the preferred and safe choice for urgent peripheral intravenous administration.

Adım Adım Çözüm

1
Analyze the client's clinical presentation and laboratory data.
The client has severe, symptomatic hypocalcemia (6.4 mg/dL6.4\text{ mg/dL}) with cardiac involvement (prolonged QT interval), requiring urgent intravenous calcium replacement.
Identifying the severity of the condition establishes the urgency of the intervention; delays can lead to life-threatening arrhythmias.
2
Evaluate the prescribed medication and route against safety parameters.
The provider prescribed calcium chloride to be given via a 22-gauge22\text{-gauge} peripheral IV line in the hand.
Nurses must verify the pharmacological safety of the route for the specific medication ordered.
3
Synthesize pharmacological knowledge regarding calcium chloride administration.
Calcium chloride is a severe vesicant and hyperosmolar solution that poses a massive risk of tissue necrosis if extravasated. It is strongly recommended for central line administration only.
Administering a severe vesicant through a small peripheral vein in the hand is clinically unsafe.
4
Determine the safest immediate intervention.
The nurse must contact the provider to request calcium gluconate, which provides the necessary electrolyte but is significantly less irritating to tissues.
This action safely addresses both the immediate physiological threat and the pharmacological safety hazard without delaying care.

Anahtar Kavram

Safe parenteral administration of calcium salts and prevention of vesicant extravasation
Tahmini Süre:2m 0s
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Pharmacological and Parenteral Therapies

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