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Zorluk: ZorPharmacological and Parenteral Therapies

A client with end-stage renal disease is brought to the emergency department with severe weakness and palpitations. The client's serum potassium level is 7.9 mEq/L7.9\text{ mEq/L} (7.9 mmol/L7.9\text{ mmol/L}), and the cardiac monitor displays widened QRS complexes. The healthcare provider prescribes STAT intravenous (IV) 10%10\% calcium gluconate, IV 8.4%8.4\% sodium bicarbonate, IV regular insulin, and IV 50%50\% dextrose. The client has a single peripheral IV line infusing 0.9%0.9\% sodium chloride. Which action by the nurse is the most appropriate?

  1. Administer the calcium gluconate and sodium bicarbonate sequentially, flushing the IV line thoroughly with 0.9%0.9\% sodium chloride between each medication.Cevap
  2. B
    Administer the calcium gluconate and sodium bicarbonate simultaneously through the primary IV tubing's Y-site to rapidly stabilize the myocardium.
  3. C
    Delay the administration of the medications until a central venous catheter is inserted to reduce the risk of peripheral tissue necrosis.
  4. D
    Calculate an IV drip rate to administer the regular insulin as a continuous infusion of 0.1 units/kg/hr0.1\text{ units/kg/hr} instead of an IV push.

Cevap

The most appropriate action is to administer the medications separately, ensuring the IV line is thoroughly flushed with 0.9%0.9\% sodium chloride between the calcium gluconate and the sodium bicarbonate.
Calcium gluconate and sodium bicarbonate are physically incompatible. When mixed, they react to form an insoluble precipitate (calcium carbonate, or chalk) which can cause life-threatening emboli. To safely administer both medications through a single peripheral IV line, the nurse must administer them sequentially and ensure the line is thoroughly flushed with a compatible solution, such as 0.9%0.9\% sodium chloride, between the infusions.

Adım Adım Çözüm

1
Analyze the client's clinical presentation and the prescribed medications.
The client has severe hyperkalemia with cardiac toxicity (widened QRS), requiring STAT administration of calcium gluconate, sodium bicarbonate, insulin, and dextrose.
Identifying the urgency and the purpose of each medication is required to prioritize safe administration.
2
Evaluate the physical compatibility of the prescribed intravenous medications.
Calcium gluconate and sodium bicarbonate are known to be highly physically incompatible when mixed together.
Mixing calcium salts with bicarbonate results in the formation of insoluble calcium carbonate precipitate.
3
Determine the safest method to administer incompatible medications through a single peripheral IV line.
The medications must be given separately, and the IV line must be flushed completely with a compatible neutral solution.
Thorough flushing prevents the incompatible medications from mixing inside the IV tubing, thereby preventing precipitation and potential embolic events.

Anahtar Kavram

Intravenous Medication Compatibility and Safe Administration Practices
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Konular

Pharmacological and Parenteral Therapies

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