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Zorluk: KolayPharmacological and Parenteral Therapies

A client who is experiencing continuous seizure activity requires an urgent intravenous (IV) dose of phenytoin. The client has a single peripheral IV access site that is currently infusing 5% dextrose in water (D5W). Which action should the nurse take to safely administer the prescribed medication?

  1. Stop the primary fluid, flush the line with 0.9% sodium chloride, administer the medication, and flush again with 0.9% sodium chloride.Cevap
  2. B
    Attach the medication syringe directly to the lowest Y-site port and push it slowly while the primary fluids continue to infuse.
  3. C
    Instruct the unlicensed assistive personnel to quickly establish a new peripheral access site for the medication.
  4. D
    Wait to administer the medication until the pharmacy delivers a compatible premixed bag of phenytoin and dextrose.

Cevap

Stop the primary fluid, flush the line with 0.9% sodium chloride, administer the medication, and flush again with 0.9% sodium chloride.
Phenytoin is physically incompatible with all dextrose-containing solutions and will rapidly precipitate if they mix. Because the client has only one IV site and requires urgent medication to stop the seizures, the nurse must temporarily pause the D5W infusion, thoroughly flush the line with 0.9% sodium chloride (normal saline) to clear any residual dextrose, administer the phenytoin safely, and then flush again with normal saline before restarting the primary fluid.

Adım Adım Çözüm

1
Identify the compatibility of the prescribed medication (phenytoin) with the currently infusing IV fluid (D5W).
Phenytoin is highly incompatible with all dextrose-containing solutions.
Mixing phenytoin with dextrose causes rapid precipitation, forming solid crystals that destroy the medication and can cause a fatal embolism.
2
Determine the safest method to administer the medication through the single available IV line.
The nurse must clear the IV line of all dextrose before and after the phenytoin is given.
Flushing the line with a compatible fluid, specifically 0.9% sodium chloride (normal saline), ensures that the two incompatible fluids never mix in the tubing.

Anahtar Kavram

Phenytoin IV compatibility and safe parenteral administration
Tahmini Süre:45s
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