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Zorluk: ZorPharmacological and Parenteral Therapies

A nurse is caring for a client with acute decompensated heart failure who is hemodynamically unstable. The client is receiving a continuous intravenous infusion of milrinone at 0.5 mcg/kg/min0.5 \text{ mcg/kg/min}. The client weighs 80 kg80 \text{ kg}. The pharmacy has supplied a premixed bag containing 20 mg20 \text{ mg} of milrinone in 100 mL100 \text{ mL} of 5% Dextrose in Water5\% \text{ Dextrose in Water}. The client has a single peripheral intravenous catheter. The healthcare provider prescribes a stat dose of intravenous furosemide 40 mg40 \text{ mg} to treat pulmonary edema. Furosemide and milrinone are visually incompatible and will form a precipitate if mixed.

Which of the following actions is the highest priority for the nurse to take?

  1. Establish a second peripheral intravenous catheter to administer the stat dose of furosemide.Cevap
  2. B
    Pause the milrinone infusion, flush the intravenous line thoroughly with 0.9% sodium chloride0.9\% \text{ sodium chloride}, push the furosemide, and resume the milrinone.
  3. C
    Administer the furosemide via the lowest Y-site port closest to the client to minimize the physical contact time between the two medications.
  4. D
    Pause the milrinone, administer the furosemide, and then restart the milrinone at a recalculated rate of 24 mL/hr24 \text{ mL/hr} to compensate for the missed medication time.

Cevap

Establish a second peripheral intravenous catheter to administer the stat dose of furosemide.
Milrinone is a critical, continuous vasoactive medication (a phosphodiesterase inhibitor) used to support cardiac output in hemodynamically unstable clients. Pausing the infusion can lead to a rapid and life-threatening decline in blood pressure and cardiac output. Because furosemide and milrinone are incompatible and will precipitate if mixed in the same line, the nurse cannot run them together or pause the milrinone to flush the line. The only safe and correct action is to immediately start a second peripheral intravenous line to administer the furosemide.

Adım Adım Çözüm

1
Identify the patient's hemodynamic status and the nature of the continuous infusion.
The patient is hemodynamically unstable and receiving milrinone, a critical life-sustaining vasoactive medication.
Vasoactive drips cannot be safely paused without risking severe cardiovascular collapse.
2
Evaluate the compatibility of the prescribed medications.
Milrinone and furosemide are physically incompatible and will precipitate if mixed in the same intravenous line.
Administering incompatible drugs through the same line risks forming a fatal embolus and losing IV access.
3
Determine the safest route for medication administration.
Because the milrinone cannot be paused and the line cannot be shared, a second intravenous access must be established.
Establishing a new line allows for the stat administration of furosemide while maintaining continuous hemodynamic support.

Anahtar Kavram

Management of Incompatible Intravenous Medications and Vasoactive Infusions
Tahmini Süre:1m 30s
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Konular

Pharmacological and Parenteral Therapies

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