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Zorluk: OrtaPharmacological and Parenteral Therapies

An adult client is receiving care in the emergency department for ongoing seizure activity. Current vital signs include a blood pressure of 118/74 mmHg118/74 \text{ mmHg} and a heart rate of 108 beats/min108 \text{ beats/min}. The client has one peripheral intravenous (IV) catheter currently infusing 5%5\% dextrose in water (D5W) at 100 mL/hr100 \text{ mL/hr}. The provider prescribes an IV loading dose of phenytoin. Which technique is safest for the nurse to use when administering this therapy?

  1. Pause the primary D5W infusion, flush the IV catheter with 0.9%0.9\% sodium chloride, deliver the phenytoin at a maximum rate of 50 mg/min50 \text{ mg/min}, and flush again with 0.9%0.9\% sodium chloride.Cevap
  2. B
    Attach the medication syringe to the lowest Y-site port on the primary tubing and deliver the dose while the D5W continues to infuse.
  3. C
    Deliver the medication as a fast bolus over 3030 to 4545 seconds to promptly suppress the seizure activity and restore normal neurological function.
  4. D
    Mix the prescribed dose of phenytoin with 10 mL10 \text{ mL} of sterile water for injection to minimize vascular irritation and infuse over 55 minutes.

Cevap

The safest technique is to pause the primary D5W infusion, flush the line with 0.9%0.9\% sodium chloride, deliver the phenytoin at a rate not exceeding 50 mg/min50 \text{ mg/min}, and flush the line again with 0.9%0.9\% sodium chloride.
The correct action involves pausing the incompatible 5%5\% dextrose in water (D5W) infusion and clearing the line with 0.9%0.9\% sodium chloride (normal saline) before and after administration. Phenytoin is highly incompatible with dextrose and will precipitate if mixed. Additionally, it must be administered slowly at a rate not exceeding 50 mg/min50 \text{ mg/min} to prevent severe adverse cardiovascular reactions such as hypotension and arrhythmias.

Adım Adım Çözüm

1
Evaluate the compatibility of the prescribed medication (phenytoin) with the current continuous IV infusion (D5W).
Phenytoin is incompatible with dextrose solutions and will precipitate.
Recognizing incompatibilities prevents the formation of crystals in the IV line, which could lead to an embolism.
2
Determine the appropriate diluent and flush solution for phenytoin administration.
0.9%0.9\% sodium chloride (normal saline) is the only compatible fluid for flushing and diluting phenytoin.
Using the correct flush solution maintains medication stability and prevents precipitation in the tubing.
3
Identify the safe administration rate for IV push phenytoin.
The medication must be administered slowly, at a maximum rate of 50 mg/min50 \text{ mg/min}.
Rapid administration of phenytoin can cause severe cardiovascular adverse effects, including hypotension, bradycardia, and cardiovascular collapse.
4
Synthesize the findings to formulate the correct sequential administration technique.
The nurse must pause the incompatible D5W, flush with normal saline, give the medication slowly, and flush again with normal saline.
This sequence ensures IV line patency, prevents drug-solution precipitation, and avoids severe adverse reactions.

Anahtar Kavram

Safe intravenous administration of phenytoin, including diluent compatibility and infusion rate limits.
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Pharmacological and Parenteral Therapies

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