The physician has ordered intravenous phenytoin (Dilantin). The patient is also receiving 5% dextrose in water (D5W) intravenously (IV). What will the nurse plan to do before administering this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply
1. Use a large vein for the infusion.
2. Use an intravenous (IV) line with a filter.
3. Flush the intravenous (IV) line with saline.
4. Monitor the patient for hypertension.
5. Monitor the patient for Stevens-Johnson syndrome.
1,2,3
Rationale 1: Phenytoin (Dilantin) is a soft-tissue irritant that will cause local tissue damage if extravasation occurs, so a large vein must be used for infusion.
Rationale 2: An intravenous filter will trap any precipitate that occurs.
Rationale 3: Intravenous lines of 5% dextrose in water (D5W) must be flushed with saline, as traces of dextrose can cause microscopic precipitate formations that become emboli, if infused.
Rationale 4: Patients receiving phenytoin (Dilantin) are at risk for hypotension, not hypertension.
Rationale 5: Stevens-Johnson syndrome is a side effect of phenytoin (Dilantin), but it takes days to occur.
Global Rationale: Intravenous lines of 5% dextrose in water (D5W) must be flushed with saline, as traces of dextrose can cause microscopic precipitate formations that become emboli, if infused. An intravenous filter will trap any precipitate that occurs. Phenytoin (Dilantin) is a soft-tissue irritant that will cause local tissue damage if extravasation occurs, so a large vein must be used for infusion. Patients receiving phenytoin (Dilantin) are at risk for hypotension, not hypertension. Stevens-Johnson syndrome is a side effect of phenytoin (Dilantin), but it takes days to occur.
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