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?
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.
Correct Answer: 1,2,3
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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