The physician has ordered intravenous (IV) phenytoin (Dilantin). The nurse does not read the drug label and administers the medication intramuscularly (IM). What is the most likely response in the patient?
1. Local tissue damage following extravasation will most likely occur.
2. A phenomenon known as purple gluteus syndrome will most likely occur.
3. A marked decrease in serum glucose levels will most likely occur.
4. Nothing adverse, the medication may be administered intravenously (IV) or intramuscularly (IM).
1
Rationale 1: Phenytoin (Dilantin) injectable is a soft-tissue irritant that causes local tissue damage following extravasation.
Rationale 2: There isn't any such thing as purple gluteus syndrome; purple glove syndrome occurs when phenytoin (Dilantin) is administered in a hand vein and causes a serious local vasoconstrictive response.
Rationale 3: Phenytoin (Dilantin) causes an increase in serum glucose.
Rationale 4: It should not be administered intramuscularly but should be given intravenously into a large vein or via a central catheter.
Global Rationale: Phenytoin (Dilantin) injectable is a soft-tissue irritant that causes local tissue damage following extravasation. It should not be administered intramuscularly but should be given intravenously into a large vein or via a central catheter. There isn't any such thing as purple gluteus syndrome; purple glove syndrome occurs when phenytoin (Dilantin) is administered in a hand vein and causes a serious local vasoconstrictive response. Phenytoin (Dilantin) causes an increase in serum glucose.
You might also like to view...
When bathing an infant, what sign does the nurse recognize as a sign of developmental hip dysplasia?
a. Hypotonicity of the leg muscles b. One leg is shorter than the other c. Broadening and flattening of the buttocks d. Two skinfolds on the back of each thigh
After spinal shock has been resolved, an indwelling catheter is removed. What way should the nurse expect this patient to empty the bladder?
a. Manual expression (Credé method) b. Spontaneous reflexive action c. Normal voluntary control d. Self-catheterization
Which are expected and intended responses to antiemetic drugs? (select all that apply)
a. Vomiting reflex is inhibited. b. Vomiting reflex pathway is uninterrupted. c. Patient is sedated. d. Nausea is relieved. e. Retching occurs as expected. f. Vomiting is prevented.
A nurse is assessing a client who has had an acute exposure to a pesticide. Which of the follow-ing symptoms is the client most likely to display?
a. Memory loss b. Musculoskeletal problems c. Cancer d. Infertility