A nurse is preparing to administer intravenous (IV) phenobarbital (Luminal) to a patient who has status epilepticus. Which of the following actions should the nurse take?

The nurse should respond by saying, "You should report these symptoms to your doctor as they may indicate toxicity." This is the correct answer because dizziness and tiredness are common side effects of gabapentin, but they may also be signs of toxicity if they are severe or persistent¹². The nurse should also ask the patient about their dose and frequency of gabapentin, and check their blood levels if possible³. The nurse should advise the patient not to stop or change their dose of gabapentin without consulting their doctor, as this can cause withdrawal symptoms or seizures¹².

The other statements by the nurse are incorrect and indicate a need for further education.

- Saying, "You should stop taking the drug and ask your doctor for something else." is wrong because the nurse should not advise the patient to stop taking gabapentin abruptly, as this can cause withdrawal symptoms or seizures. The nurse should also not suggest alternative drugs without knowing the patient's medical history, allergies, or other medications¹².

- Saying, "You should increase your dose until you get relief from your pain." is wrong because the nurse should not advise the patient to increase their dose of gabapentin without consulting their doctor, as this can cause toxicity or adverse effects. The nurse should also not imply that gabapentin is ineffective for neuropathic pain, as it is one of the first-line drugs for this condition⁴.

- Saying, "You should continue taking the drug as prescribed and avoid driving or operating machinery." is partially correct, but not the best response. The nurse should advise the patient to continue taking gabapentin as prescribed and avoid driving or operating machinery until they know how the drug affects them, but they should also report their symptoms to their doctor as they may indicate toxicity¹².

Answer: D. Monitor the patient's respiratory rate and oxygen saturation during and after the drug administration.

Rationale:

A. Dilute the drug in normal saline solution:
Phenobarbital can be administered without dilution or with minimal dilution. Diluting it in large volumes is not required and may delay administration during emergencies like status epilepticus.

B. Flush the IV line with dextrose solution before and after the drug administration:
Dextrose is not compatible with phenobarbital and can cause precipitation. The IV line should be flushed with normal saline instead to prevent interactions.

C. Give the drug by rapid IV push over 10 to 20 seconds:
Phenobarbital should be administered slowly, typically over at least 1 minute per 30 mg, to avoid respiratory depression and hypotension. Rapid IV push increases the risk of adverse effects.

D. Monitor the patient's respiratory rate and oxygen saturation during and after the drug administration:
Phenobarbital is a central nervous system depressant and can cause respiratory depression. Continuous monitoring is critical to detect and manage potential complications early.