The nurse is caring for a patient who has been receiving intravenous phenytoin (Dilantin). The patient complains of pain and burning at the IV site, and the nurse notes redness and swelling at the site. What will the nurse do?
Apply warm compresses to the site and slow the infusion rate.
Discontinue the IV line and notify the provider of a possible infiltration.
Request an order for intravenous fosphenytoin (Cerebyx) instead of phenytoin.
Stop the infusion temporarily and administer an antihistamine.
The Correct Answer is B
This is because phenytoin, a medication used to treat seizures, can cause a rare but serious side effect called “purple glove syndrome” when administered intravenously². This condition is characterized by worsening limb edema and discoloration that may result from the crystallization of phenytoin within the blood². It can lead to skin necrosis and limb ischemia, requiring amputation in severe cases². Therefore, the nurse should stop the infusion immediately, remove the IV line, and report the adverse reaction to the provider. The patient may need surgical intervention or other treatments to prevent further complications².
Choice A is wrong because applying warm compresses and slowing the infusion rate may not prevent or reverse the damage caused by phenytoin infiltration. In fact, it may worsen the condition by increasing the blood flow to the affected area and prolonging the exposure to the drug².
Choice C is wrong because requesting an order for intravenous fosphenytoin instead of phenytoin may not be appropriate or necessary at this point. Fosphenytoin is a prodrug of phenytoin that has some advantages over phenytoin, such as better solubility, faster infusion rate, and fewer cardiovascular complications⁷. However, it is not indicated for the treatment of purple glove syndrome or phenytoin infiltration. Moreover, fosphenytoin may still cause some adverse effects, such as hypotension, pruritus, rash, and paresthesia⁶. Therefore, the nurse should focus on managing the current situation rather than switching to another drug.
Choice D is wrong because stopping the infusion temporarily and administering an antihistamine may not be effective or sufficient for treating phenytoin infiltration. Purple glove syndrome is not an allergic reaction, but a local tissue injury caused by phenytoin crystallization². Therefore, an antihistamine may not have any benefit for this condition. Stopping the infusion temporarily may not prevent further damage to the tissue or blood vessels. The nurse should discontinue the IV line completely and notify the provider as soon as possible.
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Related Questions
Correct Answer is D
Explanation
This action is necessary to prevent the formation of precipitates in the IV line, which can cause thrombophlebitis or embolism. The other actions are incorrect for the following reasons:
- A. "Flush the IV line with normal saline before and after giving phenytoin". This action is correct, but not sufficient to prevent precipitation. Phenytoin is incompatible with many IV solutions and drugs, so it should be given in a separate line or flushed thoroughly with normal saline before and after administration.
- B. "Mix phenytoin with dextrose solution in a syringe". This action is incorrect because phenytoin is incompatible with dextrose solution and will form a precipitate. Phenytoin should only be diluted with normal saline.
- C. "Give phenytoin as a bolus over 1 minute". This action is incorrect because phenytoin should be given slowly, at a rate of no more than 50 mg/min, to avoid hypotension and cardiac arrhythmias.
Correct Answer is B
Explanation
This instruction is important because gabapentin can cause drowsiness, dizziness, or blurred vision as common side effects¹². These effects can impair the client's ability to drive safely and increase the risk of accidents or injuries. The client should avoid driving or operating machinery until they know how gabapentin affects them and their doctor says it is safe to do so¹². The other instructions are incorrect for the following reasons:
- A. "Take this medication with food or milk to prevent gastric irritation". This instruction is unnecessary because gabapentin does not cause gastric irritation or ulcers as a side effect¹². The client can take gabapentin with or without food, depending on their preference and tolerance¹².
- C. "Increase your intake of fluids and fiber to prevent constipation". This instruction is irrelevant because gabapentin does not cause constipation as a side effect¹². The client should maintain a normal intake of fluids and fiber to promote bowel health, but not specifically because of gabapentin use¹².
- D. "Discontinue this medication gradually to prevent withdrawal symptoms". This instruction is incorrect because gabapentin does not cause withdrawal symptoms or physical dependence as a side effect¹². However, the client should not stop taking gabapentin suddenly or without their doctor's advice, as this can increase the risk of seizures or other complications¹².
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