The nurse mixes diphenhydramine 25 mg in a 100 mL bag of 0.9% sodium chloride, which is to be administered IV over 30 minutes. The IV pump should be set to administer how many mL/hour? (Enter numeric value only.)

Understanding:

• "You can give naloxone intravenously, intramuscularly, or subcutaneously."
• "If the first dose does not work, you can give as many doses as needed to reverse respiratory depression."
• "Naloxone works best on pure agonist opioids."

No Understanding:

• "Naloxone will not affect the client's level of pain."
• "When given IV, naloxone starts working immediately and can last several hours."

Rationale:

• "Naloxone will not affect the client's level of pain. This shows no understanding because naloxone blocks all opioid receptors, including those responsible for analgesia. Once naloxone is administered, the client's opioid-induced pain relief is lost, and pain will likely intensify unless managed separately.
• "You can give naloxone intravenously, intramuscularly, or subcutaneously." This shows understanding because naloxone is approved for IV, IM, and SC administration. IV is preferred for rapid effect in emergencies, while IM or SC may be used when IV access is delayed or unavailable.
• "When given IV, naloxone starts working immediately and can last several hours." This shows no understanding because naloxone’s onset is rapid when given IV (within 1–2 minutes), but its duration is short, generally lasting 30–90 minutes. It often requires repeated dosing to sustain reversal effects.
• "If the first dose does not work, you can give as many doses as needed to reverse respiratory depression." This shows understanding because multiple doses of naloxone may be necessary depending on the opioid’s half-life and the severity of respiratory depression. Repeated dosing ensures that ventilation is supported adequately.
• "Naloxone works best on pure agonist opioids." This shows understanding because naloxone is most effective against pure opioid agonists like morphine, heroin, and fentanyl. It competitively displaces these substances from opioid receptors, reversing their full agonist effects.

Therapeutic Result:

• Semifluid stool

Non-therapeutic Side Effect:

• Non-blanchable red area
• Sinus tachycardia
• Burning sensation

Unrelated Finding:

• Pain rating 2 on pain scale of 0 to 10
• Itching in legs
• Blood pressure 135/81 mm Hg

Rationale:

• Non-blanchable red area: A non-blanchable red area indicates localized skin damage and early pressure injury. It likely results from immobility and pressure near the buttock area, especially in a client on strict bedrest, rather than an effect of bisacodyl.
• Pain rating 2 on pain scale of 0 to 10: The lower pain rating reflects effective pain management after receiving analgesics. It is a measure of comfort but not directly influenced by the administration of bisacodyl, which targets bowel function.
• Sinus tachycardia: Sinus tachycardia can occur due to pain, stress, mild dehydration from increased bowel activity, or systemic response to immobility. It is not a typical response to bisacodyl use and requires further clinical monitoring.
• Itching in legs: Itching is most likely related to nerve irritation, healing wounds, or dry skin from immobility rather than gastrointestinal effects. Bisacodyl does not commonly cause peripheral itching.
• Blood pressure 135/81 mm Hg: Blood pressure is within a stable range and reflects the client’s cardiovascular status. It is not directly connected to bisacodyl administration or its gastrointestinal actions.
• Semifluid stool: The semifluid stool is the intended therapeutic effect of bisacodyl, which stimulates peristalsis to promote bowel movement. This outcome shows the medication worked appropriately for constipation management.
• Burning sensation: The burning sensation around the anus is a known side effect of rectal bisacodyl administration. Local irritation of the rectal mucosa can occur after suppository use, especially with frequent bowel movements.