A nurse is preparing to administer IV phenytoin for status e… | MyMerci
Adverse Effects/Contraindications/InteractionsPPT
Question
A nurse is preparing to administer IV phenytoin for status epilepticus. Which preparation and administration practice is essential for safety?
1Mix in normal saline only, infuse at no more than 50 mg/min through a large vein with continuous ECG monitoring✓ Correct answer
2Push IV bolus over 30 seconds for rapid seizure control
3Mix in D5W and infuse at 100 mg/min through any available IV line
4Administer through a Y-site with running KCl infusion
Explanation
Correct (2): IV phenytoin precipitates in dextrose-containing fluids — must use normal saline only. Max rate: 50 mg/min (25 mg/min in elderly/cardiac disease) to avoid hypotension, bradycardia, and arrhythmias. Continuous ECG and BP monitoring required. Use a large vein to minimize purple glove syndrome (extravasation → soft tissue ischemia). (1) D5W causes precipitation; 100 mg/min is dangerous. (3) Bolus push causes cardiac arrest. (4) Y-site KCl coadministration risks precipitation.
In-depth explanation
Memory Tip Phenytoin IV = "Saline, Slow, Strong-vein, Strip (ECG)." Fosphenytoin is the safer alternative — water-soluble, faster infusion permitted, less local injury.
Clinical scenario
Scenario 38-year-old in status epilepticus; provider orders phenytoin 1000 mg IV loading dose. The client has a dedicated 18-gauge antecubital IV.
Key concepts
Purple glove syndrome — Limb ischemia and discoloration from phenytoin extravasation; treat by stopping infusion and elevating the limb.
Status epilepticus — Continuous seizure activity >5 minutes or recurrent seizures without recovery; medical emergency requiring rapid anticonvulsant load.