Summary
Summary ( 14 Questions)
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?
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.
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.