Comprehensive Nursing Pharmacology Q 146
The nurse observes a co-worker preparing to administer a solution of lidocaine and epinephrine to a client with multiple premature ventricular contractions. The appropriate action by the nurse is to:
A. Offer to monitor the client's heart rhythm.
B. Notify the supervisor of the error.
C. Do nothing; the drug choice is correct.
D. Prevent the administration and give a plain lidocaine solution.
Correct Answer: D. Prevent the administration and give a plain lidocaine solution.
Solutions of lidocaine containing preservatives or epinephrine are intended for local anesthesia only, and must never be given IV for dysrhythmias. Cardiac dysrhythmias are common during anesthesia and surgery. An important precipitating factor of clinically relevant arrhythmias is the intraoperative use of epinephrine. Bradykinin acts as an endogenous cardioprotective substance because it suppresses ventricular dysrhythmias induced by ischemia.
Option A: Epinephrine is a hormone that produces widespread effects. Certain effects need monitoring. Tachycardia and hypertension are expected effects when giving epinephrine intravenously, so it is important to titrate the drug carefully while monitoring hemodynamics.
Option B: Epinephrine is also used with anesthetic agents to provide analgesia. In locations where extravasation of epinephrine has occurred, prevention and treatment of ischemia-induced necrosis are necessary. The infiltrated area should receive treatment with a 10 mL to 15 mL saline solution containing 5 mL to 10 mg of phentolamine, an alpha-adrenergic blocking agent.
Option C: Another unique contraindication to be aware of is catecholaminergic polymorphic ventricular tachycardia. As is the case with prescribing any medication, all practitioners should use clinical judgment and evaluate the benefits versus risks with epinephrine.