Pharmacological and Parenteral Therapies Q 87
A female client is receiving IV Mannitol. An assessment specific to safe administration of the said drug is:
A. Vital signs q4h
B. Weighing daily
C. Urine output hourly
D. Level of consciousness q4h
Correct Answer: C. Urine output hourly
The osmotic diuretic mannitol is contraindicated in the presence of inadequate renal function or heart failure because it increases the intravascular volume that must be filtered and excreted by the kidney. Urine output also requires monitoring; failure for urine output to increase after administration of mannitol should prompt cessation of mannitol and evaluation for possible renal or genitourinary issues.
Option A: Vital signs monitoring is a must for every shift, not just for mannitol administration. It is essential to monitor cardiac function as the fluid shifts can precipitate heart failure. Additional electrolytes, including sodium, potassium, and osmolality, require monitoring by the nurses and physicians. Abnormalities in these laboratory values necessitate prompt communication to all members of the team.
Option B: The patient’s weight is a less reliable indicator especially for safe administration of mannitol. The nursing staff should pay particular attention to urine output and monitor it carefully, reporting any concerns to the treating clinician. The pharmacist can verify dosing and perform medication reconciliation and alert the team if any interactions are present.
Option D: It would be more appropriate to monitor the patient’s neurological status if she has an increase in intracranial pressure. When giving mannitol, it is essential to monitor cardiac function as the fluid shifts can precipitate heart failure. Additional electrolytes, including sodium, potassium, and osmolality, all require monitoring. The clinician should stop mannitol if significant electrolyte abnormalities develop or the osmolality reaches 320 mOsm or higher.