A nurse is caring for a client who has received an albuterol nebulization treatment. Which of the following findings should the nurse instruct the client to observe as an adverse effect of this medication?

Stop the infusion.

Disconnect the IV tubing from the IV hub.

Aspirate the medication from the IV catheter.

Elevate the affected extremity.

Brief Introduction:

Extravasationis a severe clinical complication where a vesicantmedication leaks from the intravascular space into the surrounding dermal or subcutaneous tissue. Vesicants, such as certain chemotherapeutic agents, cause cellular necrosis, tissue sloughing, and permanent nerve damage upon contact with extravascular structures. Emergency management focuses on immediate cessation of the insult and the removal of as much residual toxin as possible to mitigate localized destruction.

Rationale:

A. Disconnecting the IV tubingfrom the IV hub is the second priority action. Once the pump is deactivated, the tubing must be removed while leaving the catheter in place to serve as a conduit for further intervention. This step prepares the site for aspirationand prevents any further residual medication within the line from being accidentally flushed into the compromised tissue.

B. Elevating the affected extremityis the final step in the immediate response sequence. Elevation utilizes gravity to promote venous returnand lymphatic drainage, which helps reduce localized edema and limits the spread of the vesicant within the interstitial spaces. This maneuver is part of supportive care and should only be performed after the chemical threat has been physically addressed.

C. Stop the infusionis the absolute first action the nurse must perform the moment extravasation is suspected. Continued administration of a vesicant exponentially increases the volume of tissue exposed to the toxin, leading to wider areas of necrosis. Halting the flow immediately limits the scope of the injury and is the highest priority for limb preservation and safety.

D. Aspirate the medicationfrom the client's IV catheter is performed after the tubing is disconnected but before the catheter is removed. Using a syringe to pull back on the hub allows the nurse to extract residual vesicant still sitting in the catheter and the immediate extravasation pocket. This critical step reduces the total concentration of the drug remaining in the tissue, potentially decreasing the severity of the subsequent chemical burn.

Insulin therapy management involves the precise coordination of short-actingand intermediate-actingagents to mimic physiological glucose regulation. Regular insulinacts rapidly, whereas NPH insulincontains protamine to delay absorption and extend the duration of action. Proper mixing technique is vital to maintain the integrity of each medication and ensure accurate glycaemic control without causing cross-contamination.

Rationale:

A.Injecting air into both vials is the correct first step when mixing insulins to prevent the creation of a vacuum. The nurse must teach the client to inject air equal to the dose into the NPH vial first, followed by air into the regular vial. This equalization of pressure allows for the smooth withdrawal of the liquid medication without contaminating the regular insulin with NPH.

B.Shaking insulin vials vigorously is contraindicated as it creates air bubbles that interfere with accurate dose measurement and can denature the protein molecules. Instead, NPH insulin, which is a suspension, should be gently rolled between the palms to redistribute the particles. Regular insulin is a clear solution and does not require any agitation or rolling before withdrawal from the vial.

C.Drawing up NPH insulin first is an incorrect technique that risks contaminating the clear regular insulin vial with the cloudy protamine from the NPH. The standard protocol is to draw the "clear before cloudy" (regular before NPH) to ensure the fast-acting insulin remains pure. Contamination of the regular vial with NPH would inadvertently alter the onset and peak characteristics of the short-acting dose.

D.Inserting the needle at a 15° angle is incorrect for subcutaneous insulin administration and is more appropriate for intradermal injections. Insulin must be deposited into the fatty subcutaneous tissue, typically at a 45° to 90° angle depending on the patient's body mass and needle length. A 15° angle would likely result in an ineffective intradermal delivery, leading to unpredictable absorption rates.