A nurse is reviewing a prescription to initiate an infusion of terbutaline at 2.5 mcg/min to a client PRN more than four uterine contractions in 1 hr and to increase the infusion by 5 mcg/min every 10 min until contractions stop, not to exceed a rate of 30 mcg/min. How should the nurse interpret this prescription?
A.
The nurse should ensure that the rate of the client’s terbutaline infusion does not exceed 18 mg/hr.
B.
The nurse should weigh the client to determine the rate of the terbutaline infusion.
C.
The nurse should increase the drip rate of the infusion by 5 mL/hr when titrating the dosage.
D.
The nurse should initiate the infusion of terbutaline if the client has five or more contractions in 1 hr.
The Correct Answer and Explanation is:
The correct answer is D. The nurse should initiate the infusion of terbutaline if the client has five or more contractions in 1 hr.
Explanation:
Terbutaline is a medication used to relax uterine muscles and reduce contractions, primarily during preterm labor. The prescription in question outlines a specific protocol for administering terbutaline infusion based on the frequency of uterine contractions.
- Understanding the Prescription:
- Initial Dose: The infusion should be started at 2.5 mcg/min.
- Indication for Infusion: The infusion is to be initiated when the client has more than four uterine contractions in one hour.
- Titration: The infusion rate should be increased by 5 mcg/min every 10 minutes if contractions persist, with a maximum allowable rate of 30 mcg/min.
- Analysis of the Options:
- Option A: The statement about not exceeding 18 mg/hr is incorrect because the dosage is expressed in micrograms per minute (mcg/min), not milligrams per hour (mg/hr). To convert the maximum dosage to mg/hr: 30 mcg/min × 60 min/hr = 1800 mcg/hr or 1.8 mg/hr. The correct rate is 1.8 mg/hr, not 18 mg/hr.
- Option B: Weight is not a factor in the dosage calculation for terbutaline infusion in this scenario. The prescription is based on the frequency of contractions, not the client’s weight.
- Option C: The prescription specifies dosage changes in micrograms per minute, not milliliters per hour. The infusion rate adjustment should be based on micrograms per minute rather than a volumetric rate (mL/hr).
- Option D: This option correctly interprets the initiation criteria for the terbutaline infusion. According to the prescription, the infusion should start when the client experiences more than four contractions in one hour, which matches the guideline for initiating the medication.
Clinical Relevance:
Terbutaline is used as a tocolytic agent to manage preterm labor by reducing uterine contractions. Adhering to the correct infusion initiation and titration protocols is crucial to effectively manage labor while minimizing potential side effects. Accurate interpretation of the prescription ensures that the medication is used safely and effectively, avoiding complications associated with improper dosing or unnecessary treatment.