A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophylline) (400 mg in 500 ml) at 50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse to change the dosage to 0.45 mg/kg/hour. The nurse should:
A. Question the order because it’s too low.
B. Question the order because it’s too high.
C. Set the pump at 45 ml/hour.
D. Stop the infusion and have the laboratory repeat the theophylline measurement.
Correct Answer: A. Question the order because it’s too low.
A therapeutic theophylline level is 10 to 20 mcg/ml. The client is currently receiving 0.5 mg/kg/hour of aminophylline. Because the client’s theophylline level is sub-therapeutic, reducing the dose (which is what the physician’s order would do) would be inappropriate. Therefore, the nurse should question the order.
Option B: Intravenous administration of aminophylline occurs via two methods. A loading dose is given to achieve a serum concentration of 10 mcg/ml. Once the serum concentration has reached 10 to 15 mcg/ml, the maintenance constant infusion follows. The dosage given depends on the clearance of theophylline and whether the person has taken theophylline in the last 24 hours. These dosages vary by age, body weight, and the health status of the patient.
Option C: The loading dose is 5.7 mg/kg based on the ideal body weight for all age groups. Loading doses should be administered over 30 minutes at a rate not to exceed 21 mg/hr and should be calculated using ideal body weight. This dose is for patients who have not taken aminophylline in the past 24 hours. The loading dose calculation must use the formula given below for patients who have taken aminophylline in the last 24 hours.
Option D: Patients taking aminophylline require monitoring for CNS effects, respiratory rate, arterial blood gasses, and serum theophylline concentrations. Clinicians must measure serum concentrations before initiating a loading dose in a person who has taken theophylline in the last 24 hours. A repeat serum concentration is necessary before starting the maintenance dose, as well.
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