The nurse is caring for an intubated infant with botulism in the pediatric intensive care unit. Which health care provider prescription should the nurse clarify with the health care provider before implementing?
A) Administer 250 mg botulism immune globulin intravenously (BIG-IV) one time.
B) Provide total parenteral nutrition (TPN) at 25 ml/hr intravenously.
C) Titrate oxygen to keep pulse oximetry saturations greater than 92.
D) Administer gentamicin sulfate (Garamycin) 10 mg per intravenous piggyback every 12 hours.

Question

Quizplus · Accepted Answer

The nurse should clarify the administration of an aminoglycoside antibiotic. Antibiotic therapy is not part of the management of infant botulism because the botulinum toxin is an intracellular molecule, and antibiotics would not be effective; aminoglycosides in particular should not be administered because they may potentiate the blocking effects of the neurotoxin. Treatment consists of immediate administration of botulism immune globulin intravenously (BIG-IV) without delaying for laboratory diagnosis. Early administration of BIG-IV neutralizes the toxin and stops the progression of the disease. The human-derived botulism antitoxin (BIG-IV) has been evaluated and is now available nationwide for use only in infant botulism. Approximately 50% of affected infants require intubation and mechanical ventilation; therefore, respiratory support is crucial, as is nutritional support, because these infants are unable to feed.

The Nurse Is Caring for an Intubated Infant with Botulism