Question

Joe Nguyen is a 15-year-old brought to the clinic for a routine visit by his mother. With antiepileptic therapy, he currently has a seizure every 2 to 4 months. He asks: “How long do I gotta take this stuff?” His seizures are described as partial complex with secondary generalization. Joe developed meningitis at age 3, with onset of seizures at that time. He has been on multiple antiepileptic drugs over the years, but his old records are unavailable and his mother is a poor historian.

Data Obtained From Nursing Assessment

Attends public school; working one grade below his age level, making Cs

Two older siblings healthy and negative for seizures

Reports “rash” with the antiepileptic drug phenytoin

Vital signs: temperature, 37.1°C; pulse, 64; respiration, 12; blood pressure, 110/70

Weight: 150 pounds

Height: 67 inches

Well developed, well nourished

Cranial nerves intact and reflexes normal

On further interview, complains medications make him feel “slowed down” and “fuzzy”

Reports medications not working well enough because he still has seizures

Expresses concern that he will not be allowed to get his driver’s license next year

Lab Data

Electrolytes: sodium, 133 mEq/L; potassium: 4.6 mEq/L; chloride: 107 mEq/L; carbon dioxide: 26 mEq/L

BUN: 13 mg/dL; serum creatinine: 0.9 mg/dL; glucose: 94 mg/dL; calcium: 10.3 mg/dL; phosphorus: 3.8 mg/dL; uric acid: 4.9 mg/dL

Liver function studies: alkaline phosphatase: 310 IU/L; GGT: 42 IU/L; AST: 53 IU/L; ALT: 45 IU/L; protein: 7.6 g/dL; albumin: 4.5 g/dL; cholesterol: 198 mg/dL

CBC: Hgb: 14 g/dL; Hct: 43.5%; WBCs: 3,800/mm³; platelets: 298,000/mm³

Serum drug levels: carbamazepine: 11.3 mcg/mL; phenobarbital: 17mcg/mL

Current Drug Therapy

Carbamazepine, 600 mg PO qid

Phenobarbital, 60 mg PO bid

CONSIDER THE CORE DRUG KNOWLEDGE FOR EACH OF THESE DRUGS

How do these drugs work together to address Joe’s underlying pathologic conditions?

What other antiepileptic drugs could be used to treat Joe’s seizure disorder? Are any of these drugs contraindicated for him?

CONSIDER THE CORE PATIENT VARIABLES FOR EACH OF THESE DRUGS

What patient variables are most important to consider for Joe when assessing his drug therapy?

Are there any aspects of core drug knowledge that are especially relevant to consider because they may interact with the core patient variables?

Which of the findings from the nursing assessment demonstrate effectiveness of drug therapy?

Which of the findings from the nursing assessment demonstrate possible adverse effects from drug therapy?

CONSIDER THE NURSING MANAGEMENT NEEDED WITH THESE DRUG THERAPIES

What actions are indicated to maximize therapeutic effects?

What actions are indicated to minimize adverse effects?

What teaching is required for Joe regarding his drug therapy? Do you need any additional data to determine appropriate teaching?

Answer 1

1. How does the drug work to address pathologic condition?

Carbamazepine:

Primarily it helps to treat epilepsy and neuropathic pain associated with epilepsy. Its always used with other drugs to treat epilepsy.

Phenobarbital:

It block the excitary glutamate signal, so its actually as a anticonvulsant.

2. other epilepsy can be added: and its contraindications:

clonozepam

Phenitoin

3. Its contraindicated with,

Blood dyscriasias, slurred speech, hepatic diseases, lymph adenopathy etc.

4. Important variable to consider:

Previous history of seizure

Rash on drugs therapy

Phenobarbital and carbamazepine drug level.

Drug regimen and lab investigation.

As HOMEWORKLIB RULES rule 4 question answered.