Question

GH, a 26-year-old woman, takes phenytoin 100 mg three times daily to control tonic-clonic seizures. She and her husband are contemplating starting a family.

GH complains of frequent upset stomach and bleeding gums when brushing her teeth.

1. • To decrease GI distress, what can be suggested?
   • To alleviate bleeding gums, what patient teaching for GH must be included?
   • The nurse checks GH's serum phenytoin level. What are the indications of an abnormal serum level?
   • What appropriate actions should be taken?

Answer 1

Ans:To avoid GI distress ,take phenytoin with or after meals.

Ans: emphasize the importance of oral hygiene to the patient

• Instruct the patient to avoid vigorous brushing of teeth.
• Encourage the patient to use soft bristle brush.
• instruct the patient to inform her dentist about phenytoin therapy.

.Ans: high serum levels of phenytoin indicates phenytoin toxicity. It progresses from mild nystagmus to coma.

Ans: no specific treatment for phenytoin toxicity.

• supportive treatment including maintaining airway and breathing.
• Monitoring serum phenytoin levels.
• Removal of the drug by using activated charcoal, gastric lavage and laxatives.
• Proper treatment of adverse symptoms