Question

SS, a 26-year-old woman, takes phenytoin 100 mg t.i.d. to control grand mal seizures. SS and her husband are contemplating starting a family. SS complains of frequent “upset stomach” and “bleeding gums” when brushing her teeth and is questioning if other anticonvulsants are more appropriate than phenytoin.

1. List the different classifications of anticonvulsant medications noted on your drug list and briefly explain how they work. Describe a situation in which each could be prescribed.
2. Detail assessment criteria important before administering anticonvulsants.
3. Explain nursing interventions (not patient teaching, what interventions are appropriate for the RN when administering these medications).
4. Explain with rationale the teaching points for patients prescribed anticonvulsants (not general teaching points, they need to be specific to anticonvulsants).
5. If S.S was contemplating pregnancy what would you say to her? How do anticonvulsants impact pregnancy?
6. What are the indications of an abnormal phenytoin serum level?

Answer 1

ANSWERS :

1. DIFFERENT CLASSIFICATIONS OF ANTICONVULSANT MEDICATIONS AND ITS ACTION :

* Carbamazepine - It is the drug which is used as a anticonvulsant drug. It decreases the nerve impulses which causes seizures, trigeminal neuralgia and neuropathy. It is also used for the treatment of bipolar disorder.

* Clobazam - It is the medication used to control seizure activity in children and adults.

* Diazepam - It balances nerve activity in the brain. and reduces anxiety and agitation, relax muscles and induces sleep.

* Clonazepam - It acts as a anticonvulsant medication which treats panic attacks and calms brain and nerve activities.

* Phenytoin - It is an anti epileptic drug which slow down the impulses of brain and controls seizures.

2. ASSESSMENT CRITERIA BEFORE ADMINISTERING ANTICONVULSANTS :

* Obtain complete health history of the patient

* Assess the neurological status of the patient before drug administration

* Monitor the growth and development for children

* Collect detailed drug history, allergic history

* Assess review of systems of the patient, etc

3. NURSING INTERVENTIONS :

* Assess the neurological examination

* Monitor vital signs

* Monitor level of consciousness

* Check for effectiveness of drug therapy administered to patient

* Close monitoring for side effects of the drug

* Check for nutritional status for adults and children

* Monitor gastro instestinal system functioning status.

* Observe for the presence of signs and symptoms of bleeding of gums, inflammation, ulcers in the mouth.