Question

STORY: Kelly, a 21-year old college student has been brought to the emergency room in status epilepticus. Measures are taken to ensure here safety and prevent injury, and an IV line is started. The emergency department physician has ordered diazepam (Valium) 8mg IV push, STAT. The seizure has stopped and she is admitted to the medical-surgical floor. The admitting orders call for an initial IV dose of phenytoin, followed by oral dose of phenytoin twice a day.

Please Answer the following questions:

1. What safety measure will you take when admitting Kelly to your hospital floor
2. How does phenytoin work?
3. What teaching should she receive regarding self-care and the side effects/adverse reactions to phenytoin?
4. After 4 months, the patient’s mother calls to report that Kelly has been “very sad lately” and doesn’t want to go out with her family or friends? “She just wants to stay in her room after school.” What is the safety priority in this situation?

Answer 1

Safety measures

• High flow oxygen should be given.
• Pulse oximetry and blood gas analysis should be established.
• Monitor her for hypotension or respiratory depression as diazepam is administered.
• IV phenytoin administration can result in arrhythmias,hypotension and cardiac arrest.So strict monitoring is needed during the infusion.
• While on bed,side rails should be padded and avoid restraining kelly.
• Remove all furnitures and sharp ends nearby.

How does phenytoin work?

Phenytoin is an anticonvulsant drug and it helps in slowing down the abnormal electrical activity produced in the brain.

What teaching should she receive regarding self-care and the side effects/adverse reactions to phenytoin?

Self care

• Advice her to have a proper sleep
• don't take alcohol or over the counter drugs.
• Proper exercise for 30 minutes per day should be scheduled.
• include fruits,vegetables and whole grains in your diet.
• Take measures to control stress.

Side effects of phenytoin

• presence of swollen and tender lymph nodes in the neck,groin and armpit should be informed to the doctor.
• Teach her that IV phenytoin administration can have side effects such as arrhythmias, hypotension and cardiac arrest.
• Other side effects include skin lesions,acne,fever,chills,rash,itching,swelling of face and hands,eosinophilia, and liver injury.
• PURPLE GLOVE SYNDROME(,edema,pain and discolouration) is seen at the area distal to the injection site.
• Teach her that chance of getting infection is likely more in patients getting phenytoin.

What is the safety priority in this situation?

Low mood ,depression are usually seen in patients with epilepticus.Thoughts of self harm(suicidal tendencies) might happen.So don't allow her to be alone in a room.Help her to ventilate her feelings to friends or family.If necessary, guide her to a talk therapy.