NCM106 - Pharmacology

Module 2.1 Nursing Process Focus: Care Patients Receiving Hydantoin: Phenytoin
NAME: BLOCK:
DATE OF SUBMISSION:
CYCLE AND SCHEDULE:

Classification of the Drug: Anticonvulsants; Hydantoin derivatives

Common Indications of the Drug: To control toni-clonic (grand mal) and complex partial (temporal lobe)
seizures; to prevent and treat seizures occurring during neurosurgery
Common Brand Names: Dilantin-125; Dilantin Infatabs

Assessment Possible Nursing Diagnoses

History: Hypersensitivity to hydantoins, history of sinus
bradycardia, hypotension, severe myocardial insufficiency,
diabetes mellitus, hyperglycemia, pregnancy, lactation
Physical: assess for skin color, lesions; lymph node
palpation; liver evaluation; periodontal examination; LFTs,
Laboratory Test: urinalysis, CBC and differential, blood proteins,
blood and urine glucose, EEG, ECG
Risk for injury r/t adverse reactions
Impaired physical mobility r/t sedation
Noncompliance r/t long-term therapy
Deficient knowledge r/t drug therapy
Possible Complications:
 CNS: nystagmus, ataxia, slurred speech,
dizziness, drowsiness
 CV: CV collapse, hypotension
 GI: nausea, vomiting diarrhea, constipation,
toxic hepatitis, liver damage
 GU: nephrosis

Planning: Patient Outcomes

The patient will be able to perform activities of daily living

The patient will demonstrate an understanding of the drug action by accurately describing drug side effects and
drug action
The patient will immediately report any allergic reactions or adverse reactions while taking this drug
The patient will be free from injury and free from seizure activity

Implementation
Interventions with Rationales
 Monitor injection sites carefully; drug
solutions are very alkaline and irritating
 Monitor drug level. Therapeutic level of total
phenytoin is 10 to 20 mcg/ml in adults &
children & 8 to 15mcg/ml in neonates
 Give oral drug with or without food in
consistent manner. Give with food if pt
complains of GI upset
 Do not stop drug suddenly as this may worsen
seizures and call physician if adverse
reactions occur
 Monitor pt for suicidality or thoughts of
suicide as pt may be at increased risk
Patient Education/Discharge Planning
 Advise pt and SO to immediately report
changes in behavior that may indicate
worsening of suicidal thoughts or depression
 Advise pt to avoid driving and other
potentially hazardous activities that require
mental alertness until drug’s CNS effects are
known
 Instruct pt to maintain good oral hygiene to
prevent gum disease
 Advise pt to not change brands or dosage
forms once stabilized on therapy
 Instruct pt to report any adverse reactions.

Evaluation of Outcome Criteria (Met, Partially met, Not met)

 Goal was met
The patient sustains no injury and is free from seizure activity.
The patient maintains physical mobility.
The patient was able to demonstrate an understanding of the drug action by accurately describing drug side
effects and drug action
The patient reported no signs of any allergic reactions or adverse reactions while taking this drug.

Reference:

NPF Drug Study No. 1