NURS 1566 Clinical Form 3: Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency

Phenytoin Dilantin anticonvulsants 100 mg PO BID
Peak Onset Duration Normal dosage range
1.5-3 hr 2-24 hr (1 6-12 hr maintenance dose 300-400 mg/day
wk)
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or
Treatment/prevention of tonic-clonic (grand mal) solutions
seizures and complex partial seizures NA
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
• Hypersensitivity, Hepatic or renal disease (increased risk of
L adverse reactions; dosage reduction recommended for
i hepatic impairment)
m Common side effects
i Ataxia, diplopia, nystagmus, hypotension (increased with
t IV phenytoin and with rapid IV administration), gingival
s hyperplasia, nausea, hypertrichosis, rashes
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Interactions with other patient drugs, OTC or
herbal medicines (ask patient specifically)
chronic ingestion of alcohol may decrease phenytoin
blood levels, Additive CNS depression with other
CNS depressants, including alcohol , antihistamines
, antidepressants , opioid analgesics , and
sedative/hypnotics
Lab value alterations caused by medicine
CBC and platelet count, serum calcium, albumin,
urinalysis, and hepatic and thyroid function tests should be
monitored prior to and monthly for the first several months,
then periodically throughout therapy, May cause increased
serum alkaline phosphatase, GTT, and glucose levels,
Serum folate concentrations should be monitored
periodically during prolonged therapy, Serum phenytoin
levels should be routinely monitored. Therapeutic blood
levels are 10-20 mcg/ml in patients with normal serum
albumin and renal function.

Be sure to teach the patient the following about this

medication
May cause drowsiness or dizziness. Caution patient to avoid driving or
other activities requiring alertness until response to medication is
known. Do not resume driving until physician gives clearance based on
control of seizure disorder. Advise patient to carry identification at all
times describing disease process and medication regimen. Advise
patient to notify health care professional if skin rash, severe nausea or
vomiting, drowsiness, slurred speech, unsteady gait, swollen glands,
bleeding or tender gums, yellow skin or eyes, joint pain, fever, sore
throat, unusual bleeding or bruising, or persistent headache occurs.
Emphasize the importance of routine exams to monitor progress.
Patient should have routine physical exams, especially monitoring skin
and lymph nodes, and EEG testing.
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Nursing Process- Assessment
(Pre-administration assessment)
Assess location, duration, frequency, and
characteristics of seizure activity. EEG
may be monitored periodically throughout
therapy, Assess oral hygiene. Vigorous
oral cleaning beginning within 10 days of
initiation of phenytoin therapy may help
control gingival hyperplasia
Assessment Evaluation
Why would you hold or not give this Check after giving
med? Decrease or cessation of
Assess patient for phenytoin seizures without excessive
hypersensitivity syndrome (fever, skin sedation
rash, lymphadenopathy). Rash usually
occurs within the first 2 wk of therapy.
Hypersensitivity syndrome usually
occurs at 3-8 wk but may occur up to
12 wk after initiation of therapy. May
lead to renal failure, rhabdomyolysis,
or hepatic necrosis; may be fatal.
Progressive signs and symptoms of
phenytoin toxicity include nystagmus,
ataxia, confusion, nausea, slurred
speech, and dizziness