Nursing Implications of Anticonvulsant Therapy
Nursing Implications of Anticonvulsant Therapy ( 4 Questions)
A nurse is monitoring a patient who is receiving valproic acid (Depakote) for seizures. The patient reports nausea, vomiting, and abdominal pain. What is the nurse's best action? A. Administer an antiemetic as ordered.
The nurse should inform the prescriber and request a liver function test because nausea, vomiting, and abdominal pain may be signs of hepatotoxicity, which is a serious and potentially fatal adverse effect of valproic acid¹². The nurse should also monitor the patient's vital signs, jaundice, dark urine, clay-colored stools, and serum ammonia levels²³.
The nurse should inform the prescriber and request a liver function test because nausea, vomiting, and abdominal pain may be signs of hepatotoxicity, which is a serious and potentially fatal adverse effect of valproic acid¹². The nurse should also monitor the patient's vital signs, jaundice, dark urine, clay-colored stools, and serum ammonia levels²³.
The nurse should inform the prescriber and request a liver function test because nausea, vomiting, and abdominal pain may be signs of hepatotoxicity, which is a serious and potentially fatal adverse effect of valproic acid¹². The nurse should also monitor the patient's vital signs, jaundice, dark urine, clay-colored stools, and serum ammonia levels²³.
The nurse should inform the prescriber and request a liver function test because nausea, vomiting, and abdominal pain may be signs of hepatotoxicity, which is a serious and potentially fatal adverse effect of valproic acid¹². The nurse should also monitor the patient's vital signs, jaundice, dark urine, clay-colored stools, and serum ammonia levels²³.
This statement is incorrect because grapefruit juice does not interact with phenytoin and has no effect on its metabolism or blood levels¹. The patient does not need to avoid grapefruit juice while taking phenytoin, unless they are also taking another drug that is affected by grapefruit juice, such as some statins, calcium channel blockers, or cyclosporine²³.
The other statements by the patient are correct and indicate an understanding of the teaching.
- Choice A is correct because the patient should brush their teeth gently with a soft toothbrush to prevent gingival hyperplasia, which is an overgrowth of the gums that can occur with phenytoin use. The patient should also floss regularly and visit a dentist every 3 to 4 months.
- Choice B is correct because the patient should wear a medical alert bracelet that says they have epilepsy and are taking phenytoin. This can help emergency personnel to provide appropriate care and avoid drug interactions if the patient has a seizure or another medical problem.
- Choice C is correct because the patient should check their blood pressure regularly while taking phenytoin, as this drug can cause hypotension, especially when given intravenously or in high doses. The patient should also monitor their heart rate and rhythm, as phenytoin can cause bradycardia or arrhythmias.