Copyright 2014 Wolters Kluwer Health Lippincott Williams Wilkins

Copyright 2014 wolters kluwer health lippincott

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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Anticonvulsants: Precautions (cont.) Anticonvulsants: Precautions (cont.) Phenytoin is used cautiously in patients with hypotension; severe myocardial insufficiency; hepatic impairment Trimethadione is used with caution in patients with eye disorders Miscellaneous anticonvulsants are used cautiously in patients with glaucoma or increased intraocular pressure; a history of cardiac, renal, or liver dysfunction; and psychiatric disorders
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Anticonvulsants: Interactions Anticonvulsants: Interactions Interacting drug Effect of interaction Antibiotics/antifungals Increased effect of anticonvulsant Tricyclic antidepressants Increased effect of anticonvulsant Salicylates Increased effect of anticonvulsant Cimetidine Increased effect of anticonvulsant Theophylline Decreased serum levels of anticonvulsant
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Anticonvulsants: Interactions (cont.) Anticonvulsants: Interactions (cont.) Interacting drug Effect of interaction Antiseizure medications May increase seizure activity Protease inhibitors Increased carbamazepine levels resulting in toxicity Oral contraceptives Decreased effectiveness of birth control, resulting in breakthrough bleeding or pregnancy Analgesics or alcohol Increased depressant effect Antidiabetic medications Increased blood glucose levels
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment Nursing Process: Assessment Preadministration assessment: Obtain vital signs at the time of the initial assessment to provide baseline data Thorough patient history is necessary to identify type of seizure disorder Primary health care provider may order laboratory and diagnostic tests
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment (cont.) Nursing Process: Assessment (cont.) Ongoing assessment: Carefully document each seizure with regard to time of occurrence; duration of seizure; psychic or motor activity occurring before, during, after seizure Dosage adjustments are based on patient’s response to therapy, as well as occurrence of adverse reactions Serum plasma levels of anticonvulsant are measured regularly to monitor for toxicity
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Nursing Diagnoses Risk for Injury related to seizure disorder, drowsiness, ataxia, and vision disturbances Risk for Impaired Skin Integrity related to adverse reactions (rash) Risk for Infection related to immunosuppression secondary to drug therapy Impaired Oral Mucous Membranes related to gum overgrowth secondary to hydantoins
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Planning Nursing Process: Planning Expected outcomes for patient depend on the type and severity of the seizure but may include: Optimal response to therapy Support of patient needs related to management of adverse reactions Understanding of and compliance with prescribed therapeutic regimen
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