McKenna's Pharmacology for Nursing, 2e

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P A R T 4  Drugs acting on the central and peripheral nervous systems

CRITICAL THINKING What teaching implications should be considered when meeting with J.M.? Consider his age and the setting of his first seizure. What problems might J.M. encounter in school and in athletics related to the diagnosis and the prescribed medication? Consider measures that may help him avoid some of the unpleasant side effects related to this particular drug therapy. Driving a car may be a central social focus in the life of an older high school student . What problems can be anticipated and confronted before they occur concerning laws that forbid individuals with newly diagnosed epilepsy from driving? Develop a teaching protocol for J.M. How will you involve the entire family in the teaching plan? DISCUSSION On their first meeting, it is important for the healthcare professional to establish a trusting relationship with J.M. and his family. J.M., who is at a sensitive stage of development, requires a great deal of support and encouragement to cope with the diagnosis of epilepsy as well as the need for drug therapy. He may need to ventilate his feelings and concerns and discuss how he can re-enter school without worrying about having a seizure in class. The healthcare professional should implement a thorough drug teaching program, including a description of warning signs to watch for that should be reported to a healthcare professional. J.M. should be encouraged to take the following preventive measures: • Have frequent oral hygiene to protect the gums. • Avoid operating dangerous machinery or performing tasks that require alertness while drowsy and confused. • Pace activities as much as possible to help deal with any fatigue and malaise. • Take the drugs with meals if gastrointestinal upset is a problem. This information should be given to both J.M. and his family in written form for future reference, along with the name of a healthcare professional and a telephone number to call with questions or comments. The importance of continuous medication to suppress the seizures should be stressed. The adverse effects of many of these drugs make it difficult for some people to remain compliant with their drug regimen. After the discussion with J.M., the healthcare professional should meet with his family members, who also need support and encouragement to deal with his diagnosis and its implications. They need to know what seizures are, how the prescribed antiepileptic drugs affect the seizures, what they can do when seizures occur, and complete information about the drugs he must take and their anticipated effects. In addition, it is important to work with family members to determine whether any particular

thing precipitated the seizures. In other words, was there any warning or aura? This may help with adjustment of drug dosages or avoidance of certain situations or stimuli that precipitate seizures. Family members should be encouraged to report and record any seizure activity that occurs. Most states and territories do not permit individuals with newly diagnosed epilepsy to drive, and states have varying regulations about the return of the driver’s licence after a seizure-free interval. In New Zealand drivers are prohibited from driving for 12 months after a seizure. Driving may then be allowed once the epilepsy is considered to be under control. If driving makes up a major part of J.M.’s social activities, this news may be even more unacceptable than his diagnosis. J.M. and his family should be counselled and helped to devise other ways of getting to places and coping with this restriction. J.M. may be interested in referral to a support group for teens with similar problems, where he can share ideas, support and frustrations. J.M.’s condition is a chronic one that will require continual drug therapy and evaluation. He will need periodic reteaching and should have the opportunity to ask additional questions and to ventilate his feelings. J.M. should be encouraged to wear or carry a MedicAlert tag so that emergency medical personnel are aware of his diagnosis and the medications he is taking. CARE GUIDE FOR J.M.: ANTIEPILEPTIC AGENTS Assessment: History and examination Allergies to any of these drugs; hypotension; arrhythmias; bone marrow suppression; coma; psychoses; pregnancy or breastfeeding; hepatic or renal dysfunction Concurrent use of sodium valproate, cimetidine, disulfiram, isoniazid, sulfonamides, diazoxide, folic acid, rifampicin, sucralfate, theophylline, primidone, paracetamol Skin: colour, lesions, texture, temperature GI: abdominal evaluation, bowel sounds Respiratory: respiration, adventitious sounds Laboratory tests: FBC, liver and renal function tests Implementation Discontinue drug at first sign of liver dysfunction or skin rash. Provide comfort and safety measures: positioning; give with meals; skin care. Provide support and reassurance to cope with diagnosis, restrictions and drug effects. Provide teaching regarding drug name, dosage, side effects, symptoms to report and the need to wear MedicAlert information; other drugs to avoid. Evaluation Evaluate drug effects: decrease in incidence and frequency of seizures; serum drug levels within therapeutic range. CV: blood pressure, pulse, peripheral perfusion CNS: orientation, reflexes, affect, strength, EEG