McKenna's Pharmacology for Nursing, 2e

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

What therapeutic goals might the nurse set with L.G. and his caregiver? How might these be evaluated? What additional drug-related information should be posted in the group home and reviewed with L.G. and his caregivers? DISCUSSION In the first visit to the home, the nurse needs to establish a relationship with L.G. and his caregivers. They should all realise that drug therapy, and other measures, are needed to help L.G. attain his full potential and make use of his existing assets. Step-by-step therapeutic goals should be established and written down for future reference. Small reachable goals, such as partially dressing himself, walking to the table for meals, and managing parts of his daily hygiene routine are best at the beginning. Written goals provide a good basis for future evaluation when drug therapy is stopped briefly to determine its therapeutic effectiveness. It also helps L.G. to see progress and improvement. In addition, the nurse should perform a complete examination to obtain baseline data. The person should be asked about any noticeable changes or problems since starting the drug. If improvement appears to have occurred, the dosage may be slowly increased until the optimal level of functioning has been achieved. The nurse is in a position to evaluate this and report it to the primary caregiver. While in the home, the nurse can also evaluate resources and environmental limitations and suggest improvements (e.g. use of leg braces). L.G. and his caregivers should receive a drug teaching card that includes a telephone number to call with questions or concerns; warning signs of liver disease; and a list of findings to report. The nurse should discuss anticipated appointments for liver function tests to ensure that L.G. can keep the appointments. The healthcare team should work closely with L.G. to maximise his involvement in his care and to minimise unnecessary problems and confusion. Because the treatment involves a long-term commitment, a good working relationship among all members of the healthcare team is important to ensure continuity of care and optimal results. CARE GUIDE FOR L.G.: MUSCLE RELAXANTS Assessment: History and examination Concentrate the health history on allergies to any skeletal muscle relaxants, respiratory depression, muscle weakness, hepatic or renal dysfunction, and concurrent use of verapamil or alcohol. Focus the physical examination on the following: CV: blood pressure pulse rate, peripheral perfusion, ECG

CNS: orientation, affect, reflexes, grip strength Skin: colour, lesions, texture, temperature GI: abdominal examination, bowel sounds Respiratory: respiration, adventitious sounds Laboratory tests: renal and hepatic function Implementation Discontinue drug at first sign of liver dysfunction. Provide comfort and safety measures: positioning, orientation, safety measures, pain medication as needed. Provide support and reassurance to help L.G. deal with spasticity and drug effects. Teach L.G. about drug, dosage, drug effects and symptoms of reportable serious adverse effects. Evaluation Evaluate drug effects: relief of spasticity, improved daily function. Monitor for adverse effects: multiple CNS effects, respiratory depression, rash, skin changes, GI problems (diarrhoea, hepatotoxicity), urinary urgency or weakness. Monitor for drug–drug interactions: myocardial suppression with verapamil or alcohol. Evaluate effectiveness of teaching program. TEACHING FOR L.G. • The drug prescribed for you is a direct-acting skeletal muscle relaxant called dantrolene ( Dantrium ). This drug makes spastic muscles relax. Because this drug may cause liver damage, it is important that you have regular medical check-ups. • Common side effects of skeletal muscle relaxants, such as dantrolene, include: • Fatigue, weakness and drowsiness: Try to pace activities evenly throughout the day and allow rest periods to avoid discouraging side effects. If they become too severe, consult your healthcare provider. • Dizziness and fainting: Change position slowly to avoid dizzy spells. If these effects should occur, avoid activities that require coordination and concentration. • Diarrhoea: Be sure to be near bathroom facilities if this occurs. This effect usually subsides after a few weeks. • Report any of the following to your healthcare provider: fever, chills, rash, itching, changes in the colour of your urine or stool, or a yellowish tint to the eyes or skin. • Keep this drug and all medications out of the reach of children. • Do not overexert yourself when you begin to feel better. Pace yourself. • Take this drug exactly as directed and schedule regular medical checkups to evaluate the effects of this drug on your body.