Week 3- Anti-Epileptic Medications

Profile:

Ms. Xanxy is a nursing student who transporting home via public transportation and she begins to feel “not quite normal”. She tells her friends, who are with her, that she feels funny, she is seeing a bright light and can smell rubber burning. While she is talking, she becomes unconscious and her friends are able to lower her to the ground so that she does not hit her head. Her friends observe a tonic-clonic seizure, and they alert EMS. When EMS arrives the student is still having tonic-clonic movements that consisted of arching of her back, her head was extended, her knees were bent and her arms and fingers were flexed rigidly at the joints. At regular intervals the experienced alternating contraction and relaxation of all muscles of the extremities and hyperventilation. The friends estimate the total seizure time is about 15 minutes. The friends tell the EMS what the student had said prior to becoming unconscious. The EMS apply a non-rebreather mask to the student and take her to the nearest hospital.

Case Study:

On arrival to the hospital, she is taken directly into a triage area. There is no visible seizure activity that is occurring. The student responsive to tactile stimulation and very slow to respond to verbal stimuli. Her speech is mumbled and she is very lethargic. The student presents with incontinence of urine, and pupils that are slow to react to light.

The student is placed side lying into one of the ED beds and there is suction available at the bedside. The bed is placed in the lowest position and bed rails are padded. She is on a non- rebreather oxygen mask and her O2 saturation is 96.

VS-

HR- 108

Respirations- 22

BP- 108/72

Temperature- 98.5 F

The ED physician orders Valium 1 mg/ KG to be given stat IV push. The IV is NS going at 100 ml/hr in the student’s left hand with a 18g needle. The student’s weight is 125 pounds.

The ED physician also requests serum labs: glucose, total calcium, CBC, drug screening, and electrolyte levels (BMP).

1. Based on the student’s weight, how much valium does the nurse give?
2. How do you give IV push medications in an IV?
3. What is the main purpose of giving valium to this student? Why is given as an IV medication?
4. What classification of medications does Valium belong to?
5. There are many uses of valium. Other than to treat seizure activity, what other uses can valium be used for?
6. Giving valium IV, what assessments are the most important for the nurse to do while giving IV valium?
7. Describe what an aura is. What symptoms of an aura did this student have?
8. Describe what is the pathophysiology of a tonic-clonic seizure.
9. Explain why the physician has ordered the blood work; Glucose, total calcium, CBC, drug screening, electrolyte levels.
10. How much phenytoin (Dilantin) does the nurse administer to this patient?
11. How should the nurse administer the phenytoin (Dilantin) IV?
12. Why does the ED order the first dose of phenytoin (Dilantin) to be given IV and the other doses PO?
13. What adverse effects are associated with both phenytoin (Dilantin) and carbamazepine (Tegretol)?
14. Why is the ED physician ordering Dilantin and Tegretol levels in the AM on this client?
15. What should the nurse do if the Dilantin and Tegretol levels come back too low or too high? Why?
16. Discuss any drug-drug or drug-food interactions that are associated with Dilantin and Tegretol.
17. When the client is finally released from the hospital, what teaching does this client need regarding self-care and taking these medications?