Question

A nurse is teaching a client who has epilepsy and is to start therapy with phenytoin. Which of the following instructions should the nurse include in the client's medication teaching plan?

A. Rinse with antiseptic mouthwash instead of using dental floss.
B. Use an over-the-counter antihistamine if a rash develops.
C. Slowly taper the medication after 6 consecutive months without seizure activity.
D. Take medications at a consistent time each day to maintain therapeutic blood levels.

Answer 1

The essential instruction for a client starting on phenytoin is to take the medication at the same time every day to maintain therapeutic blood levels. It is important not to stop the medication suddenly but to taper it if needed under supervision. Proper oral hygiene is crucial, and a healthcare provider should be consulted if a rash develops.

Step-by-step explanation:

When instructing a client who is starting therapy with phenytoin for epilepsy, it is important to emphasize medication adherence and safety precautions. A key instruction for maintaining therapeutic blood levels is to take medications at a consistent time each day. This helps to ensure the medication's efficacy in preventing seizures. It is also recommended to avoid sudden discontinuation of the medication; instead, if it is deemed necessary to stop the medication due to a significant period without seizure activity, it should be tapered slowly under the guidance of a healthcare professional to prevent withdrawal seizures. Unlike anticonvulsants such as diazepam, which are often used in acute settings for actively seizing patients, phenytoin is used for long-term management of epilepsy.

Proper oral hygiene is crucial as phenytoin can cause gum hyperplasia; however, the use of an antiseptic mouthwash is not a replacement for dental floss. Lastly, if a rash develops, it is essential to consult with a healthcare provider rather than using an over-the-counter antihistamine, as skin reactions can be a sign of a more serious adverse effect.