Question

The MD writes the following order for a patient with seizures: 1. Loading dose: phenytoin 250 mg PO four times per day today—3-6-xx. 2. Then, phenytoin 250 mg PO twice per day for 2 days—3-7-xx and 3-8-xx. 3. Then, maintenance dose: phenytoin 400 mg PO four times per day. The drug reference states: Route/Dosage Antiepileptic PO (Adults): Loading dose: 250 mg four times daily for 1 day, then 250 mg twice daily for 2 days, then maintenance at 300 to 400 mg/day in divided doses one to four times/day. Based on this information, which clinical judgment by the nurse is correct

Answer 1

The nurse should identify the discrepancy between the MD’s prescribed maintenance dose of phenytoin (400 mg four times daily) and the standard reference stating a maintenance dose of 300-400 mg/day. Verifying the order with the physician is necessary to prevent potential overdose.

Step-by-step explanation:

When reviewing the medication orders for a patient with seizures, the correct clinical judgment by the nurse would take into account the dosage and route of administration as prescribed by the MD compared to the standard drug reference information. According to the drug reference, an antiepileptic like phenytoin should be initiated with a loading dose of 250 mg four times daily for 1 day, followed by 250 mg twice daily for 2 days, and then continued with a maintenance dose of 300 to 400 mg/day in divided doses. However, the MD's order for the maintenance dose prescribes 400 mg four times per day, which exceeds the recommended range provided by the drug reference. The nurse should recognize this discrepancy and verify the order with the prescribing physician to prevent potential overdose and associated toxicity.