Anticonvulsants

Nursing Considerations for Patients Receiving Anticonvulsants.

1. Assess for contraindications and cautions: any known allergies to these drugs to avoid hypersensitivity reactions,
2. Assess for history of bone marrow suppression or renal stones, which could be exacerbated by these drugs
3. History of renal or hepatic dysfunction that might interfere with drug metabolism and excretion.
4. Assess for current status of pregnancy or lactation, which are contraindicated or require caution when using these drugs.
5. Inspect the skin for color and lesions to determine evidence of possible skin effects;
6. Assess pulse and blood pressure and auscultate heart to evaluate for possible cardiac effects;
7. Assess level of orientation, affect, reflexes, and bilateral grip strength to evaluate any CNS effects;
8. Monitor bowel sounds and urine output to determine possible gastrointestinal or genitourinary effects.
9. Assess the patient’s renal and liver function, including renal and liver function tests, to determine the appropriateness of therapy and determine the need for possible dose adjustment.
10. Monitor the results of laboratory tests such as urinalysis and CBC with differential to identify changes in bone marrow function.

Nursing Diagnoses
Nursing diagnoses related to drug therapy might include the following:

•  Acute Pain related to GI and CNS effects
•  Disturbed Thought Processes related to CNS effects
•  Risk for Injury related to CNS effects
•  Risk for Infection related to bone marrow suppression effects
•  Deficient Knowledge regarding drug therapy

Implementation With Rationale

1.  Administer the drug with food to alleviate GI irritation if GI upset is a problem.
2.  Monitor CBC before and periodically during therapy to detect and prevent serious bone marrow suppression.
3.  Protect the patient from exposure to infection if bone marrow suppression occurs.
4.  Discontinue the drug if skin rash, bone marrow suppression, unusual depression, or personality changes occur to prevent further serious adverse effects.
5.  Discontinue the drug slowly, and never withdraw the drug quickly, because rapid withdrawal may precipitate seizures.
6.  Arrange for counseling for women of childbearing age who are taking these drugs. Because these drugs have the potential to cause serious damage to the fetus, women should understand the risk of birth defects and use barrier contraceptives to avoid pregnancy
7. Provide safety measures to protect the patient from injury or falls if CNS changes occur.
8.  Provide patient teaching, including drug name and prescribed dosage, as well as measures for avoidance of adverse effects, warning signs that may indicate possible problems, and the need for periodic laboratory testing and monitoring and evaluation to enhance patient knowledge about drug therapy and to promote
   compliance.

Evaluation

1.  Monitor patient response to the drug (decrease in incidence or absence of seizures).
2.  Monitor for adverse effects (CNS changes, GI depression, bone marrow suppression, severe dermatological reactions,
   liver toxicity, renal stones).
3.  Evaluate the effectiveness of the teaching plan (patient can give the drug name and dosage and name possible adverse effects to watch for and specific measures to prevent them; patient is aware of the risk of birth defects and the need to carry information about the diagnosis and use of this drug).
4. Patients being treated with antiepileptic are often on long term therapy, which requires compliance with their drug regimen and restrictions associated with their disorder and the drug effects. Educate the patients about this.