pic therapy

8/9/2019 pic Therapy

1/25

Antiepileptic Agents

Seizure Control


2/25

Focus Drugs

Tegretol (carbamazepine) iminostilbene

Klonipine (clonazepam) benzodiazepine

Dilantin (phenytoin) hydantion

Zarontin (ethosuximide) succinimide Solfoton (Phenobarbital) barbituate

Depakote (valproic acid) misc antiepileptic

Neurontin (gabapentin) misc antiepileptic

Gabitril (tiagabine) misc antiepileptic


3/25

Therapeutic Uses

Seizure- abnormalbrain activity

Convulsion-spasmodic contractions

Epilepsy- chronicreoccurring


4/25

Seizures

Seizures are usuallydivided into two maintypes: partial and

generalized. Partialseizures involve aspecific area inthebrainwhereas general

seiz

ures

invol

vethe

entire brain (Dreifuss,1989). .


5/25

EEG Machine

Classification of

seizures involves

monitoring the brain

using anEEG

machine while

seizures are occurring,

orin between

seizures.


6/25

EEG Waves

Forinstance, a

diagnosis of complex

partial seizures may

be givenif a patient

was found to have

spikes or sharp waves

inthetemporal region

(Wyllie, Rothner, &

Luders, 1989).


7/25

Epilepsy

Cause- 50% is unknown

Primary or idiopathic

Secondary- trauma, infection, CVA ,brain tumors, neurological disease

In Children secondary caused by

Developmental defects

Metabolic disorders

Birth Injury


8/25

International Classification

Partial Seizures

Simple Seizures

Complex Seizures Generalized Seizures


9/25

Antiepileptic Therapy

Balancing the seizure control with theside effects of the medications is

difficult. Drug induced toxicity can occur

Two or more seizures means medication

If one drug will control great but, two

drugs to control is common.

Never stop abruptly get blood levels


10/25

Side effects

Side effects are

many

Individual drugscarry difference

effects

Interactions are

common with otherdrugs


11/25

Nursing Care Plan- Students

Assessment

Nursing Diagnosis

Planning

Implementation

Evaluation


12/25

Case # 1

Jason has just starting

taking Klonipine

(Clonazepam) what will

he need to know? He is 14 years-old and

recently diagnosed with

epilepsy.

He

h

as a very overprotective mother who

is very nervous about

him being injured.


13/25

Case #2

Nick, age 25, has been taking

Dilantin or phenytoin for

epilepsy for 5 years.

He ask the doctor to switch

him to Zarontin or

ethosuximide because he does

not like the way the skin on

his face looks.

He has a history of

personality problems. He heard about Zarontin

from a friend.


14/25

Case #3

Christy, age 34, has

been on

Phenobarbital for

many years and is

now wanting to

become pregnant

What does she need

to know about the

AEDs and

pregnancy?


15/25

Case #4

Mr Jackson, 52 yearsold, is on the phone-out of town and does noth

aveh

is Neurotin buth

edoes have his Tegretol.

He has been on Tegretol(carbamazepine) andNeurotin (gabapentin)for two years.

What instructions doeshe need?


16/25

Case #5

Joseph, age 17, want to

get his drivers license.

His last seizure was 4

months ago and he hasbeen suspended from

school twice for

drinking at parties.

He is on Valproic acid.


17/25

Case Study #6

Mr. Jones, a twenty

year old male, is

suffering from a seizure

disorder after a headinjury. The patient

suffers from mainly

tonic clonic and focal

seizure activity and is in

the hospital now. Thepatient has been started

on Valproic acid given

250 mg three times a

day.


18/25

Nursing Diagnosis

His nursing diagnosis is risk for injury

related to seizure disorder or adverse

drug reactions. Pt may also be at risk for ineffective

management of therapeutic regimen

related to lack of knowledge of drug

therapy.


19/25

Patient Teaching

Compliance with drug therapy and side effectsof the drug.

Prevent injuries or falls until his seizures are

controlled.

Taking this medication only as directed by thedoctor, at the prescribed times and to

Never stop taking this medication suddenly.

In the event that this medicine is stoppedabruptly it can precipitate increased seizureactivity.


20/25

Patient Teaching

Provide a safe environment free of

clutter or obstacles which could injure

the patient during seizure activity and toalways

Keep the patients side rails up to avoid a

fall during seizure activity.


21/25

Patient Teaching

The patient may need to be switched to anew medication due to the ineffectiveness ofthis particular medicine with this patient or

adverse side effects such as impairment dueto increased lethargy or altered mentalstatus. The patient may be switched to amedication like Zonegran which may onlyneed to be taken once daily and providesrelief from seizure activity and has fewerside effects.


22/25

Question 1

1. The patient or caregiver would understand the

potential of risk for injury related to seizure disorder

by demonstrating the following:

A. The caregiver places pillows and loose throw rugs on patients floor. B. The patient sits up abruptly and attempts to reposition himself.

C. The caregiver places all side rails in upright position and pads rails.

D. The patient does not need supervision when sitting up alone on side of

bed.


23/25

Question 2

2. Which statement indicates the patient orcaregiver best understands the principlebehind the medication?

A. The patient may skip a couple days therapy ifhe has nauseaor vomiting.

B. The caregiver can give the pt his medicine at different timesof the day as long as he takes it three times a day.

C. The patient or caregiver says even thoughhe may not bebenefiting from the medicine they must continue taking it asprescribed until consulting withhis doctor.

D. The patient may double up on a dose if misses one.


24/25

Question 3

3. Valproic acid may include the

following side effects:

A. Photosensitivity, blurred vision B. Hair loss, dizziness and behavioral changes

C. Toxic hepatitis

D. All of the above


25/25

C, C, D

pic therapy

Documents