Question

The nurse is caring for a client with epilepsy who is being treated with carbamazepine (Tegretol). Which laboratory value might indicate a serious side effect of this drug? A. Uric acid of \(5 \mathrm{mg} / \mathrm{dL}\) B. Hematocrit of \(33 \%\) C. WBC 2,000 per cubic millimeter D. Platelets 150,000 per cubic millimeter

Short answer

A) Uric acid level 5 mg/dL B) Hematocrit level 33% C) White blood cell count 2,000 per cubic millimeter D) Platelet count 150,000 per cubic millimeter Answer: C) White blood cell count 2,000 per cubic millimeter

Step-by-step solution

Understanding Carbamazepine side effects

First, let's understand the potential side effects of carbamazepine. This drug is an anticonvulsant that mainly used to treat seizures and nerve pain. Side effects of carbamazepine treatment can include gastrointestinal issues, dizziness, drowsiness, dry mouth, and hematological issues like leukopenia (low white blood cells).

Evaluate Option A - Uric acid levels

Option A states a uric acid level of \(5 \mathrm{mg} / \mathrm{dL}\). The normal range for uric acid is between \(3.4\) to \(7.0 \mathrm{mg} / \mathrm{dL}\). This value lies within the normal range and does not indicate a serious side effect.

Evaluate Option B - Hematocrit levels

Option B states a hematocrit level of \(33 \%\). The normal hematocrit range is \(36\% - 46\%\) for women and \(42\% - 52\%\) for men. Though this level is slightly below the normal range, it is not indicative of a serious side effect of carbamazepine.

Evaluate Option C - White blood cell count

Option C states a WBC count of \(2,000\) per cubic millimeter. The normal range for white blood cell count is between \(4,000\) and \(11,000\) per cubic millimeter. This value is significantly below the normal range, indicating leukopenia, which is one of the serious side effects of carbamazepine.

Evaluate Option D - Platelet count

Option D states a platelet count of \(150,000\) per cubic millimeter, which is within the normal range of \(150,000\) to \(400,000\) per cubic millimeter. This value does not indicate a serious side effect.

Conclusion

Based on the analysis above, the answer is Option C (WBC 2,000 per cubic millimeter), which indicates leukopenia, a known serious side effect of carbamazepine.

Key concepts

Carbamazepine Side Effects

Carbamazepine is a medication primarily used to treat seizures, nerve pain, and mood disorders. While it is effective, it can also lead to a variety of side effects. Some common side effects include feeling dizzy, drowsy, or experiencing gastrointestinal discomfort. Patients might also experience dry mouth or skin rashes. It's important to monitor for these symptoms, but there are more serious side effects to be aware of as well.

Among the severe side effects, hematological issues are of particular concern. **Leukopenia**, or a drop in white blood cell count, is a significant risk. This can make the body more vulnerable to infections. Other potential serious effects include anemia (low red blood cells) and thrombocytopenia (low platelets). Therefore, regular blood tests are crucial when taking carbamazepine to catch these issues early. **Nurses and healthcare providers** should monitor patients closely and report any unusual findings to a physician immediately. This ensures prompt management of any adverse effects.

Leukopenia

Leukopenia is a condition characterized by an abnormally low level of white blood cells (WBCs) in the blood. White blood cells are essential for fighting off infections, meaning that patients with leukopenia are at greater risk of becoming ill.

Symptoms of leukopenia might include frequent infections, fevers, chills, or experiencing symptoms more severely than usual. If any of these symptoms occur, it's vital to seek medical attention. **Causes of leukopenia** include medications like carbamazepine, certain autoimmune diseases, or even viral infections.

**Diagnosis of leukopenia** typically requires a complete blood count (CBC) to measure the levels of WBCs. If diagnosed, treatment involves stopping or adjusting medications if they are the cause, and addressing any underlying health issues. For those on medications like carbamazepine, regular CBCs help in monitoring blood counts and preventing serious side effects from developing.

Nursing Education

Nurses play a crucial role in medication management and patient safety. Education and training focus on understanding medications, monitoring patient responses, and recognizing adverse effects early. For medications like carbamazepine, where side effects can be serious, being informed is critical.

**Nursing responsibilities include:**

• Educating patients about their medication, including potential side effects.
• Monitoring vital signs and laboratory tests to promptly identify any issues.
• Communicating effectively with the healthcare team about changes in the patient's condition.
• Ensuring that patients understand the importance of following treatment plans and attending regular check-ups.

With a solid foundation in these areas, nurses can provide quality care and contribute significantly to positive patient outcomes. Ongoing education ensures nurses stay updated on the latest medication guidelines and safety protocols, reinforcing their critical role in healthcare.