Question

A client taking Dilantin (phenytoin) for tonic-clonic seizures is preparing for discharge. Which information should be included in the client's discharge care plan? A. The medication can cause dental staining. B. The client will need to avoid a high-carbohydrate diet. C. The client will need a regularly scheduled CBC. D. The medication can cause problems with drowsiness.

Short answer

Answer: The client will need a regularly scheduled CBC.

Step-by-step solution

Analyzing option A: Dental staining

Dilantin (phenytoin) is known to cause gum hyperplasia – overgrowth of gum tissues, but it does not cause dental staining. So, option A can be eliminated.

Analyzing option B: Avoiding high-carbohydrate diet

There is no strong evidence that suggests a high-carbohydrate diet directly affects seizures or the effectiveness of Dilantin (phenytoin). However, a ketogenic diet (low-carbohydrate, high-fat) might be helpful for some patients with epilepsy, but that is not specifically related to phenytoin. Therefore, option B can be eliminated.

Analyzing option C: Regularly scheduled CBC

Dilantin (phenytoin) can cause adverse hematologic effects such as anemia, leukopenia, and thrombocytopenia. Thus, it is important to monitor the patient's blood counts regularly with a Complete Blood Count (CBC) to ensure early detection and intervention. Option C is correct.

Analyzing option D: Drowsiness

While drowsiness can be a side effect of some antiepileptic medications, it is not a common issue with Dilantin (phenytoin). Therefore, option D can be eliminated. The correct answer is C: "The client will need a regularly scheduled CBC."

Key concepts

Phenytoin Side Effects

Phenytoin, marketed under the brand name Dilantin, is a medication widely used in the management of tonic-clonic and complex partial seizures. When prescribing this drug, understanding its side effects is critical for ensuring patient safety.

As an antiepileptic drug, phenytoin can have multiple effects on the body. One such effect is gum hyperplasia, an overgrowth of the gum tissues that may require specialized dental care but does not result in dental staining. Hence, routine dental checks are advised. Beyond this, phenytoin has been linked to various systemic side effects. Hematological effects like anemia, leukopenia, and thrombocytopenia are particularly concerning—these conditions reflect a decrease in blood cell populations that can be detected with a Complete Blood Count (CBC). Monitoring CBC values becomes essential to promptly identify and address these adverse effects.

Other possible side effects of phenytoin may include dizziness, unsteadiness, nausea, and in some cases, drowsiness, although the latter is not typically prominent. Patients should be counseled about the potential risks and advised to report any unusual symptoms or side effects to their healthcare provider promptly.

Patient Discharge Care Plan

Creating a comprehensive discharge care plan for patients is a crucial step to ensure continuity of care once they leave the hospital. For individuals being treated with medications like phenytoin, the discharge plan should include instructions for medication management, follow-up appointments, and lifestyle modifications.

Specifically, the plan should detail the importance of taking phenytoin exactly as prescribed and not missing doses, as consistency is key in managing seizure disorders. It should also outline the need for regular blood work, in this case, Complete Blood Count (CBC), to monitor for potential side effects of the medication, as indicated in the correct answer to the NCLEX-PN pharmacology question.

Additionally, the patient should be provided with information on recognizing signs of potential complications, how to maintain oral health to prevent gum hyperplasia, and when to seek medical advice. Educational material regarding seizure precautions and the importance of wearing medical identification should also be included. A discharge care plan empowers patients with the knowledge and resources needed to manage their health proactively once they return to their daily environment.

Complete Blood Count (CBC) Monitoring

The Complete Blood Count (CBC) is a fundamental laboratory test that evaluates the cellular components of blood, including red blood cells, white blood cells, and platelets. CBC monitoring is especially pertinent for patients on medications like phenytoin because of the potential impact on blood cell counts.

Regular CBC tests can detect hematological side effects early, such as anemia (a decrease in red cells or hemoglobin), leukopenia (a drop in white blood cell count), or thrombocytopenia (reduced platelet count), which could indicate bone marrow suppression or other serious drug-related hematological conditions. Early intervention may include modifying the phenytoin dose or switching to an alternative medication.

Healthcare providers should educate patients about the importance of CBC monitoring and schedule regular lab visits. Understanding the rationale behind such tests enriches the patient's knowledge about their health and furthers the decision-making process for their treatment plan. Prompt CBC monitoring is a proactive strategy to minimize risks and ensure patient well-being while on antiepileptic therapy.