Question

An older client was recently discharged from the hospital for evaluation of seizure activity. His history reveals that he has late-stage Alzheimer's disease, Parkinson's disease, hypertension, and type II diabetes mellitus, which is controlled by diet. He lives at home, where his wife and daughter take care of him. His discharge medications include phenytoin (Dilantin), 100 mg BID; hydrochlorothiazide (HydroDIURIL), 50 mg QD; levodopa (Sinemet), 25/100 TID; and haloperidol (Haldol), 1 mg before bed. The client has been referred for home care nursing follow-up.

Questions:

On the initial home visit by the nurse, what assessments should be made?

The wife and daughter need teaching about his antiepileptic medication. What teaching should be included?

During the initial home visit, the client experiences a generalized seizure. What action should the nurse take?

Answer 1

1). On the initial home visit, the nurse should assess the patient’s orientation, and mental health using the Glasgow Coma Scale. Assessing the cranial nerve performance is also needed. The nurse should ask the patient about the progression of health status. The nurse should ask the patient whether the drugs are being taken as prescribed and any possible side effects or adverse effects of the drugs prescribed.

2). Phenytoin is an anti-epileptic drug, which should be taken regularly as prescribed, its use should not be stopped abruptly. The patient’s wife and daughter must be taught about the possible side effects of the medication. It must be informed that the patient must be provided with a gum or a sugarless candy to maintain oral hygiene and avoid dry mouth (possible with phenytoin use). Also, it is important to prevent the patient from taking alcohol or any other illegal drugs as they are likely to interfere with the functioning of the medication and also interfere with the sleep pattern of the patient.

3). If the patient experiences a generalized seizure during the home visit, the nurse should place the patient on a flat surface, remove all the hard and sharp objects away from the patient, and provide a soft material to place under the head. The patient must be turned towards one side, the duration of the seizure must be noted, and emergency help must be requested.