Question

1. As a nurse what are your nursing responsibilities when caring for patients who are receiving phenytoin (Dilantin)?

2. As a nurse what are your nursing responsibilities when caring for patients who are taking antineoplastic drugs?

3. As a nurse what are your nursing responsibilities when caring for patients who are on cyclosporine (Sandimmune)?

Answer 1

1. For phenytoin

• History: Hypersensitivity to hydantoins; sinus bradycardia, AV heart block, Stokes-Adams syndrome, acute intermittent porphyria, hypotension, severe myocardial insufficiency, diabetes mellitus, hyperglycemia, pregnancy, lactation
• Physical: Temperature; skin color, lesions; lymph node palpation; orientation, affect, reflexes, vision examination; Pulse, BP; adventitious sounds; bowel sounds, normal output, liver evaluation; periodontal examination; LFTs, urinalysis, CBC and differential, blood proteins, blood and urine glucose, EEG and ECG
• Administer IV slowly to prevent severe hypotension; the margin of safety between full therapeutic and toxic doses is small. Continually monitor patient’s cardiac rhythm and check BP frequently and regularly during IV infusion. Suggest use of fosphenytoin sodium if IV route is needed.
• Monitor injection sites carefully; drug solutions are very alkaline and irritating.
• WARNING: Monitor for therapeutic serum levels of 10–20 mcg/mL.
• Discontinue drug if rash, depression of blood count, enlarged lymph nodes, hypersensitivity reaction, signs of liver damage

2. For antineoplastic drugs

The nurse is responsible for the safe and appropriate administration of cancer therapy medications in accordance with national standards and local policy. The nurse is responsible for ensuring the protocol and prescription is reviewed, the patient has received appropriate education and information on therapy and that protocol stated patient assessments are performed prior to administration of therapy.

The nurse should watch out for any anyphylaxis that the patient suffers and inquire the patient if any discomfort he/she is facing.

Physical: Temperature; skin color, lesions; lymph node palpation; orientation, affect, reflexes, vision examination; Pulse, BP; adventitious sounds; bowel sounds, normal output, liver evaluation; periodontal examination; LFTs, urinalysis, CBC and differential, blood proteins, blood and urine glucose, EEG and ECG

Look out for signs of nausea and vomiting which are fairly common in such patients

3. for cyclosporine

• May cause seizures, tremors, hypertension, hepatotoxicity, diarrhea, gingival hyperplasia
• Increases immune suppression with corticosteroids- so take a careful history of the patient regarding history of intake of with steroids or check for current prescription if the patient has any
• Avoid grapefruit juice while taking this medications as it is an enzyme inhibitor and inhibits metabolism of cyclosporine.
• Assess for signs of organ rejection
• Monitor renal panel, liver enzymes
• Take medication as directed
• Lifelong therapy required for transplant patients. so counsel the patients for this
• Regulate blood pressure periodically