May impair vision Changes in vision, concentration, or coordination should be reported to doctor. Should not be stopped abruptly because of the potential for status epilepticus Do not take with antacids Priority for a pt in the postictal phase is to assess the pt’s breathing pattern for effective rate, rhythm , and depth Carbamazepine- [Tegretol] - Anticonvulsant that prevent further seizures Anticonvulsants should NEVER be stopped suddenly- they need to be tapered Sudden stop of drug can lead to life threatening status epilecticus During the seizure The RN should not movement of pt’s head, eyes and muscle rigidity, especially when the seizure first begins To obtain clues about the location of the trigger focus in the brain Also note the progression and duration, respiratory status, loss of consciousness pupil size and incontinence of urine and stool When a dressing sticks to a wound, it is best to moisten the dressing with sterile NS and then remove it carefully. Trying to remove a dry dressing is likely to irritate the skin and wound. May contribute to tension or tearing along the suture line. Aura- a premonition of an impending seizure. Usually of sensory nature- olfactory, visual, gustatory, or auditory Topamax- [Topirmate] – Toxic effects- nephrolithiasis Encourage pt’s to drink 6-8 glasses of water a day to dilute urine and flush the renal tubules to avoid stone formation Dilantin- [Phenytoin] - Common adverse effect of long-term use- overgrowth of gingival tissue Encourage good oral hygiene Clonazepam- crosses the placental barrier Stroke Glasgow Coma Scale Provides objectives neurologic assessments: on a scale of 3-15 Spontaneity of eye opening Best motor response Best verbal command Coumadin [ Warfarin Sulfate] Maximum dose is not achieved until 3-4 days after starting the medication Effects continue for 4-5 days after discontinuing the medication Vitamin K is antidote t-PA treatment within 3 hours after the onset of a stroke have better outcomes
Treatment oral or IV antibiotics for 1-2 weeks, elevation of the affected extremity, and application of warm, moist packs to the site Constipation lasting 3 days or longer is unusual – warrants immediate tx Who is coping with Loss, grief, Bereavement, and Spiritual Distress Denial is a defense mechanism used to shut out a situation that is too frightening Many cancer survivors question why they are doing so good and other are not and feel guilty Ethical and legal issues r/t client with Cancer End-of- Life care Chapter 14 Surgery Preparing for surgery Garlic has anticoagulant properties and may pose a problem with bleeding if enough has been taken too close to surgery. A pimple close to the incision site may be reason for the surgeon to cancel the surgical procedure because it increases the risk of infection Pt who are allergic to shellfish are allergic to iodine skin preparations [Iodophor and Betadine] or any other products containing iodine, such as dyes. Serum potassium level of 5.8 mEq/L places the pt at risk for arrhythmias when under general anesthesia Brittle nails indicate poor nutrition The preadmission nurse, the first person in contact with the pt, starts the discharge planning for the pt undergoing surgery. Malignant Hyperthermia Congenital metabolic tendency Occurs in the presence of certain of anesthesia signs tachycardia, hypotension, and muscle rigidity Late signs rapid, extreme rise in temperature Potentially and rapidly fatal in more than 50% of cases Having large, bulky muscles is a risk factor Pt who have had long-term multiple exposure to latex products are at increased risk for latex allergies. Deep Breathing Splinting the incision is important to avoid stress on the surgical site and to promote comfort so that the pt will adhere to the plan of care The most important step is asking the pt to hold the inhaled breath for about 5 seconds, which keeps the alveoli expanded Repeating the exercise 5-10 hourly is the second most important point to emphasize in this teaching plan. Splint the incision site Inhale through the nose