A client taking Dilantin (phenytoin) for grand mal seizures is preparing for discharge. Which information should be included in the client's discharge plan?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

Phenytoin is an anticonvulsant that works on the central nervous system (CNS) and commonly causes dose-related side effects.
Drowsiness, lethargy, and dizziness are among the most frequent CNS effects, which can impair a patient's ability to perform daily activities safely.
Informing the client about drowsiness is a critical safety intervention, as it affects activities like driving and operating machinery.
Signs of toxicity include increased drowsiness, ataxia (difficulty walking), and confusion, which should be reported to the healthcare provider immediately.

Option A: Phenytoin does not cause dental staining. A well-known oral side effect of this medication is gingival hyperplasia, which is the overgrowth of gum tissue.
Option B: There is no general dietary restriction against carbohydrates for patients taking phenytoin. Patients should maintain a consistent, balanced diet.
Option C: While phenytoin can rarely cause serious blood dyscrasias (like agranulocytosis or aplastic anemia), a regularly scheduled CBC is not the primary routine monitoring. The most crucial lab monitoring is for therapeutic serum phenytoin levels.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Patient education for side effects of Phenytoin (Dilantin) as background academic context rather than a clinical decision trigger.
A nurse's primary role in discharge planning is to ensure patient safety and medication adherence. Teaching about common side effects like drowsiness is paramount.
Emphasize that the patient should not stop taking phenytoin abruptly, as this can precipitate status epilepticus, a medical emergency.
What if? If the patient reports not only drowsiness but also unsteady gait and slurred speech, the nurse should suspect phenytoin toxicity. The priority action would be to hold the next dose and notify the provider for an order to check serum phenytoin levels.

How to Approach the Question

First, identify the core of the question: It asks for essential discharge information for a client taking phenytoin.
Analyze each option based on known pharmacology of phenytoin. The question is asking for information that should be included, implying a common, important, or critical teaching point.
Evaluate Option A (dental staining): Recall or look up oral side effects. Phenytoin causes gingival hyperplasia, not staining. This is incorrect.
Evaluate Option B (diet): Consider if there are major dietary interactions. There are no common restrictions against carbohydrates. This is incorrect.
Evaluate Option C (CBC): Think about monitoring. While blood issues are a rare risk, the most critical routine lab is the serum drug level. This is less of a universal discharge teaching point than common side effects.
Evaluate Option D (drowsiness): Consider CNS effects. Drowsiness is a very common, dose-related side effect that impacts patient safety. This is a high-priority teaching point.

Concept Tested & Keywords

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E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2105-2107

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 51-53

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.