A Nurse Is Preparing To Administer Phenytoin Suspension 300 Mg

A Nurse is Preparing to Administer Phenytoin Suspension 300mg: A Comprehensive Guide

Administering medications accurately and safely is paramount in nursing practice. This detailed guide focuses on the safe and effective administration of phenytoin suspension 300mg, covering every aspect from preparation to post-administration observation. Phenytoin, also known as Dilantin, is an anticonvulsant medication commonly used to treat seizures. Understanding its properties and the nuances of administering its suspension form is crucial for optimal patient care.

Understanding Phenytoin and its Suspension Form

Phenytoin is available in various formulations, including tablets, capsules, and intravenous preparations. However, the suspension form is particularly relevant for patients who have difficulty swallowing solid medications or require a more flexible dosage regimen. Phenytoin suspension is a liquid formulation that is readily absorbed by the body. This makes it a suitable choice for various patient populations, including children and elderly individuals.

Key Properties of Phenytoin Suspension:

• Therapeutic Use: Primarily used to treat and prevent seizures (tonic-clonic, partial, and status epilepticus). It can also be used for certain types of neuropathic pain.
• Absorption: Absorption can be affected by factors such as food intake and the pH of the gastrointestinal tract.
• Distribution: Bound to plasma proteins. Variations in protein binding can influence the drug's efficacy.
• Metabolism: Primarily metabolized by the liver. Liver function impairment can significantly affect its metabolism and clearance.
• Excretion: Primarily excreted via the kidneys. Renal function should be considered when administering phenytoin.
• Stability: Phenytoin suspension can be sensitive to light and temperature fluctuations, necessitating appropriate storage conditions. Always check the expiry date.

Step-by-Step Guide to Administering Phenytoin Suspension 300mg

The following steps provide a comprehensive guide to safely and effectively administering phenytoin suspension 300mg. Remember to always refer to the medication's package insert and your institution's policies and procedures.

1. The Six Rights of Medication Administration:

Before even touching the medication, meticulously verify the Six Rights:

• Right Patient: Confirm the patient's identity using two identifiers (e.g., name and date of birth).
• Right Medication: Double-check the medication name, dosage, and form against the physician's order.
• Right Dose: Ensure the prescribed dose (300mg in this case) is accurate. Carefully calculate the volume needed based on the concentration of the suspension.
• Right Route: Confirm that the ordered route is oral (suspension).
• Right Time: Administer the medication at the scheduled time.
• Right Documentation: Record the administration accurately and completely in the patient's chart, including the time, dose, route, and any observations.

2. Preparation:

• Hand Hygiene: Thoroughly wash your hands with soap and water or use an alcohol-based hand rub.
• Gather Supplies: You will need the prescribed phenytoin suspension, a medication cup or syringe (appropriate for the volume needed), and a patient chart. A paper towel can be useful for cleaning up spills.
• Medication Verification: Visually inspect the medication bottle. Check for any signs of damage, discoloration, or precipitation. Verify the expiration date.
• Dosage Calculation: Accurately calculate the volume of phenytoin suspension required to deliver the 300mg dose. This depends entirely on the concentration of the suspension. Always double-check your calculations. If unsure, consult a pharmacist or senior colleague.
• Prepare the Medication: Gently shake the bottle to ensure the suspension is well mixed. Then, using the appropriate measuring device (syringe or cup), carefully measure the calculated volume of the suspension.

3. Administration:

• Patient Assessment: Before administering the medication, assess the patient's swallowing ability and any potential allergies.
• Medication Administration: Administer the phenytoin suspension to the patient orally. You can offer water or other fluids to assist with swallowing, if needed. Never crush or dilute the suspension unless specifically instructed by the medication's label or physician's orders.
• Post-Administration Care: Remain with the patient for a short period to ensure they have successfully swallowed the medication and to monitor for any adverse reactions.

4. Documentation:

• Complete Charting: After successful administration, meticulously document the time, date, dose, route, and any observations in the patient's chart. This is crucial for tracking the effectiveness of the medication and identifying any potential problems. Include any patient complaints or observed side effects.

Potential Adverse Effects and Precautions

Phenytoin, like any medication, can have potential side effects. It's vital to monitor the patient closely for these.

Common Side Effects:

• Nausea and Vomiting: These are relatively common and can often be managed with antiemetic medications.
• Dizziness and Headache: Patients may experience dizziness or headaches; advising rest and appropriate safety precautions is important.
• Ataxia: This refers to a lack of coordination or balance, and patients should be cautioned about activities requiring fine motor skills.
• Nystagmus: Involuntary eye movements can occur. Monitor for this, as it can indicate a potential problem with medication levels.
• Skin Rash: A skin rash is possible; report this to the physician immediately.

Serious Side Effects (Require Immediate Medical Attention):

• Stevens-Johnson Syndrome: A rare but potentially life-threatening skin reaction. Look out for severe blistering or peeling skin.
• Toxic Epidermal Necrolysis: Similar to Stevens-Johnson Syndrome but even more severe.
• Hepatotoxicity: Liver damage, which can be indicated by abnormal liver function tests.
• Blood Dyscrasias: Changes in blood cell counts.
• Gingival Hyperplasia: Excessive gum growth, potentially requiring dental intervention.

Precautions and Interactions:

• Liver and Kidney Function: Patients with impaired liver or kidney function may require dose adjustments. Always check the patient's lab results.
• Drug Interactions: Phenytoin interacts with numerous medications. Check for potential interactions with other medications the patient is taking. This is especially crucial. Consult a pharmacist or physician if you have any doubts.
• Pregnancy and Breastfeeding: Use in pregnant or breastfeeding women requires careful consideration and monitoring.

Monitoring and Follow-Up

Regular monitoring is essential to ensure the effectiveness and safety of phenytoin therapy. This includes:

• Clinical Assessment: Regularly assess the patient's seizure control, neurological status, and any adverse effects.
• Laboratory Monitoring: Periodically monitor blood levels of phenytoin to ensure therapeutic levels are maintained. This helps to optimize treatment and minimize the risk of adverse effects. Therapeutic drug monitoring (TDM) is often crucial for phenytoin.
• Patient Education: Educate the patient and their caregivers about the medication, potential side effects, and the importance of regular follow-up appointments. Provide clear instructions on medication storage and administration. Stress the importance of adherence to the prescribed regimen.

Conclusion

Administering phenytoin suspension 300mg requires meticulous attention to detail and adherence to strict protocols. By following the steps outlined in this guide and maintaining a strong understanding of the medication's properties, potential side effects, and precautions, nurses can ensure the safe and effective delivery of this important anticonvulsant medication, contributing to optimal patient outcomes and improving their quality of life. Always remember to consult your institution's policies and procedures, and seek guidance from a senior colleague or pharmacist if you have any questions or concerns. Patient safety should always be the paramount concern.