Assessment 2

Batch 42 Pharmacology Drug Classification
ACKNOWLEDGEMENT
Upon doing this Assignment we would like to thank all those who contributed whether directly
or indirectly in helping us compiling information through research and editing it. Nothing is
possible without the health and strength of the Almighty, so we want to thank him for seeing us
through the completion this project. We owe thanks to our classmates as well for sharing
information with us, for team work is common grounds to success. Lastly thanks to Miss. Moss
for this research base assignment that would help us as we are training to become Professional
Nurses.
Prepared by: Male Surgical Ward 1 01/11/2017

INTRODUCTION
The study of drugs or chemicals and the effects they have on living animals is
called pharmacology. Pharmacology explains what drugs are, what they do to body functions and
what the body does to them. Pharmacology also explains why a person may experience side
effects when they take drugs and why there is such a wide spectrum of differences between drug
actions in different people.
Everyone at one stage or another in life will rely on a pharmaceutical product, whether it is for
themselves, a friend or a family member. Therefore, it is useful to have a basic understanding of
pharmacology.

WARFARIN CLASSIFICATION
CLASSIFICATIONS:
ANTICOAGULANT
Pregnancy Category: X
ACTION & THERAPEUTIC EFFECT

Indirectly interferes with blood clotting by depressing hepatic synthesis of vitamin K -
dependent coagulation factors: II, VII, IX, and X.
USES
- Prophylaxis and treatment of deep vein thrombosis, and its extension, pulmonary
embolism
- Treatment of atrial fibrillation with embolization.
- Treatment of coronary occlusion, cerebral transient ischemic attacks (TIAs), and as a
prophylactic in patients with prosthetic cardiac valves. Used extensively as rodenticide.
CONTRAINDICATIONS
Hemorrhagic tendencies, vitamin C or K deficiency, hemophilia coagulation factor
deficiencies, dyscrasias; active bleeding; open wounds, active peptic ulcer, visceral
carcinoma, esophageal varices, malabsorption syndrome; uncontrolled hypertension, cerebral
vascular disease; heparin-induced thrombocytopenia (HIT); pericarditis with acute MI;
severe hepatic or renal disease; continuous tube drainage of any orifice; subacute bacterial
endocarditis; recent surgery of brain, spinal cord, or eye; regional or lumbar block
anesthesia; threatened abortion; unreliable patients; pregnancyDOSAGE
- Adult: PO/IV Usual dose 210 mg daily with dose adjusted to maintain a PT 1.22
control or INR
- Child: PO 0.10.3 mg/kg/day, adjust to maintain INR of 23
ADVERSE EFFECTS
- Body as a Whole: Major or minor hemorrhage from any tissue or organ; hypersensitivity
(dermatitis, urticaria, pruritus, fever).
- GI: Anorexia, nausea, vomiting, abdominal cramps, diarrhea, steatorrhea, stomatitis.
- Other: Increased serum transaminase levels, hepatitis, jaundice, burning sensation of
feet, transient hair loss.
Overdosage: Internal or external bleeding, paralytic ileus; skin necrosis of toes (purple toes
syndrome), tip of nose, buttocks, thighs, calves, female breast, abdomen, and other fat-rich
areas
NURSING IMPLICATIONS
Assessment & Drug Effects
- Determine PT/INP prior to initiation of therapy and then daily until maintenance dosage
is established.
- Obtain a COMPLETE medication history prior to start of therapy and whenever altered
responses to therapy require interpretation; extremely IMPORTANT since many drugs

interfere with the activity of anticoagulant drugs (see INTERACTIONS).
- Lab tests: For maintenance dosage, PT/INR determinations at 14-wk intervals
depending on patient's response; periodic urinalyses, stool guaiac, and LFTs. Blood
samples for PT/INR should be drawn at 1218 h after last dose (optimum).
- Patients at greatest risk of hemorrhage include those whose PT/INR are difficult to
regulate, who have an aortic valve prosthesis, who are receiving long-term anticoagulant
therapy, and older adult and debilitated patients.
PATIENT & FAMILY EDUCATION

- Understand that bleeding can occur even though PT/INR are within therapeutic range.
Stop drug and notify physician immediately if bleeding or signs of bleeding appear:
Blood in urine, bright red or black tarry stools, vomiting of blood, bleeding with tooth
brushing, blue or purple spots on skin or mucous membrane, round pinpoint purplish red
spots (often occur in ankle areas), nosebleed, bloody sputum; chest pain; abdominal or
lumbar pain or swelling, profuse menstrual bleeding, pelvic pain; severe or continuous
headache, faintness or dizziness; prolonged oozing from any minor injury (e.g., nicks
from shaving).
- Stop drug and report immediately any symptoms of hepatitis (dark urine, itchy skin,
jaundice, abdominal pain, light stools) or hypersensitivity reaction
- Take drug at same time each day, and do NOT alter dose.
- Risk of bleeding is increased for up to 1 mo after receiving the influenza vaccine.
- Fever, prolonged hot weather, malnutrition, and diarrhea lengthen PT/INR (enhanced
anticoagulant effect).
- A high-fat diet, sudden increase in vitamin Krich foods (cabbage, cauliflower, broccoli,
asparagus, lettuce, turnip greens, onions, spinach, kale, fish, liver), coffee or green tea
(caffeine), or by tube feedings with high vitamin K content shorten PT/INR.
- Avoid excess intake of alcohol.
- Use a soft toothbrush and floss teeth gently with waxed floss.
- Use barrier contraceptive measures; if you become pregnant while on anticoagulant
therapy the fetus is at great potential risk of congenital aformations.
- Do not take any other prescription or OTC drug unless specifically approved by
physician or pharmacist.

PATIENT ASSESSMENT TOOL
Initials: M.G
Age: 61 years
Area: Sharpes Dale
Date: 19th October 2017
Diagnosis: Deep Vein Thrombosis, HTN
Instructions: Place a tick in the relevant box and write comments when necessary.
ASSESSMENT DATA YES NO COMMENTS

Introduce self, explain
purpose, seek permission
Does patient know name Pt is knowledgeable about drug and dosage
and dose of the drug?
What does the patient say Pt verbalized that the warfarin is to treat her
about the action of the thrombosis by preventing the blood from clotting
drug?
Has the patient ever Pt verbalized a frequent salty taste in her mouth,
experienced side effects of blood in her stool and bleeding under the skin
the drug? (refer to the
drug information for at
least 5 and specify side
effects discussed in the
comments)
What action did he/she Reported her observations to her doctor
take?
Has the patient
experienced any allergies
to the drug? Specify the
allergies discussed in the
comments
Does the patient/family Pt said her family is familiar with the drug and knows
adhere to any special she must take it after breakfast to prevent nausea
precautions when taking
the drug?
E.g. checking pulse prior
use.
List at least one special
precaution discussed in

the comments.
What are the Pt and family are well informed and knowledgeable
patient/familys KEY about the drug
learning needs in relation
to the drug?
Thank the patient
Using Maslows hierarchy
of basic needs and the
patient profile, cluster the
data under the relevant
need
Document the assessment
data on the sample
progress notes
Construct a brief lesson
plan for teaching the
patient on areas of
deficiency
Conduct the teaching to
last no more than 10 - 15
minutes
Evaluate patients
knowledge
Document specific
content taught and
outcomes on the sample
progress notes
While consulting with the
Registered Nursing staff,
implement other
interventions that are
within your scope of
practice and document
same
Thank you!

SVG COMMUNITY COLLEGE

DIVISION OF NURSING EDUCATION
PATIENTS PROFILE
PROFILE NEEDS ASSESSMENT NEED

INTERFERENCE
Name: M.G General Appearance/ Handing Over:
Pt was lying in bed seen in no respiratory distress
however complains of mild pain (6) and tenderness to
Age: 61 yrs the affected leg. Patient is, conscious and alert and seen
with (R) leg elevation and clean clothing and linens.
D.O.A: 19.10.17 Right leg appears slightly swollen with red discoloration
around the area and weak muscular strength.
History of Illness: Oxygen Need:

Pt. has a history of:
Deep Vein Thrombosis of
(R) leg
Pt. verbalized that the
condition was first
discovered ten (10) years
prior and has been treated
recurrently with little
effect
HTN
Diagnosis: Nutrition Need:

Deep Vein Thrombosis of Low vitamin k diet
(R) leg No dark green leafy vegetables
HTN
Lab Investigations: Elimination:

INR 0.7 L Subjective data: Pt verbalize occasional bloody stool
PTT 4.0 seconds
HGB 13.0
Medication: Rest, Activity & Comfort:

Warfarin 5mg PO OD Subjective data: Pt verbalize pain to the affected leg
Lisinopril 50mg PO OD upon movements
Decreased physical mobility


PATIENTS PROFILE

INTERFERENCE
Doctors Rounds:
Continue management and
pain medication.
Collect old Notes.
Rpt. INR and PPT
Monitor v/s
Keep leg in raised position
Safety & Security:

Risk for bleeding
Psychosocial:
Pt verbalize that she doesnt like taking the Warfarin drug, is
depressed due to hospitalization and restriction of foods of
preference
Pt stated that shes uncomfortable in the sun and that she bruises
easily
Sexuality:

ST. VINCENT AND THE GRENADINES COMMUNITY COLLEGE

NURSING CARE PLAN
Patients Name: M.G Age 61 Ward: F.M.W Date: 25.10.2017
Diagnosis Deep Vein Thrombosis of (R) leg and HTN
Needs Affected: Nutrition Need, Elimination, Rest, Activity & Comfort
ASSESSMENT DIAGNOSIS GOAL INTERVENTION EVALUATION

SUBJECTIVE Risk for impaired Client will Monitor vital signs Pt. has not
M.G is sad because gas exchange continue to and note changes in reported any
she is hospitalized. related to demonstrate cardiac rhythm. Blood difficulty as it
Alveolar- satisfactory Pressure changes are relates to
Stated that she is capillary ventilation allied with developing breathing
uncomfortable in membrane and hypoxemia. Changes
the Sun. changes including oxygenation in heart rhythm and M.G. goal was
active bleeding. within the extra heart sounds met as there was
States that she normal may show increased no evidence of
bruises easily. Ineffective Tissue range cardiac load and this pulmonary
Perfusion related can lead to failing embolism
States that she to vessel wall M.G. will ventilation imbalance.
misses home. injury evidence not Goal was not
by edema, experience Assess and measure 0fully met as
Unhappy that she is swelling, warmth any blood the circumference of M.G. expressed
unable to eat her and tenderness clot. the pt. affected leg she was still
preferred Foods. during palpation with a measuring tape experiencing
of calf muscle. Pt. will for signs and pain.
OBJECTIVE verbalize symptoms of deep
Sad Facial Acute pain approaches vein thrombosis it is Pt. verbalized
Expression Related to that offer presumed when there that she was
Restricted inflammatory relief and is a variance of above experiencing
Mobility. response in report when 3 cm between the bruising and
Edema in the Right affected vein the pain has extremities blood in stool so
Leg. evidence by eased. the goal was not
Swelling of the restlessness and Maintain bed rest, meet
right Leg. reports of pain. Pt. will not elevate affected .
Warmth in the experience extremity as this assist
Skin. Risk for bleeding any circulation, decreases
Distention of related to bleeding stasis and edema
Surface Vein. anticoagulation formation.
Pain Scale of 6/10 therapy for deep
Blood Pressure vein thrombosis Assess for primary
reading of 140/90. signs and symptoms of
Taking Medication: bleeding, noting
Warfarin 5 mg PO bruises and gum
OD bleeding are the
Lisinoprol 50 mg earliest signs of
PO OD impulsive bleeding.


LESSON PLAN
COURSE: Pharmacology
UNIT: Unit Three
TOPIC: Deep Bone Thrombosis
AUDIENCE: One Male Patient
LEVEL: Adult
SIZE: 1 patient
VENUE: Male Surgical Ward
DATE: 25th October, 2017
TIME: 3:30 p.m.
DURATION: 15 minutes
LEARNING THEORY: (Self-Driven Learning): learning is open, genuine, inviting,
active, and student driven. Student should participate in
their own learning.
PRINCIPLES OF LEARNING THEORY: Carl Rogers: Humanistic learning
METHODOLOGY: Discussion
TEACHING AIDS: Hand-outs
AIM OF THE LESSON: At the end of this lesson, patient would be able to:
1. Understand the importance of the medication used
EVALUATION: Patient should be able to:
1. Explain the importance of taking Warfarin
SPECIFIC OBJECTIVES:
1. Define deep bone thrombosis
2. List 2 types of deep bone thrombosis
3. Explain the types of deep bone thrombosis
4. List 3 symptoms of deep bone thrombosis
5. Define Warfarin
6. List 5 side effects of warfarin

7. List the dosage of warfarin and how it should be taken
REFERENCES:
https://medical-dictionary.thefreedictionary.com/deep+vein+thrombosis
https://www.news-medical.net/health/Types-of-Thrombosis.aspx
https://www.nhs.uk/conditions/arterial-thrombosis/Pages/Introduction.aspx
www.heart.org/.../What-is-Venous-Thromboembolism-VTE_UCM_479052_Article.js
https://www.healthline.com/health/deep-venous-thrombosis
https://www.nhs.uk/Conditions/Deep-vein-thrombosis/Pages/Causes.aspx
https://www.webmd.com/drugs/2/drug-3949/warfarin-oral/details
https://www.drugs.com Drugs A to Z

CONTENT
NOS. OBJECTIVES CONTENT TEACHER STUDENT EVALUATION

ACTIVITY ACTIVITY
1. Define the term According to the Medical Teacher Patient states
Deep bone Dictionary Deep bone would what he
thrombosis. thrombosis can be defined explain the understands by
as: terminology Deep bone
- Deep vein thrombosis deep bone thrombosis
(DVT) is a blood clot thrombosis
in a major vein that
usually develops in
the legs and/or pelvis.
2. List the types of Venous thrombosis State the State the List the types of
deep bone Arterial thrombosis types of types of deep bone
thrombosis Deep bone Deep bone thrombosis
thrombosis thrombosis
3. Explain the -
Arterial thrombosis is Explain the State the
types of deep a blood clot that types of deep types of
bone develops in an artery bone deep bone
thrombosis which can be thrombosis thrombosis
dangerous because it
can stop the blood
from flowing to the
organs.
- Deep vein thrombosis
(DVT) is a clot in a
deep vein, usually in
the leg, but
sometimes in the arm
or other veins.
4 List 3 Symptoms of Deep Bone State the Explain the
symptoms of Thrombosis: symptoms types of Deep
deep bone - swelling in your foot, and causes of bone
thrombosis ankle, or leg, usually deep bone thrombosis
on one side thrombosis
- cramping pain in
your affected leg that
usually begins in
your calf

- an area of skin that

feels warmer than the
skin on the
surrounding areas
5 Define Warfarin Warfarin is an Explain the Define what

anticoagulant used to prevent meaning of is
heart attacks, strokes, and the word Warfarin
blood clots. Learn about side Warfarin
effects, interactions and
indications.
6 List 3 side Side Effects of Warfarin State 3 side

effects of - Nausea effects of
warfarin - Loss of appetitee Warfarin
- stomach/abdominal
pain may occur
7 List the dosage Dose for Deep Vein State the

of warfarin Thrombosis - Recurrent amount of
Event Warfarin that
Initial dose: 2 to 5 mg orally should be
once a day taken
Maintenance dose: 2 to 10
mg orally once a day


PHARMOCOLOGY
PROGRESS NOTES
Date: 25.10.2017
DATE TIME REMARKS SIGNATURE
25.10.2017 1:35 P.M. Patient taken over was lying in bed conscious and alert and First year R.N
was aware of the surroundings. Patient was seen in no student N.A
respiratory distress.__________________________________
1:48 P.M. On initial contact Patients complaints of mild pain rated 6 on First year R.N
a scale of 1-10 and tenderness to the affected (R) leg which student N.A
was elevated. The right leg appeared slightly swollen with red
discoloration around the area and weak muscle strength.____
2:00 P.M. Patients vitals First year R.N
Temperature 98C student N.A
Blood Pressure 140/90
Pulse 85 bpm
Respiration 22 bpm
2:15pm Upon assessment the following needs of the patient were
affected
Nutrition Need First year R.N
Low vitamin k diet and No dark green leafy vegetables_____ student N.A
Elimination:
Subjective data: Patient verbalized occasional bloody stool__
Rest, Activity & Comfort:
Pain related to right affected leg and decreased physical
mobility___________________________________________
Psychosocial
Patient verbalize that she doesnt like taking the Warfarin
drug and is depressed due to hospitalization and restriction of
consuming her favorite food __________________________
2:28 P.M. Nursing plan of care
Ensure low K diet is served
Administer medication as necessary
Monitor v/s
Keep (R) leg in raised position
Teaching Plan

PHYENTOIN CLASSIFICATION
CLASSIFICATION(S):
Antiarrhythmic, Class IB
anticonvulsant, hydantoin
ACTION
Acts in the motor cortex of the brain to reduce the spread of electrical discharges from the
rapidly firing epileptic foci in this area.
USAGE
- Chronic epilepsy, especially of the tonic-clonic, psychomotor type. Not effective against
absence seizures and may even increase the frequency of seizures in this disorder.
- Parenteral: Status epilepticus and to control seizures during neurosurgery. IV for PVCs
and tachycardia. Particularly useful for arrhythmias produced by digitals over-dosage.
- PO: Certain PVCs. Investigational: Paroxysmal choreoathetosis; to treat blistering an
erosions in clients with recessive dystrophic epidermolysis bullsa; episodic dyscontrol;
trigeminal neuralgia; as a muscle relaxant in neuromyotonia, myotonia dystrophy; to treat
cardiac symptoms in overdosage of tricyclic antidepressants. Severe preeclampsia.
DOSAGE
- ORAL SUSPENSION; TABLETS, CHEWABLE
Seizures.
- Adults, initial: 100mg (125 mg of the suspension) 3 times per day; adjust dosage at 7-10
day intervals until seizures are controlled; usual, maintenance: 300-400 mg/day,
although 600 mg/day (625 mg dose of the suspension) may be required in some.
- Pediatric, initial: 5 mg/kg/day in two to three divided doses; maintenance, 4-8mg/kg
(up to maximum of 300 mg/day). Children over 6 years may require up to 300 mg/day.
Geriatric: 3 mg/kg initially in divided doses; then, adjust dosage according to serum
levels and response. Once dosage level has been established, the extended capsules may
be used for once-a-day dosage.
- Capsules for seizures
- Adults, initial: 100mg 3 times per day; adjust dose at 7- to -10 day intervals until control
is changed. An initial loading dose of 12-15 mg/kg divided into two to three doses over 6
hr followed by 100mg 3 times per day on subsequent days may be preferred if seizures
are frequent.
- Pediatric: See dose for Oral Suspension and Chewable Tablets.
Arrhythmias.
Adults: 200-400 mg/day
- IV
Satus epilepticus
Adults, loading dose: 10-15 mg/kg at a rate not to exceed 50 mg/min; then, 100mg PO
or IV q 6-8hr. Pediatric, loading dose: 5-10 mg/kg given at a rate of 1-3 mg/kg/min.
Arrhythmias
Adults: 100mg q 5 min up to maximum of 1 gram.

- IM
Neurosurgery.
Dose should be 50% grater than the PO dose. 100-200 mg q 4 hr during and after surgery
(during first 24 hr, administer no more than 1,000 mg; after first day, give maintenance
dosage).
SIDE EFFECTS
- The most notable signs of toxicity associated with the intravenous use of this drug are
cardiovascular collapse and/or central nervous system depression. Hypotension does
occur when the drug is administered rapidly by the intravenous route. The rate of
administration is very important; it should not exceed 50 mg per minute in adults, and 1-
3 mg/kg/min (or 50 mg per minute, whichever is slower) in pediatric patients.
Body As a Whole
- Allergic reactions in the form of rash and rarely more serious forms (see Skin and
Appendages paragraph below) and DRESS (see WARNINGS) have been observed.
Anaphylaxis has also been reported.
- There have also been reports of coarsening of facial features, systemic lupus
erythematosus, periarteritis nodosa, and immunoglobulin abnormalities.
Cardiovascular
- Severe cardiovascular events and fatalities have been reported with atrial and ventricular
conduction depression and ventricular fibrillation. Severe complications are most
commonly encountered in elderly or critically ill patients (see WARNINGS).
Nervous System
- The most common adverse reactions encountered with phenytoin therapy are nervous
system reactions and are usually dose-related. Reactions include nystagmus, ataxia,
slurred speech, decreased coordination, somnolence, and mental confusion. Dizziness,
vertigo, insomnia, transient nervousness, motor twitchings, paresthesia, and headaches
have also been observed. There have also been rare reports of phenytoin induced
dyskinesias, including chorea, dystonia, tremor and asterixis, similar to those induced by
phenothiazine and other neuroleptic drugs.
- A predominantly sensory peripheral polyneuropathy has been observed in patients
receiving long-term phenytoin therapy.
Digestive System
- Acute hepatic failure, toxic hepatitis, liver damage, nausea, vomiting, constipation,
enlargement of the lips, and gingival hyperplasia.
Skin and Appendages
- Dermatological manifestations sometimes accompanied by fever have included
scarlatiniform or morbilliform rashes. A morbilliform rash (measles-like) is the most
common; other types of dermatitis are seen more rarely. Other more serious forms which
may be fatal have included bullous, exfoliative or purpuric dermatitis, Stevens-Johnson
syndrome, and toxic epidermal necrolysis (see WARNINGS section). There have also
been reports of hypertrichosis.
- Local irritation, inflammation, tenderness, necrosis, and sloughing have been reported
with or without extravasation of intravenous phenytoin (see WARNINGS).

Hematologic and Lymphatic System

- Hematopoietic complications, some fatal, have occasionally been reported in association
with administration of phenytoin. These have included thrombocytopenia, leukopenia,
granulocytopenia, agranulocytosis, and pancytopenia with or without bone marrow
suppression. While macrocytosis and megaloblastic anemia have occurred, these
conditions usually respond to folic acid therapy. Lymphadenopathy, including benign
lymph node hyperplasia, pseudolymphoma, lymphoma, and Hodgkin's Disease have been
reported (see WARNINGS).
Special Senses
- Altered taste sensation including metallic taste.
Urogenital
- Peyronie's disease
CONTRAINDICATIONS
- Hypersensitivity to hydantoins, exfoliative dermatitis, sinus bradycardia, second- and
third- degree AV block, clients with strokes- Adams syndrome, SA block. Lactation
EFFECTS ON PREGNANCY:
Pregnancy category: C
NURSING IMPLICATIONS
- Do not confuse Dilantin with DIlaudid (a narcotic analgesic). Do not confuse phenytoin
with fosphenytoin or mephyton (also anticonvulsants).
ADMINISTRATION/ STORAGE
- Full effectiveness of PO administered hydantoins is delayed and may take 6-9 days to be
fully established. A similar period of time will elapse before effects disappear
completely.
- When hydantoins are substituted for or added to another anticonvulsant medication, their
dosage is gradually increased, while dosage of the other drug is decreased proportionally.
- Avoid IM, SC, or previous injections. Pain, inflammation, and necrosis may be caused by
the highly alkaline solutions.
- If receiving tube feedings of Isocal or Osmolite, the PO absorption of phenytoin may be
decreased. Do not administer together.
- Due to potential differences in bio-availability between PO products, do not interchange
brands. Also, when switching from extended to prompt products, dosage adjustments
may be required.
- Use of IV infusion is not recommend, as the drug is poorly soluble and may form a
precipitate. Inject slowly and directly into a large vein through a large-gauge needle or IV
catheter.
- For parenteral preparations:
Use only a clear solution.
Dilute with special diluent supplied by manufacturer.
Shake the vital until the solution is clear. I may take about 10 min for the drug to
dissolve.

To hasten the process, warm the vital in warm water after adding the diluent.
The drug is incompatible with acid solutions.
-
ASSESMENT
- List the reason for therapy, onset, characteristics of S&S, clinical presentation, blood
vessels, other agents trailed, outcome.
- Note history and nature of seizures, addressing location, frequency, duration,
causes/characteristics, triggers and EEG findings.
- Determine if hypertensive to hydantoins or has exfoliative dermatitis. Consider
fosphenytoin in those unable to tolerate phenytoin. Do not breastfeed following delivery.
- Monitor ECG, VS,CBC, liver, and renal function studies. May lower serum Mg, folate,
calcium and vitamin D. Avoid with sinus bradycardia, sion-atrial block, second and third
degree A-V block.
INTERVENTIONS
- During IV administration, monitor VS and for hypotension.
- Monitor serum drug levels because the serum concentrations of phenytoin increase
disproportionately as the dosage is increased:
Seven to 10 days may be required to recommended serum levels. Drug is highly
protein bound; may order free and bound drug levels to better assess response.
Drug is metabolized much slower by the elderly; thus most may be managed with
once a day dosing.
If receiving drugs that interact with hydantoins or with impaired liver function,
obtain level more frequently. Dilantin induces hepatic microsomal enzymes for
drug metabolism.
- Oral form has variable absorption; do not administer with tube feedings. Administer
separately, flush, and clamp tube for 20 min to ensure absorption.
CLIENT/FAMILY TEACHING
- May take with food to minimize GI upset. Do not take antacids within 1 hr of ingestion.
Do not chew or crush; take tablets whole.
- Use care when performing tasks that require mental alertness. Drug may cause
drowsiness, dizziness, and blurred vision.
- Do not substitute products of exchange brands; bioavailability of phenytoin may vary.
Seizure control may be lost or toxic blood levels may be develop with substitutions.
- Prompt-release forms cannot be substituted for another unless the dosage is also adjusted.
- If taking phenytoin extended, do not substitute chewable tablets for capsules. Medication
strengths are not equal.
- If taking phenytoin extended, check bottle carefully. Chewable tablets are never extended
form.
- With extended release, take only a single dose daily; take only as directed and only in the
brand prescribed.
- If dose is misses, take as soon as remembered. Then resume the usual schedule. Do not
double up to make up for the missed dose. If the doses of drug are scheduled through the

day, and one of the doses is missed, take the drug as soon as it is realized unless its
within 4 hr of the next dose. In that case, omit unless otherwise instructed.
OUTCOMES/EVALUATE
- Control of seizures
- Termination of ventricular arrhythmias; stable cardiac rhythm
- Therapeutic drug levels (5-20 mcg/mL)

PATIENT ASSESSMENT TOOL
Initials: J.G
Age: 38yrs
Area: Pinehill
Date: 25/10/17
Diagnosis: Seizure (uncontrolled), Epilepsy, Hydrocephalus
Instructions: Place a tick in the relevant box and write comments when necessary.
ASSESSMENT DATA Yes No Comments

Introduce self, explain Y
purpose, seek permission E
S
Does patient know name Y Patient was a bit confused at the time of assessment, but
and dose of the drug? E his mother was there to help in answering this question
S by stating yes he knows the name and dosage of the
drug but he is a little bit out of it right now.
What does the patient say Y Patient stated that the drug helps with his jumps
about the action of the E (seizures).
drug? S
Has the patient ever N

experienced side effects of O
the drug? (refer to the
drug information for at
least 5 and specify side
effects discussed in the
comments)
What action did he/she N
None
take? O
Has the patient N
None
experienced any allergies O
to the drug? Specify the
allergies discussed in the
comments

Does the patient/family Patient and family partially adheres to some precautions
adhere to any special such, as taking the drug with food and not chewing it up
precautions when taking but taking it whole.
the drug?
E.g. checking pulse prior
use.
List at least one special
precaution discussed in the
comments.
What are the Side effects of the drug and other necessary precautions
patient/familys KEY when taking the drug.
learning needs in relation
to the drug?
Thank the patient Y
E
S
Using Maslows hierarchy Y

of basic needs and the E
patient profile, cluster the S
data under the relevant
need
Document the assessment Y
data on the sample E
progress notes S
Construct a brief lesson Y

plan for teaching the E
patient on areas of S
deficiency
Conduct the teaching to Y
last no more than 10 - 15 E
minutes S
Evaluate patients Y
knowledge E
S

Document specific content Y

taught and outcomes on E
the sample progress notes S
While consulting with the Y

Registered Nursing staff, E
implement other S
interventions that are
within your scope of
practice and document
same
Thank you!


PATIENTS PROFILE

INTERFERENCE
Name: J.G General Appearance/ Handing Over:

Patient taken over lying in bed, in, confused, but
conscious and appears to be in no obvious
respiratory distress. Patient has a intravenous site
Age: 38yrs in right hand, and it is clean and dry.
D.O.A: 25/10/17
History of Illness: Oxygen Need:

Hydrocephilus
Epilepsy
Diagnosis: Nutrition Need:

Seizure (uncontrolled)
Hydrocephalus
Epilepsy
Lab Investigations: Elimination:

Patient stated that he has incontinence of bladder
when having a seizure.

Medication: Rest, Activity & Comfort:

Patient verbalized that he has problems sleeping
Ditaltin 100mg IV when coming to the jumps (seizures), when he
q8h/prn wakes up from the event it is hard for him to fall
back to sleep. Patient needs assistance with
Valium 10mg IMD movements/turns, and therefore would need
q8h/prn for active assistance with activities of daily living due to
seizures weakness of his body.


PATIENTS PROFILE

INTERFERENCE
Doctors Rounds:
Continue medication
Continue dressing
using saline
Repeat UCE
Monitor strict I&O
For dipstick
Continue pain
management
Safety & Security:

Impaired physical mobility
Risk for infection
Risk for physical injury
Risk for allergic reaction
Psychosocial:
Pt has no knowledge of drugs taken
Pt is uneducated on effects, usage, dosage and side effects of
all medications taken
Risk for loneliness
Sexuality:


NURSING CARE PLAN
Patients Name: J.G Age:38yrs Ward: Male Medical Date:25/10/17

Diagnosis(es) Seizure (uncontrolled), Epilepsy,Hydrocephalus
Need Affected Elimination, Rest, activity and comfort, Psychosocial.

ASSESSMENT DIAGNOSIS GOAL INTERVENTI EVALUATION

ON
Subjective: Risk for J.G would Ascertain J.D after following

Trauma or maintain knowledge of regimen showed increase
Confusion Suffocation treatment various stimuli in condition as he remains
related to regimen to that may stable.28.10.17
weakness uncontrolled control or precipitate
seizure activity eliminate seizure activity.
Medication was
Lack of sleep seizure administered as the
Deficient activity. Rational doctor ordered and J.G.
J.G stated that knowledge as Certain stimuli was compliant in taking
seizures are evidenced by J.G would be like sleep in this them.28.10.17
affecting him from J.G not in a modified case may
living a normal knowing the environment increase brain J.G has no injuries.
life side effects of to enhance activity, thereby 28.10.17
his mediation safety. increasing the
Bladder and his limited potential for J.G stated that he is
incontinence knowledge on J.G will be seizure activity. coping bit better with his
precautions in able to show condition.28.10.17
Objective: relation to his understanding Monitor the
medication and of adverse twitching of the J.G now has relative
Limited condition effects of hands, feet and knowledge on drug and
knowledge drugs and mouth or other precautions that need to
Ineffective precautions facial muscles be followed. 28.10.17
Taking Coping related that need to be
medication: to psychosocial followed after Rational
Dilantin 100mg IV and economic 1 teaching To look out for
Q 8 hrs consequences of session. signs that a
epilepsy seizure may be
Valium 10mg IMD J.D would be coming on
Q 8hrs/PRN for better able to
active seizures. cope with his Ensure patient
condition. gets medication
Not able to move as prescribed
out of bed
Rational
To improve
condition

Provide
neurological or
vital sign check
after seizure.
Rationale
Documents
postictal state and
time or
completeness of
recovery to normal
state. May identify
additional safety
concerns to be
addressed
Do not leave the

patient during and
after seizure
Rationale
Promotes safety
measures
Use and pad side

rails with bed in
lowest position, or
place bed up
against wall and
pad floor if rails
not available or
appropriate
Rational
Prevents or
minimizes injury
when seizures
(frequent or
generalized) occur
while patient is in
bed.
Turn head to side

and suction airway
as indicated. Insert

plastic bite block

only if jaw relaxed.
Rationale
Helps maintain
airway potency
and reduces risk of
oral trauma
Discuss adverse
side effects of
drugs and
precautions
related to drug
and condition.
Rationale
May indicate need
for change in
dosage or choice of
drug therapy.
Promotes
involvement and
participation in
decision-making
process and
awareness of
potential long-
term effects of
drug therapy, and
provides
opportunity to
minimize or
prevent
complications.
Provide emotional
support
Rationale
Seizures are
serious and
upsetting to
witness. The more
empathy and
support you can
provide patients

and loved ones, the

better.


LESSON PLAN
COURSE: Pharmacology
UNIT: 3
TOPIC: Seizures and its medication
AUDIENCE: Adult Male Patient and His Family
LEVEL: 1st year RN Student
SIZE: Four
VENUE: Milton Cato Memorial Hospital
DATE: 31/10/17
TIME: 3:00P.M.
DURATION: 20 Minutes
LEARNING THEORY: Andragogy refers to a theory of adult learning that details some of the
ways in which adults learn differently than children. For example, adults tend to be more self-
directed, internally motivated, and ready to learn. Teachers can draw on concepts of andragogy
to increase the effectiveness of their adult education classes.
PRINCIPLES OF LEARNING THEORY: Malcom Shepherd Knowles
METHODOLOGY: Discussion
TEACHING AIDS: Handouts

AIM OF THE LESSON: At the end of this teaching activity, the patient and his family will be
able to have a better understanding about Seizures and its medication that are taught in the
lesson.
EVALUATION: Patient will be able to correctly answer questions regarding Seizure and its
medication.
1. What do you understand by the term Seizure
2. Medication used to control Seizure
3. Side effects of the Medication
4. Dosage in taking Dilantin
SPECIFIC OBJECTIVES:
1. Define Seizures
2. State how to Maintain a safe environment before and during Seizure
3. List the types, symptoms, causes, and Treatment
4. Define what is Dilantin (Phenytoin or fen-i-toyn)
5. State the Side effects of Dilantin (Phenytoin or fen-i-toyn)
6. State the dosage for Dilantin (Phenytoin or fen-i-toyn)
REFERENCES:
http://web.b.ebscohost.com/nrc/detail?vid=4&sid=0c692a76-4bcc-4ee0-
8d122f5e25288ed4%40sessionmgr101&bdata=JnNpdGU9bnJjLWxpdmU%3d#AN=200
9565414&db=nrc
https://www.drugs.com/dilantin.html
CONTENT
NOS. OBJECTIVES CONTENT TEACHER STUDENT EVALUATION

ACTIVITY ACTIVITY
1. Definition of State what the Introduction Patient will Patient states
seizures lesson will base on. of all the explain what what are
There would be a students to seizures are. seizures.
total of eight the patient
objectives to be and his
covered during the family and
25 minutes. the topic.
Seizures are
changes in the
brains electrical
activity. This
change can cause
dramatic,
noticeable
symptoms or it may
not cause any
symptoms. The
symptoms of a
severe seizure
include violent
shaking and a loss
of control.
However, mild
seizures can also be
a sign of a
significant medical
problem, so
recognizing them is
important. Because
some seizures can
lead to injury or be
evidence of an
underlying medical
condition, its
important to seek
treatment if you
experience them.
2 State how to The risk that a Ask the Patient will Patient states
maintain a safe person with patient and explain how how to maintain
environment epilepsy will be his family if to maintain a a safe
before and injured during a they are safe environment.
during seizure. seizure at home aware of environment.
can be greatly how to
reduced by taking maintain a
some simple safety safe
precautions: environment
- Carpet the before and
floors with during a
heavy pile seizure.
and thick
under
padding.
- If the person
with epilepsy
wants to iron
clothing or
use a curling
iron, be sure
that the
device has an
automatic
shut-off
switch to
prevent
burns.
- Use chairs
with arms to
help prevent
falling.
- In the
bathroom:
Hang doors
so they open
outwards
instead of
inwards.
Then if the
person falls
against the
door, it can
still be
opened.
- The person
with epilepsy
should not
use any
electrical
appliances in
the bathroom
or near water.
In the
kitchen:
Cook with a
microwave
oven. When
using the
stove, try to
use the back
burners.
- Use plastic
containers,
plates, and
drinking cups
whenever
possible. Use
cups with
lids
(commuter
cups) to
prevent burns
from spills.
- If the person
with epilepsy
needs to
move
containers of
hot food or
liquids, it is
safer to slide
them along
the counter
or use a cart
to move them
to another
room. It is
safer for the
person to
wear rubber
gloves when
handling
knives or
washing
dishes and
glassware in
the sink.
- In the
bedroom:
Avoid
putting your
bed against a
wall, to
prevent
knocking
your limbs.
Put cushions,
pillows or a
mattress on
the floor
around the
bed, to
reduce
injuries if
you fall out
of bed.
Choose a low
bed, so there
is less
distance to
fall to the
floor. Keep
sharp-edged
objects and
furniture
away from
the bed.
3 List the types, There are various Ask the Patient and The patient and his
symptoms, causes types and names of patient and his family will family have a
and treatment of seizures such as grand family if they explain the knowledge about
seizures. mal (tonic- Clonic), are aware of types, the types,
petit mal (absence), the types, symptoms, symptoms, causes,
and psycho-motor. The symptoms, causes, and and Treatment for
international causes, and treatment for seizures.
classifications of treatment for seizures.
seizures are seizures.
Generalized, Non-
epileptic seizures and
Partial Seizures. A
person may have more
than type of seizures.
The symptoms can last
anywhere from a few
seconds to 15 minutes
per episode.
- Generalized
Seizures These
seizures occur
on both sides of
the brain and
affect both
sides of the
body.
Generalized
seizures include
grand mal or
tonic-clonic
seizures.
- These seizures
can occur if
you have
epilepsy, which
is a condition
that causes
repeated
seizures. This
type of seizure
happens on
only one side of
the brain. As a
result, one side
of the body is
affected during
a seizure. Other
names for
partial seizures
include focal,
Jacksonian, and
temporal lobe
seizures.
- Non-epileptic
seizures result
from an injury,
such as a blow
to the head, or
an illness.
When you get
treatment for
the condition,
the seizures go
away.
Symptoms:
Sometimes, symptoms
occur before the
seizure takes place.
These include:
- A sudden
feeling of fear
or anxiousness
a feeling of being sick
to your stomach,

dizziness, a change in
vision, a jerky
movement of the arms
and legs that may
cause you to drop
things, an out of body
sensation, and
headache.
Symptoms that indicate
a seizure is in progress
include: losing
consciousness, which
is followed by
confusion,
having uncontrollable
muscle spasms,
drooling or frothing at
the mouth, falling,
having a strange taste
in your mouth,
clenching your teeth,
biting your tongue,
having sudden rapid
eye movements,
making unusual noises,
such as grunting,
losing control of
bladder or bowel
function and having
sudden mood changes.
Causes: Seizures can

stem from a number of
health conditions.
Anything that affects
the body also may
disturb the brain and
lead to a seizure. Some
examples include:
alcohol withdrawal,
bites, stings, a brain
infection, such as
meningitis, a brain
injury during
childbirth, a brain

defect present at birth,

choking, drugs abuse,
drug withdrawal, an
electrolyte imbalance
and electric shock.
Treatment:
Treatments for seizures
depend on the cause.
By treating the cause
of the seizures, you
may be able to prevent
future seizures from
occurring. The
treatment for seizures
due to epilepsy
include:
- Medications
- surgery to
correct brain
abnormalities
- nerve
stimulation
- a special diet,
known as a
ketogenic diet
With regular treatment,
you can reduce or stop
seizure symptoms.
4 Define Dilantin Dilantin (phenytoin) is Ask the Patient will Patient has gains
an anti-epileptic drug, patient if he explain the knowledge about
also called an understands term Dilantin Dilantin.
anticonvulsant. It the term (phenytoin).
works by slowing Dilantin
down impulses in the (phenytoin).
brain that cause
seizures. Dilantin is
used to control
seizures. Phenytoin
does not treat all types
of seizures; Dilantin
may also be used for
purposes not listed in
this medication guide.

5 List the side The side effects of Ask the Patient will Patient has no
effects of Dilantin Dilantin: patient what explain what knowledge of what
- fever, swollen are the side the side effects the side effects of
glands, sore effects of of Dilantin are. Dilantin are.
throat, trouble taking
breathing, Dilantin.
painful mouth
sores, sores
around your
eyes; skin rash,
easy bruising or
bleeding,
severe
weakness;
severe muscle
pain;
- nausea,
vomiting, upper
stomach pain,
loss of appetite,
dark urine,
jaundice
(yellowing of
the skin or
eyes);
- bone pain
(especially in
your hips, legs,
or lower back),
trouble with
walking; or
- severe skin
reaction - fever,
sore throat,
swelling in
your face or
tongue, burning
in your eyes,
skin pain,
followed by a
red or purple
skin rash
- Severe muscle
pain; sh that
spreads

(especially in
the face or
upper body)
and causes
blistering and
peeling.
- Dizziness,
drowsiness,
confusion,
nervousness;
Tremors,
slurred speech,
loss of balance
or coordination;
Rash;
Abnormal eye
movement;
Headache; or
Sleep problems
(insomnia).
6 List the dosage of Dosage: Ask the Patient will Patient is
Dilantin - Oral (Adults): patient what explain the knowledgeable
Loading dose are the dosage dosage for about the dosage of
of 1520 mg/kg for taking Dilantin. Dilantin.
as extended Dilantin.
capsules in 3
divided doses
given every 24
hr; maintenance
dose 56
mg/kg/day
given in 13
divided doses;
usual dosing
range = 200
1200 mg/day.
- Intravenous
(Adults): Status
epilepticus
loading dose
1520 mg/kg.
Rate not to
exceed 2550
mg/min.
Maintenance

dosesame as
PO dosing
above.


PHARMOCOLOGY
PROGRESS NOTES
Date: 25.10.2017
DATE TIME REMARKS SIGNATURE
25.10.2017 2:00PM. Patient taken over laying in bed, confused, but

conscious and appears to be in no obvious respiratory
distress. Patient has a intravenous site in right hand, and
it is clean & dry. ___________________
2:25PM On initial contact patient verbalized that he is feeling
weak, tired, and he only feels pain when being turned,
so he requested that care be taken when turning him. A
neurological test was done. _______________________
2:30PM Patients vital signs:
Blood pressure 130/90___________________________
Pulse 80 beats per minute________________________
Respiration 22 breaths per minute__________________
Temperature 98 degrees__________________________
2:45PM. On further assessment, the following needs were found
to be affected: _________________________________
Elimination:
Patient stated that he has incontinence of bladder when
having a seizure. _______________________________
Rest, activity and comfort:
Patient verbalized that he has problems sleeping when
coming to the jumps (seizures), when he wakes up
from the event it is hard for him to fall back to sleep.
Patient needs assistance with movements/turns, and
therefore would need assistance with activities of daily
living due to weakness of his body._________________
Psychosocial:
Patient has little knowledge when it comes to the side
effects of his medication, and the precautions needed to
be taken in relation to his medication and
condition._____________________________________
2:55 P.M. Patient complained that the seizures are affecting him
from living a normal life._________________________
Nurses Plan of Care
Monitor Vitals ( 2-4 hr) 1st RN Student
If patient seizes, perform neurological test after S. King

Ensure medications are administered as ordered
Assist with activities of daily living
Turn patient every 2 hours
3:00 P.M. Offer emotional support
Refer to PRN__________________________________
Pt was taught on the topic Seizures and its medications
3:03 P.M.
where pt had stated what his definition of seizures
was._________________________________________
3:10 P.M Pt and his family were asked about how to maintain a
safe environment before and during seizures. The pt and
his family had a relative knowledge.________________
Pt was taught about the types, symptoms, causes and
3:18 P.M. treatment for seizures. The pt and his family had a
relative knowledge about the types, symptoms, causes
3:20 P.M. and treatment for seizures. _______________________
Pt was asked about the tablet Dilantin, pt had a relative
Knowledge of the tablets.________________________
3:24 P.M. Pt was asked about side effects of Dilantin, pt had no
knowledge of the side effects. The pt took what was said
into consideration and asked questions.______________
Pt was taught about the dosage of Dilantin. Pt responded
3:26PM. well to the information. Pt asked question about the
dosage he was receiving because he had little
knowledge of it.________________________________
Nurses Plan of Care
- Monitor Vitals ( 2-4 hours )
- Lies with staff nurse to ensure medications are
administered as ordered
- Assist with ADLs
- Turn patient every 2 hours
- Provide meals in keeping with recommended
diet
- Refer to PRN

References
https://medical-dictionary.thefreedictionary.com/deep+vein+thrombosis
https://www.news-medical.net/health/Types-of-Thrombosis.aspx
https://www.nhs.uk/conditions/arterial-thrombosis/Pages/Introduction.aspx
www.heart.org/.../What-is-Venous-Thromboembolism-VTE_UCM_479052_Article.js
https://www.healthline.com/health/deep-venous-thrombosis
https://www.nhs.uk/Conditions/Deep-vein-thrombosis/Pages/Causes.aspx
https://www.webmd.com/drugs/2/drug-3949/warfarin-oral/details
http://web.b.ebscohost.com/nrc/detail?vid=4&sid=0c692a76-4bcc-4ee0-
8d122f5e25288ed4%40sessionmgr101&bdata=JnNpdGU9bnJjLWxpdmU%3d#AN=200956541
4&db=nrc
https://www.drugs.com/dilantin.html

EVALUATION SHEET
CANDIDATE NO SOME FULL
PARTICIP PARTICIPATION PARTICIPATION
ATION
Did some assigned Submitted all
Did not work assigned work
produce
work Submitted work but Work submitted
same was was adequate or
Did not inadequate exceeded
submit work expectations
Work assigned had
No work to be completed by Participated fully in
done other group discussion and
members group activity
GRADE
ZER0 Showed minimal GRADE 1
interest in
discussion and
group activity

GRADE 0.5
RaeDawn Abbott
Oneka Adams
Nateisha Alexis
Corey Balcombe
Jameasha Ballantyne
Michella Hannaway
Ronessa Haddaway
Alsheka John
Rosamond John
Shaique King
Janeiata Lavia
Kimiesha Lavia

Assessment 2

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Assessment 2

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Batch 42 Pharmacology Drug Classification

Prepared by: Male Surgical Ward 1 01/11/2017

actions in different people.

themselves, a friend or a family member. Therefore, it is useful to have a basic understanding of

Prepared by: Male Surgical Ward 2 01/11/2017

ACTION & THERAPEUTIC EFFECT

responses to therapy require interpretation; extremely IMPORTANT since many drugs

PATIENT & FAMILY EDUCATION

Prepared by: Male Surgical Ward 4 01/11/2017

PATIENT ASSESSMENT TOOL

ASSESSMENT DATA YES NO COMMENTS

Prepared by: Male Surgical Ward 5 01/11/2017

Prepared by: Male Surgical Ward 6 01/11/2017

SVG COMMUNITY COLLEGE

PROFILE NEEDS ASSESSMENT NEED

History of Illness: Oxygen Need:

Diagnosis: Nutrition Need:

Lab Investigations: Elimination:

Medication: Rest, Activity & Comfort:

Prepared by: Male Surgical Ward 7 01/11/2017

SVG COMMUNITY COLLEGE

PROFILE NEEDS ASSESSMENT NEED

Safety & Security:

Prepared by: Male Surgical Ward 8 01/11/2017

ST. VINCENT AND THE GRENADINES COMMUNITY COLLEGE

Patients Name: M.G Age 61 Ward: F.M.W Date: 25.10.2017

Diagnosis Deep Vein Thrombosis of (R) leg and HTN

Needs Affected: Nutrition Need, Elimination, Rest, Activity & Comfort

ASSESSMENT DIAGNOSIS GOAL INTERVENTION EVALUATION

Prepared by: Male Surgical Ward 9 01/11/2017

Prepared by: Male Surgical Ward 10 01/11/2017

ST. VINCENT AND THE GRENADINES COMMUNITY COLLEGE

6. List 5 side effects of warfarin

Prepared by: Male Surgical Ward 12 01/11/2017

NOS. OBJECTIVES CONTENT TEACHER STUDENT EVALUATION

Prepared by: Male Surgical Ward 13 01/11/2017

- an area of skin that

5 Define Warfarin Warfarin is an Explain the Define what

6 List 3 side Side Effects of Warfarin State 3 side

7 List the dosage Dose for Deep Vein State the

Prepared by: Male Surgical Ward 14 01/11/2017

SVG COMMUNITY COLLEGE

DATE TIME REMARKS SIGNATURE

Prepared by: Male Surgical Ward 15 01/11/2017

Adults: 100mg q 5 min up to maximum of 1 gram.

Prepared by: Male Surgical Ward 17 01/11/2017

Hematologic and Lymphatic System

Prepared by: Male Surgical Ward 18 01/11/2017

Prepared by: Male Surgical Ward 19 01/11/2017

Prepared by: Male Surgical Ward 20 01/11/2017

PATIENT ASSESSMENT TOOL

ASSESSMENT DATA Yes No Comments

Has the patient ever N

Prepared by: Male Surgical Ward 21 01/11/2017

Using Maslows hierarchy Y

Construct a brief lesson Y

Prepared by: Male Surgical Ward 22 01/11/2017

Document specific content Y

While consulting with the Y

Prepared by: Male Surgical Ward 23 01/11/2017

SVG COMMUNITY COLLEGE

PROFILE NEEDS ASSESSMENT NEED

Name: J.G General Appearance/ Handing Over: