Nursing Process Focus: Patients Receiving Phenobarbital (Luminal)

Transcription

1 Assessment Prior to administration: Obtain complete health history, including allergies, neurological, pulmonary, cardiac, renal, biliary, and mental disorders including blood studies: CBC, BUN, creatinine, electrolytes, PT, PTT, liver enzymes, etc. Obtain patient s drug history to determine possible drug interactions and allergies. Assess neurological status, including identification of recent seizure activity. Nursing Process Focus: Patients Receiving Phenobarbital (Luminal) Potential Nursing Diagnoses Disturbed Sensory Perception, related to effects of drug Risk for Injury, related to seizure activity Imbalanced Nutrition: Less than Body Requirements, related to vitamin deficiency Deficient Knowledge, related to newly prescribed drug Disturbed Sleep Pattern, related to medication-induced somnolence Planning: Patient Goals and Expected Outcomes Patient will Experience the absence of, or reduction in the number or severity of, seizures. Avoid physical injury related to seizure activity or medication-induced somnolence. Demonstrate understanding of the drug's action by accurately describing drug effects and precautions. Implementation Patient Education/Discharge Planning Monitor vital signs, especially blood pressure and depth and rate of respirations. (Because phenobarbital produces sedation, respiratory depression occurs.) Phenobarbital may produce laryngospasm; keep resuscitative equipment accessible. *Perform neuro-checks regularly, including level of consciousness (LOC), according to unit protocol. Excessive somnolence may occur. Observe for persistent seizures. Patient Education/Discharge Planning monitor vital signs regularly, particularly blood pressure and respirations. withhold medication for any difficulty in breathing or respirations below 12 breaths per minute. report any significant change in sensorium: lethargy, stupor, or auras, visual changes and other effects that may indicate an impending seizure. report dizziness which may indicate hypotension.

2 *Monitor response to and effectiveness of drug therapy. *Ensure patient safety by monitoring ambulation until response of the drug is known. Elevate bed rails; place call bell within patient's reach. *Monitor for adverse reactions, especially due to CNS depression: confusion, agitation, nightmares, GI upset, lethargy, anxiety, cognitive changes, etc. (Changes in response to medication may indicate toxicity and requires evaluation.) Monitor for signs of vitamin deficiency. (Phenobarbital increases metabolism of the nutrients Vitamin D, Vitamin K, folate and other B vitamins. Vitamin D deficiency results in impaired bone synthesis. Vitamin K deficiency results in impaired blood coagulation, other deficiencies result in impaired cellular reproduction and repair, causing anemia.) Obtain consult with dietitian per health care provider's order as needed. Monitor for signs of hepatic or renal toxicity. (Phenobarbital is metabolized by the liver and excreted by the kidneys.) Monitor laboratory blood tests and urinalysis: CBC with differential, electrolytes, BUN, PT, PTT, liver enzymes, etc. (Impaired function results in increased serum drug levels.) *Use with caution in children, the elderly, and be aware that drug will cause initial drowsiness; this effect may diminish with continued therapy. avoid potentially hazardous activities that require mental alertness (driving, operating equipment etc.) bear in mind that full therapeutic effect of oral phenobarbital may take 2-3 weeks. not discontinue abruptly, or reduce dosage, as increased seizure activity and/ or withdrawal symptoms may occur. keep a seizure log or diary to chronicle symptoms. call for assistance when getting out of bed or attempting to walk. remove any tripping hazards from the home environment. *Instruct patient to immediately report any idiosyncratic or disabling effects. Instruct the patient or caregiver: regarding the role of vitamins and nutrition in maintaining health. Instruct the patient to immediately report signs of vitamin deficiency. Vitamin K: easy bleeding (nasal, oral, rectal, etc.), tarry stools, bruising, pallor. Vitamin D: Joint pain, bone deformities. Vitamin B6: skin changes, dandruff (seborrhea), peripheral neuropathy, fatigue. regarding intake of a nutrient-rich diet. observe for signs of toxicity: nausea, vomiting, diarrhea, rash, jaundice, abdominal pain, tenderness or distention, or change in color of stool, flank pain, hematuria. adhere to a regular schedule of laboratory testing for liver and kidney function as ordered by the health care provider. Instruct patient and caregiver:

3 those with pre-existing diseases, such as that children respond differently because respiratory disorders. These patients require their nervous systems are not yet fully reduced dosages. Paradoxical response to drug mature. may occur, which may cause psychomotor the elderly are more susceptible to the agitation (hyperactivity). effects of phenobarbital due to increased serum drug levels related to reduced efficiency of the liver and kidneys as a result of aging. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

4 Assessment Prior to administration: Obtain complete health history including allergies, developmental, neurological, pulmonary, cardiac, hematological, renal, biliary, and mental disorders including blood studies: CBC, BUN, creatinine, electrolytes, PT, PTT, liver enzymes, etc. Obtain patient s drug history to determine possible drug interactions and allergies. Assess neurological status, including identification of recent seizure activity. Assess growth and development. Nursing Process Focus: Patients Receiving Phenytoin (Dilantin) Potential Nursing Diagnoses Deficient Knowledge, related to drug regimen, action, and side effects Imbalanced Nutrition: Less than Body Requirements, related to nutrient deficiency Impaired Oral Mucous Membrane, related to drug effects Risk for Impaired Skin Integrity, related to adverse drug reaction Risk for Injury, related to drug side effects Planning: Patient Goals and Expected Outcomes The patient will: Report absence of seizure activity. Demonstrate understanding of drug action by accurately describing drug side effects and precautions. Demonstrate proper daily oral hygiene. Implementation Interventions and (Rationales) *In emergencies (status epilepticus) monitor ALL vital signs, including cardiac output, central venous pressure, etc. per Intensive Care Unit (ICU) or Emergency Department (ED) protocol). Monitor EKG during I.V. infusion of the drug. *Monitor neurological status, especially changes in level of consciousness and/or mental status. or chorea. (At high doses, phenytoin may produce respiratory depression and delirium. Phenytoin may have a paradoxical effect, producing involuntary movements such as dyskinesia or chorea.) Patient Education/Discharge Planning *Instruct the patient to immediately report: any difficulty breathing, palpitations, chest pain, dizziness or impending syncope. *Report any significant change in sensorium, such as slurred speech, confusion, hallucinations, or extreme lethargy. *Report any changes in seizure quality or unexpected involuntary muscle movement, such as twitching, tremor or nystagmus. *Avoid driving and other activities requiring mental alertness and physical coordination until effects of the medication are known.

5 *Monitor for adverse immune reaction, such as hypersensitivity syndrome and dermatological manifestations such as purpuric dermatitis or Stevens-Johnson syndrome. *Immediately report shortness of breath, wheezing, tightness in the throat, itching or any changes in the skin such as a measles-like ("morbilliform") rash or dermatitis, fever, joint pain, profound fatigue. *Call the health care provider immediately (before the next scheduled dose) for any adverse reaction. *Keep in mind that abrupt cessation of the drug can cause rebound seizures.

6 *Monitor effectiveness of drug therapy. *Observe for developmental changes indicating the need for dose adjustment. (Phenytoin needs increase with initial maturing, especially at puberty, a time of rapid growth.) *Use cautiously in the elderly. (Diminished kidney and liver function related to aging result in lowered drug clearance and increased serum drug levels.) *Monitor oral health. Observe for signs of gingival hypertrophy, bleeding, inflammation, etc. *Provide patient with information concerning contraceptive use. (Phenytoin may reduce the effectiveness of oral contraceptives.) *Monitor serum glucose and observe for signs of diabetes mellitus. (Phenytoin alters glycemic control and may cause hyperglycemia.) *Monitor laboratory tests such as CBC, BUN, Instruct patient to: *Keep a "seizure diary" during drug initiation phase, or during dose adjustment. *Take the medication exactly as ordered, including the same manufacturer's drug each time the prescription is refilled. Switching brands may result in alterations in seizure control. *Take a missed dose as soon as remembered, but do not double doses to "catch up" (doubling doses could result in toxic serum level.) Instruct patient to: Keep all appointments for follow-up lab studies. Report signs of toxicity to the health care provider immediately. *Use a soft toothbrush, and oral rinses as prescribed by the dentist. *Avoid mouthwashes containing alcohol, which dries mucous membranes. *Brush and floss teeth after every meal; massage the gums daily. *Report changes in oral health such as excessive bleeding or inflammation of the gums. *Maintain regular schedule of dental visits. *Remain abstinent or use reliable birth control while taking this medication. *Inform the health care provider if pregnancy occurs. *Avoid abrupt cessation of the drug; rebound seizures may cause harm to the fetus. *Phenytoin dose requirements increase during pregnancy. *Observe for subtle signs of hyperglycemia (e.g. polydipsia, polyuria, slow wound healing, etc.) *Regularly monitor blood and/or urine glucose levels as specified by the health care provider. *Adhere to a calorie-controlled low refined sugar (or ADA) diet as prescribed by the health care provider.

7 creatinine, electrolytes including serum calcium, urinalysis and liver enzymes to determine kidney and liver function. (Phenytoin is metabolized in the liver and excreted by the kidneys; impaired organ function can increase serum drug levels.) Include effects of phenytoin use on lab tests in teaching plan. Reduces free thyroxine levels. Reduces 17 keto-steroid levels. Decreases dexamethasone suppression values, and urine 6-b hydroxycortisol levels. *Monitor nutritional status. (Phenytoin's action on electrolytes at the cellular level [desensitizing sodium channels] contributes to decreased absorption of folic acid, vitamin D, magnesium and calcium. Folic acid deficiency leads to anemia; vitamin D, magnesium and calcium deficiencies lead to osteoporosis.) *Observe patterns of elimination. (Phenytoin's central nervous system depressant effects decrease gastrointestinal motility, producing constipation.) *Report shortness of breath, profound fatigue, pallor (signs of anemia.) *Report nausea, vomiting, diarrhea, rash, jaundice, abdominal pain, tenderness, distention, or change in color of stool. *Adhere to laboratory testing regimen for blood tests and urinalysis as directed. Inform the patient that: Phenytoin may cause false positive results on tests for hypothyroidism, ant other endocrine tests. The patient should notify laboratory personnel of phenytoin drug therapy when providing blood or urine samples. *Eat well balanced meals high in vitamins and nutrients. *Regularly take vitamin and mineral supplements (Vitamin D, folic acid, magnesium, and calcium) as recommended by the health care provider. Instruct patient to: *Take the drug with food to reduce gastrointestinal upset. *Immediately report any severe or persistent heartburn, upper G.I. pain, nausea or vomiting. *Increase exercise, fluid and fiber intake to facilitate stool passage. *Consult the health care provider regarding the need for a bulk laxative or stool softener for chronic constipation. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

8 Assessment Prior to administration: Obtain complete health history including allergies, neurological, hematological, pulmonary, cardiac, renal, biliary, and mental disorders including blood studies: CBC, BUN, creatinine, electrolytes, PT, PTT, liver enzymes, etc. Obtain patient s drug history to determine possible drug interactions and allergies. Assess neurological status, including identification of recent seizure activity. Assess mental status, including affect and lucidity. Assess gastrointestinal status, including identification of biliary tract or upper digestive discomfort. Assess growth and development. Nursing Process Focus: Patients Receiving Valproic Acid (Depakene) Potential Nursing Diagnoses Ineffective Health Maintenance, related to seizure activity Deficient Knowledge, related to drug action, and adverse effects Disturbed Thought Processes, related to bipolar disorder Imbalanced Nutrition: More than Body Requirements, related to weight gain Risk for Injury, related to drug side effects Planning: Patient Goals and Outcomes Patient will: Experience the absence of, or reduction in the number or severity of seizures. Avoid physical injury related to seizure activity or medication induced sensory changes. Demonstrate understanding of the drug's action by accurately describing drug effects and precautions. Maintain weight within expected range. Implementation Interventions and (Rationales) *Monitor neurological status, especially changes in level of consciousness and/or mental status. *Observe for signs of mania and/or mental depression. Obtain a verbal "no-self-harm" contract from patients with significant mental depression. *Ensure patient safety. Raise bed rails. Place call bell within patient's reach. (Postural Patient Education/Discharge Planning *Report any significant change in sensorium, such as diplopia, confusion, hallucinations, or psychomotor agitation. *Report any severe dysphoria, especially suicidal ideation. *Report any changes in seizure quality or unexpected involuntary muscle movement, such as twitching, tremor or nystagmus, or muscle weakness and profound lethargy. *Avoid driving and other activities requiring mental alertness and physical coordination until effects of the medication are known. *Call for assistance before getting out of bed or

9 hypotension related to CNS depressant effects of valproic acid may occur.) Monitor for adverse effects, including severe hepatotoxicity. Life-threatening hepatotoxicity may occur in the presence of vague symptoms such as fever, malaise, and lethargy. Monitor laboratory studies including CBC, chemistry panel, PT, PTT, liver enzymes, etc. *Observe for tremors. (Tremors may indicate the need for a reduced dosage.) *Monitor gastrointestinal status; observe for bleeding. (Valproic acid is a gastrointestinal irritant and anticoagulant.) *Conduct guiac stool testing for occult blood. *Monitor CBC for signs of anemia related to blood loss. *Monitor effectiveness of drug therapy. *Observe for developmental changes indicating the need for dose adjustment. (Valproic acid needs increase with initial maturing, especially at puberty, a time of rapid growth.) attempting to ambulate alone. *Avoid sudden changes of position to prevent dizziness caused by postural hypotension. *Remove tripping hazards from the home environment. *Review emergency actions and safety precautions when responding to a seizure. Immediately report fever, arthralgia, malaise, lethargy, pruritis, anorexia, nausea, diffuse abdominal pain, tenderness, distention or rigidity, jaundice, a change in the color and character of stools or urine. Explain that hepatotoxicity may have an insidious onset, so any vague "flu-like" illness, should be reported. *Instruct patient/caregiver to report tremors immediately to the health care provider. Inform the patient: That vomiting brown emesis that looks like coffee grounds or passing tarry stools are signs of gastrointestinal bleeding. To adhere to a regimen of laboratory testing as ordered by the health care provider. To keep all follow-up appointments as directed by the health-care provider. Instruct patient to: Immediately report frank bleeding or heartburn, nausea and vomiting with "coffee grounds" emesis, epistaxis, hematuria, melena, menorrhagia, excessive bruising, bleeding gums, weakness and pallor. Regarding the method of obtaining stool samples and home testing for occult blood as indicated by the health care provider. Instruct patient to: *Keep a "seizure diary" during drug initiation phase, or during dose adjustment. *Take the medication exactly as ordered, including the same manufacturer's drug each time the prescription is refilled. Switching brands may result in alterations in seizure control. *Take a missed dose as soon as remembered, but do not double doses to "catch up" (doubling

10 *Monitor renal status and urinary output. *Monitor BUN, creatinine, and urinalysis. *Monitor nutritional status. Observe for changes in appetite and eating patterns. *Use with caution in patients who are pregnant and lactating. As stated in the Prototype Drug box, this drug is pregnancy category D. *Use cautiously in the elderly. (Diminished kidney and liver function related to aging result in lowered drug clearance and increased serum drug levels.) doses could result in toxic serum level.) *Do not take within two weeks of an MAOI. * Report dysuria, oliguria, lower abdominal or flank pain, urine quality and color changes including hematuria. *Monitor fluid intake and output. *Adhere to a regular regimen of blood and urine testing as directed by the health care provider. Inform patient that valproic acid may cause both an increase in appetite and weight gain. Instruct the patient to consult with a nutritionist or dietician as directed by the health care provider. Encourage the patient to participate in a weight management and support group if desired. *Remain abstinent or use reliable birth control while taking this medication. *Inform the health care provider if pregnancy occurs. *Avoid abrupt cessation of the drug; rebound seizures may cause harm to the fetus. *Instruct patient to report changes in amount and characteristics of urinary output. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

11 Assessment Prior to administration: Obtain complete health history: neurological, hematological, pulmonary, cardiac, renal, biliary, and mental disorders including blood studies: CBC, BUN, creatinine, electrolytes, PT, PTT, liver enzymes, etc. Obtain patient s drug history to determine possible drug interactions and allergies. Assess neurological status, including identification of recent seizure activity. Assess mental status, including affect and lucidity. Assess gastrointestinal status, including identification of biliary tract or upper digestive discomfort. Assess growth and development. Nursing Process Focus: Patients Receiving Ethosuximide (Zarontin) Potential Nursing Diagnoses Deficient Knowledge, related to drug therapy, side effects and precautions Disturbed Thought Processes, related to side effects of drug Imbalanced Nutrition: Less than Body Requirements, related to weight loss Impaired Oral Mucous Membrane, related to drug side effects Risk for Injury, related to drug side effects Planning: Patient Goals and Expected Outcomes The patient will: Experience the absence of, or a reduction in, the number or severity of seizures. Avoid physical injury related to seizure activity or medication-induced sensory changes. Demonstrate understanding of the drug's action by accurately describing drug effects and precautions. Maintain intact mucous membranes.

12 Implementation Interventions and (Rationales) Patient Education/Discharge Planning *Monitor vital signs especially temperature Instruct patient: and respirations. *Regarding methods to monitor vital signs at *Observe respiratory patterns, especially home, especially temperature and respirations, during sleep. ensuring proper use of home equipment. *Elevated temperature may result from infection or indicate a blood disorder. *Snoring is NOT normal; it is a sound created by obstruction in the upper respiratory tract, and may signal sleep apnea. *Monitor neurological status, especially changes in level of consciousness and/or mental status. *Observe for psychosis and/or labile emotions, especially mental depression. *Obtain a verbal "no-self-harm" contract from patients with significant mental depression. *Report any significant change in sensorium such as visual changes (myopia), confusion, difficulty concentrating, hallucinations, or psychomotor agitation. *Report dizziness, headache, lethargy, fatigue, ataxia, sleep pattern disturbances or hiccups. *Report any changes in seizure quality or unexpected involuntary muscle movement. *Avoid driving and other activities requiring mental alertness and physical coordination until effects of the medication are known. *Instruct patient to report any severe dysphoria, especially suicidal ideation.

13 *Monitor for adverse hypersensitivity reaction, including dermatological manifestations/stevens-johnson syndrome. *Immediately report shortness of breath, wheezing, tightness in the throat, itching or any changes in the skin such as rash or dermatitis *Call the health care provider immediately (before the next scheduled dose) for any adverse reaction *Keep in mind that abrupt cessation of the drug can cause rebound seizures. *Monitor immune status. *Observe for signs of infection which may indicate insidious onset of blood dyscrasia: fever, sore throat, malaise, joint pain, ecchymoses, profound fatigue, shortness of breath, pallor, etc. *Monitor laboratory tests such as CBC, BUN, creatinine, electrolytes, (including serum calcium), PT, PTT, liver enzymes and urinalysis, to determine kidney and liver function. (Ethosuximide is metabolized in the liver and excreted by the kidneys; impaired organ function may result.) Instruct the patient or caregiver: *To immediately report any "flu-like" symptoms: shortness of breath, fever, sore throat, malaise, joint pain, profound fatigue, etc. *Flu-like symptoms may herald the "silent" onset of serious blood disorder, such as bone marrow suppression. *Bruising is a sign of bleeding which can also indicate the presence of a serious blood disorder. *Immediately report any distressing symptoms to the health care provider. *Adhere to laboratory testing regimen for blood tests and urinalysis as directed by the health care provider. *Monitor renal function. *Observe for signs of nephrotoxicity, including oliguria and pitting edema. *Monitor laboratory values (see previous box above). *Monitor fluid intake and output. *Immediately report changes in urine color, character or output (hematuria, oliguria, cloudiness, etc.) *Immediately report nausea, fever, malaise and/or flank pain.

14 *Monitor gastrointestinal status. *Observe for signs of gastrointestinal bleeding or hepatic toxicity. *Monitor gastrointestinal elimination; conduct guiac stool testing for occult blood. *Monitor nutritional status. *Observe for weight loss secondary to anorexia. *Monitor effectiveness of drug therapy. *Observe for developmental changes indicating the need for dose adjustment. (Ethosuximide needs increase with initial maturing, especially at puberty, a time of rapid growth.) *Use cautiously in the elderly. (Diminished kidney and liver function related to aging result in lowered drug clearance and increased serum drug levels.) Instruct the patient: *Report any frank bleeding, abdominal pain, anorexia, heartburn, nausea, vomiting, jaundice or a change in the color or character of stools. *Vomiting brown emesis that looks like coffee grounds or passing tarry stools are signs of gastrointestinal bleeding. *Regarding the method of obtaining stool samples and home testing for occult blood as indicated by the health care provider. *Adhere to a regimen of laboratory testing as ordered by the health care provider and keep all follow-up appointments as scheduled. Instruct patient: *To measure body weight weekly. *To inform the health care provider of losses, especially greater than two pounds. *Regarding measures to enhance weight maintenance and appetite: small frequent meals, calorie-dense snacks, nutritional supplement drinks, etc. *To consult with a nutritionist or dietician as ordered by the health care provider. *Take the medication exactly as ordered, including the same manufacturer's drug each time the prescription is refilled. Switching brands may result in alterations in seizure control. *Take a missed dose as soon as remembered, but do not double doses to "catch up" (doubling doses could result in toxic serum level.) *Instruct the patient to report symptoms of drug toxicity such as visual changes, hallucinations, headache, or dizziness. *Inform patient of need to use alternate forms of birth control. (Drug may decrease *Remain abstinent or use reliable birth control effectiveness of oral contraceptives.) while taking this medication. *Inform the health care provider if pregnancy occurs. *Avoid abrupt cessation of the drug; rebound seizures may result. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).

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16 Nursing Process Focus: Patients Receiving Diazepam (Valium) NOTE: this information is specific to the use of diazepam as a treatment for epilepsy only, not to other uses, such as anxiety. Assessment Potential Nursing Diagnoses Prior to administration: Ineffective Airway Clearance, related to Obtain patient s drug history to determine sedative effect of drug possible drug interactions and allergies, Risk for Injury, related to sedative effect of including history of anti-seizure drug drug therapy and alcohol or tobacco use. Acute Confusion, related to drug side Assess neurological status, including effects LOC. Identify type and etiology of recent Risk for Impaired Skin Integrity, related to seizure activity. adverse drug reaction Assess growth and development, Disturbed Sensory Perception, related to including age, body mass index, and drug side effect pregnancy/lactation status. Deficient Knowledge, related to drug Assess skin integrity and identify action, side effects locations for venipuncture/intravenous drug administration; insert intravenous catheter and I.V. line if not present. Obtain complete health history: neurological, pulmonary, cardiac, hematologic, renal, biliary, and mental disorders and including laboratory values: serum anticonvulsant level, CBC, BUN, creatinine, electrolytes, PT, PTT, and liver enzymes. Note: *Diazepam is given in response to status epilepticus, a medical emergency. Obtain as much key data as possible. Planning: Patient Goals and Expected Outcomes Patient will: Maintain a patent airway and adequate tissue perfusion. Experience the cessation of tonic-clonic seizures of status epilepticus. Avoid serious physical injury related to status epilepticus. Experience the return of normal consciousness and achieve stable neurological status. Demonstrate an understanding of the drug's action by accurately describing drug effects and precautions. Implementation Interventions and (Rationales) *Monitor respiratory rate and breathing pattern, as well as pulse oximetry and/or arterial blood gases. *Place an oral airway, or assist with intubation as needed. Provide suction Patient Education/Discharge Planning *Instruct patient and caregivers that keeping an open airway and having sufficient oxygen is necessary to prevent permanent brain damage, which may occur related to status epilepticus.

17 between seizures. Administer oxygen as ordered. Keep resuscitative equipment accessible. *Monitor all vital signs, including temperature, cardiac output and central venous pressure per Intensive Care Unit or Emergency Department protocol. Monitor EKG during I.V. infusion. *Observe for severe respiratory depression and bradycardia. (Diazepam is a CNS depressant which affects cardiorespiratory status.) Instruct caregivers: That status epilepticus is a life threatening emergency and that direct IV administration of diazepam also has risks such as respiratory and cardiac depression or arrest. Reassure that all necessary measures are being taken to preserve life and neurologic function. *Monitor neurological status. Observe for changes in level of conscious. (Status epilepticus generally causes loss of consciousness; patients are at risk of entering a coma due to increased cerebral metabolic demand.) *Observe for rebound seizures. (Diazepam is very short-acting.) *Monitor metabolic status. (Increased temperature increases metabolic demands; lactic acidosis may follow generalized motor seizures as common in status epilepticus.) *Monitor fluid and electrolyte balance and intake and output. (Electrolyte imbalances may precipitate status epilepticus.) *Ensure patient safety. Place patient in semiprone position, with head turned to reduce the risk of aspiration. Use padded cot sides. Remove any restrictive clothing. Anchor IV lines per unit protocol. Instruct patient/caregiver to: Always take anti-seizure medication exactly as prescribed. Inform the health care provider of any other illness; don't self-medicate with OTC medications. Avoid using alcohol, tobacco and recreational drugs. *Advise caregivers regarding variations in fluid and electrolytes which may increase susceptibility to seizures. Instruct patients and caregivers to: Review standard safety precautions regarding seizure activity. Discuss guidelines for seizures requiring emergency intervention and transport to a hospital. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning ).