An older adult who has an albumin level of 2.5 g/dl takes aspirin and phenytoin (Dilantin) by mouth daily. Which adverse effect of these medications does the nurse expect because of the older adult's nutritional status?
a. Depressed mood
b. Clay-colored stools
c. Increased heart rate
d. Gingival hyperplasia
B
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A Incorrect. Depression is a common adverse effect of antiseizure medication, es-pecially phenytoin, but is unrelated to hypoalbuminemia.
B Correct. Serum albumin at 2.5 g/dl is below normal, indicating that the older adult has hypoproteinemia. The medication is partially inactivated after absorp-tion because a percentage of it binds with serum proteins, especially albumin. If the older adult does not have an adequate serum albumin level, a greater per-centage of active medication circulates in the blood stream since an insufficient amount of albumin is available for binding; thus toxic levels can develop. When aspirin is taken by an individual, the inactivated form is excreted by the kidneys, and the liver metabolizes the active compound. However, an older adult with hypoalbuminemia exposes the liver to potentially toxic levels of aspirin that can lead to hepatotoxicity as evidenced by clay-colored stools.
C Incorrect. Tachycardia is not a commonly associated adverse effect of aspirin or phenytoin.
D Incorrect. Gingival hyperplasia is a common adverse effect of phenytoin, but it does not indicate toxicity, and it is unrelated to hypoalbuminemia.
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