The nurse is completing discharge teaching to a patient following hospitalization for a seizure disorder who is being prescribed phenytoin (Dilantin). What should the nurse include in these instructions?

Question

1. "Maintain good oral hygiene, use a soft toothbrush, massage the gums, and floss daily."
2. "Carry identification indicating the type of seizures for which you are being treated."
3. "You will need to have your sodium level monitored."
4. "If you skip a dose, make sure you double the dose the next day."

Answer 1

Correct Answer: 1
Phenytoin causes gingival hyperplasia, which results in soft, enlarged gums that are prone to bleeding. Oral hygiene using a soft toothbrush, massaging the gums, flossing daily, and scheduling regular dental checkups are included in discharge teaching. Carrying identification about the seizure disorder is important but not specific to the patient on phenytoin. Liver function studies and serum calcium levels should be monitored to avoid liver problems and bone demineralization, which are characteristic of phenytoin. Blood levels of antiseizure drugs should be maintained so taking the exact dosage as prescribed is important. Patients should not alter the daily dose without discussing this with their primary care provider.