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5. If a seizure occurs, assess seizure activity, including
location and duration (see Chapter 58 for
management of seizures).
6. Protect the client from hazards in the environment
during a seizure.
C. Client education (Box 59-6)

D. Hydantoins: Fosphenytoin, phenytoin

1. Hydantoins are used to treat partial and generalized
tonic-clonic seizures.
2. Phenytoin is also used to treat dysrhythmias.
3. Side and adverse effects
a. Gingival hyperplasia (reddened gums
that bleed easily)
b. Slurred speech
c. Confusion
d. Sedation and drowsiness
e. Nausea and vomiting
f. Blurred vision and nystagmus
g. Headaches
h. Blood dyscrasias: Decreased platelet
count and decreased white blood cell
count
i. Elevated blood glucose level

4. Interventions

a. Alopecia or hirsutism
b. Rash or pruritus
c. Tube feedings may interfere with the
absorption of the enteral form of
phenytoin and diminish the
effectiveness of the medication;
therefore, feedings should be
scheduled as far as possible away from
the time of phenytoin administration.
d. Monitor therapeutic serum levels to
assess for toxicity.
e. Monitor for signs of toxicity.
f. When administering phenytoin
intravenously, dilute in normal saline,
because dextrose causes the
medication to precipitate.
g. When administering phenytoin
intravenously, infuse with an inline
filter and no faster than 25 to
50 mg/minute; otherwise, a decrease in
blood pressure and cardiac

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