wear a medical information bracelet. The patient and family need to be educated about
medications as well as care during a seizure.
Monitoring and Managing Potential Complications
Status epilepticus, the major complication, is described later in this chapter. Another
complication is the toxicity of medications. The patient and family are instructed about
side effects and are given specific guidelines to assess and report signs and symptoms
that indicate medication overdose. Many antiseizure medications require careful
monitoring for therapeutic levels. The patient should plan to have serum drug levels
assessed at regular intervals. Many known drug interactions occur with antiseizure
medications. A complete pharmacologic profile should be reviewed with the patient to
avoid interactions that either potentiate or inhibit the effectiveness of the medications.
Promoting Home and Community-Based Care
Teaching Patients Self-Care
Thorough oral hygiene after each meal, gum massage, daily flossing, and regular dental
care are essential to prevent or control gingival hyperplasia in patients receiving
phenytoin (Dilantin). The patient is also instructed to inform all health care providers of
the medication being taken, because of the possibility of drug interactions. An
individualized comprehensive teaching plan is needed to assist the patient and family to
adjust to this chronic disorder. Written patient education materials must be appropriate
for the patient's reading level and must be provided in alternative formats if warranted
(Murphy, Chesson, Berman et al., 2001). See Chart 61-5 for home care instruction
points.
Continuing Care
Because epilepsy is a long-term disorder, the use of costly medications can create a
significant financial burden. The Epilepsy Foundation of America (EFA) offers a mail-
order program to provide medications at minimal cost and access to life insurance. This
organization also serves as a referral source for special services for people with
epilepsy.
For many, overcoming employment problems is a challenge. State vocational
rehabilitation agencies can provide information about job training. The EFA has a
training and placement service. If seizures are not well controlled, information about
sheltered workshops or home employment programs may be obtained. Federal and state
agencies and federal legislation may be of assistance to people with epilepsy who
experience job discrimination. As a result of the Americans with Disabilities Act, the
number of employers who knowingly hire people with epilepsy is increasing, but
barriers to employment still exist (Bader & Littlejohns, 2004).
People who have uncontrollable seizures accompanied by psychological and social
difficulties can be referred to comprehensive epilepsy centers where continuous audio-
video and EEG monitoring, specialized treatment, and rehabilitation services are
available (Bader & Littlejohns, 2004). Patients and their families need to be reminded
of the importance of following the prescribed treatment regimen and of keeping follow-
up appointments. In addition, they are reminded of the importance of participating in
health promotion activities and recommended health screenings to promote a healthy
lifestyle. Genetic and preconception counseling is advised.
Evaluation
Expected Patient Outcomes
Expected patient outcomes may include the following: