Download NURSING PROCESS FOCUS: Patients Receiving Levodopa

NURSING PROCESS FOCUS:
Patients Receiving Levodopa (Larodopa)
Potential Nursing Diagnoses
Assessment
Prior to administration:
•
Falls, risk for
• Obtain complete health history including
•
Knowledge deficit related to
allergies, drug history and possible drug
medication effects
interactions.
•
Mobility, impaired
• Obtain baseline evaluation of severity of
•
Self-care deficit, ADLs, feeding,
Parkinson’s disease to determine
toileting
medication effectiveness.
•
Constipation
• Obtain baseline vital signs, especially
blood pressure and pulse
Planning: Patient Goals and Expected Outcomes
Patient will
• Report increased ease of movement and decreased symptoms of Parkinson’s disease
• Demonstrate an understanding of the drug’s action by accurately describing drug side effects
and precautions, and measures to take to decrease any side effects
• Immediately report side effects and adverse reactions
• Adhere to the medication regimen
Implementation
Interventions and (Rationales)
Patient Education/Discharge Planning
●
●
●
●
●
Monitor vital signs closely when
levodopa dose is being adjusted.
(Hypotension could occur as result of
dose adjustment. Dysrhythmias can occur
in patients predisposed to cardiac
problems.)
Provide for patient safety. (Orthostatic
hypotension may occur.)
Instruct patient to:
• Report signs of hypotension, dizziness,
light-headedness, feelings that heart is
racing or skipping beats, or dyspnea
• Have routine EKGs and vital signs taken
Instruct patient:
• To change position slowly and to resume
normal activities slowly.
• How to protect self from falls.
Monitor for behavior changes. (Drug
Instruct patient and caregiver to:
increases risk of depression or suicidal
• Watch for and report immediately any
thoughts, and may cause other mood
signs of changes in behavior or mood.
disturbances such as aggressiveness and
• Seek counseling or a support group to help
confusion.)
deal with these feelings; assist patient to
find such resources if needed.
Monitor for symptoms of overdose.
• Instruct patient or caregiver to be aware of
(Muscle twitching and blepharospasm are
newly occurring muscle twitching,
early symptoms.)
including muscles of eyelids and to report
immediately.
Monitor for improved functional status
• Instruct patient or caregiver to report rapid,
followed by a loss of therapeutic effects
unpredictable changes in motor symptoms
(on-off phenomenon), due to changes in
to healthcare provider immediately, and
dopamine levels that may last only
that this can be corrected with changes in
●
●
minutes, or days. (Usually occurs in
patients on long-term levodopa therapy.)
Evaluate diet. (Absorption of levodopa
decreases with high protein meals or high
consumption of pyridoxine-containing
foods.)
levodopa dosage schedule.
Instruct patient to:
• Take on empty stomach, but food may be
eaten 15 minutes after, to decrease GI
upset.
• Avoid taking levodopa with high protein
meals.
• Avoid high consumption of foods
containing vitamin B6 (pyridoxine) such as
bananas, wheat germ, green vegetables,
liver, legumes.
• Watch for vitamin B6 in multivitamins,
fortified cereals, and antinauseants, so
these products should be avoided.
Monitor glucose levels in patients with
Instruct diabetic patient to:
diabetes mellitus. (Loss of glycemic
• Consistently monitor blood glucose both
control may occur in the diabetic patient.)
by self and with periodic lab studies.
• Report symptoms of hypo- or hyperglycemia.
●
Monitor for decreased kidney or liver
• Instruct patient to keep all appointments
function. (Decrease in these functions
for liver and kidney function tests during
may slow metabolism and excretion of
therapy.
drug, possibly leading to overdose or
toxicity.)
●
Monitor for side effects in the elderly.
• Instruct elderly patients to report any
(Elderly patients may experience more
symptoms involving cardiovascular
rapid and severe side effects, especially
system: changes in heart rate, dizziness,
those affecting cardiovascular system.)
faintness, edema, or palpitations.
●
Monitor for other drug-related changes.
• Inform patient that urine may darken and
(Drug may cause urine and perspiration
sweat may be dark colored, but not to be
to darken in color, but it is not a sign of
alarmed.
overdose or toxicity.)
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes have been met (see “Planning”)
Nursing Process Focus:
Patients Receiving Benztropine (Cogentin)
Assessment
Prior to administration:
• Obtain complete health history including
allergies, drug history and possible drug
interactions.
• Obtain baseline of severity of Parkinson’s
symptoms to determine effectiveness.
• Assess for use of other medications,
• Obtain lab work to include a complete
blood count, liver and renal function studies
• Obtain baseline vital signs, especially pulse.
Potential Nursing Diagnoses
• Constipation, risk for related to side
effects of drug
• Injury, risk for related to effects of drug
• Risk for imbalanced body temperature
• Sleep pattern, disturbed, insomnia or
extreme drowsiness related to action of
drug
• Therapeutic regimen management,
ineffective
• Urinary retention relation to side effect of
drug
Planning: Patient Goals and Expected Outcomes
Patient will
• Experience relief of Parkinson’s symptoms or EPS due to anti-psychotic medications
• Immediately report any occurrence of adverse reactions
• Demonstrate an understanding of the drug’s action by accurately describing drug side
effects and precautions, and measures to take to decrease any side effects
• Maintain compliance with drug regimen
• Maintain normal bowel pattern
Implementation
Interventions and (Rationales)
Patient Education/Discharge Planning
• Monitor adherence to recommended
• Instruct patient to take benztropine as
therapy. Benztropine should be begun with
ordered, unless side effects occur; then
low dose, then gradually increased.
notify health care provider that it usually
takes 2-3 days before desired effect will be
noticed
• Monitor proper storage of benztropine.
• Advise patient to store benztropine in
tightly covered, light resistant container at
moderature room temperature.
• Monitor environmental temperature.
• Advise patient to avoid strenuous activity
(Patient will have decreased ability to
in hot weather, to plan rest periods, and to
tolerate heat, and may develop heat stroke.)
avoid strenuous activity during heat of day
to decrease risk of heat stroke.
Instruct patient to:
• Monitor patient’s ability to void, as well as
intake and output. (Benztropine can cause
• Report infrequent voiding, or feeling of
urinary hesitation or retention, secondary to
fullness after emptying the bladder
its anticholinergic effect.)
• Keep a record of intake and output with
times of occurrence, and to report
imbalance in intake and output
• Monitor drug use in elderly. (Increased
Instruct patient to:
• Disclose any history of psychiatric
problems or other medication use to all
health care providers
• Report urinary problems, blurred vision,
constipation, dry skin, nausea, vomiting,
drowsiness, dysphagia, photophobia
• Advise patient to report any drowsiness.
•
•
•
Evaluate medication regimen for drugs that
interact with benztropine. (Concurrent use
of phenothiazines causes increased risk of
adverse anticholinergic effects; patient will
need decreased phenothiazine dose, and
close monitoring for worsening symptoms
of psychiatric disorder.)
sedative effects of benztropine may occur
and lower doses may be needed.)
Monitor for anticholinergic effects such as
dry mouth.
Teach patient measures to use sugarless
hard candy or gum, frequent drinks of
water, frequent rinsing of mouth.
Review with patient and family:
• Observe for increased symptoms of
Parkinson’s or EPS. (If involuntary
• Exactly how to take medication.
movements or increased rigidity occur,
• To report increased muscle rigidity,
medication levels may not be therapeutic.)
difficulty changing position, muscle
spasms or other involuntary movements
Advise patient to:
• Monitor for constipation and for signs of
paralytic ileus. (This may be caused by
• Take benztropine after meals to decrease
decreased GI motility due to drug’s
GI irritation
anticholinergic effects.)
• Decrease constipation by increasing fluids,
fruits and vegetables, exercise if possible
• Report signs of paralytic ileus (abdominal
pain, intermittent constipation, abdominal
distention, nausea, and vomiting)
• Observe for unsafe activities. (Benztropine • Instruct family to supervise ambulation
may cause sedation or dizziness.)
until response to medication is known
• Advise patient not to drive until response
to medication is known
• Monitor for symptoms of overdose. (Some
• Advise patient to report immediately:
adverse reactions may result from atropinehallucinations, confusion, disorientation,
like toxicity, and may be eliminated by
delusions, anxiety, hyperthermia,
lowering dose of benztropine.)
tachycardia, increased respirations.
Evaluation of Outcome Criteria
Evaluate the effectiveness of drug therapy by confirming that patient goals and expected
outcomes have been met (see “Planning”).