The nurse is caring for a female client newly diagnosed with epilepsy who has been prescribed phenytoin. Which of the following should the nurse include in client teaching? Select all that apply.

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Epilepsy is characterized by chronic seizure activity. Clients typically require lifelong anticonvulsant medication. The nurse should provide education about identifying and avoiding seizure triggers, such as excessive alcohol intake, sleep deprivation, and stress (Option A). Practicing relaxation techniques (eg, biofeedback) may help reduce the number of episodes. The client should also be encouraged to wear an epilepsy medical identification bracelet in case of emergency (Option D). Phenytoin (Dilantin), a hydantoin anticonvulsant, may decrease the effectiveness of some medications (eg, oral contraceptives, warfarin) due to stimulation of hepatic metabolism. An alternate, nonhormonal birth control method (eg, condoms, copper intrauterine device) should be used in addition to or instead of oral contraceptives (Option E). Clients should discuss pregnancy plans with their health care provider, as phenytoin can cause fetal abnormalities (eg, cleft palate, heart malformations, bleeding disorders). Clients taking phenytoin should also receive education about practicing good oral hygiene as gingival hyperplasia is a potential complication. Anticonvulsants should not be stopped abruptly, as this increases the risk of seizure (Option B). (Option C) For a client with epilepsy, it is not necessary to go to an emergency department after a seizure, unless status epilepticus (ie, prolonged, repeated seizures) occurs or the client is injured. Educational objective: Clients prescribed phenytoin should receive education about the potential need for nonhormonal birth control as well as the importance of good oral hygiene and not abruptly stopping anticonvulsants. Other teaching for epilepsy includes avoiding seizure triggers and wearing a medical identification bracelet.

The Nurse Is Caring for a Female Client Newly Diagnosed