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P A R T 4
Drugs acting on the central and peripheral nervous systems
What therapeutic goals might the nurse set with L.G. and
his caregiver? How might these be evaluated?
What additional drug-related information should be posted
in the group home and reviewed with L.G. and his
caregivers?
DISCUSSION
In the first visit to the home, the nurse needs to establish
a relationship with L.G. and his caregivers. They should all
realise that drug therapy, and other measures, are needed
to help L.G. attain his full potential and make use of his
existing assets. Step-by-step therapeutic goals should be
established and written down for future reference. Small
reachable goals, such as partially dressing himself, walking
to the table for meals, and managing parts of his daily
hygiene routine are best at the beginning. Written goals
provide a good basis for future evaluation when drug
therapy is stopped briefly to determine its therapeutic
effectiveness. It also helps L.G. to see progress and
improvement.
In addition, the nurse should perform a complete
examination to obtain baseline data. The person should
be asked about any noticeable changes or problems since
starting the drug. If improvement appears to have occurred,
the dosage may be slowly increased until the optimal level
of functioning has been achieved. The nurse is in a position
to evaluate this and report it to the primary caregiver.
While in the home, the nurse can also evaluate
resources and environmental limitations and suggest
improvements (e.g. use of leg braces). L.G. and his
caregivers should receive a drug teaching card that includes
a telephone number to call with questions or concerns;
warning signs of liver disease; and a list of findings to
report. The nurse should discuss anticipated appointments
for liver function tests to ensure that L.G. can keep the
appointments. The healthcare team should work closely
with L.G. to maximise his involvement in his care and to
minimise unnecessary problems and confusion. Because
the treatment involves a long-term commitment, a good
working relationship among all members of the healthcare
team is important to ensure continuity of care and optimal
results.
CARE GUIDE FOR L.G.: MUSCLE RELAXANTS
Assessment: History and examination
Concentrate the health history on allergies to any skeletal
muscle relaxants, respiratory depression, muscle
weakness, hepatic or renal dysfunction, and concurrent
use of verapamil or alcohol.
Focus the physical examination on the following:
CV: blood pressure pulse rate, peripheral perfusion, ECG
CNS: orientation, affect, reflexes, grip strength
Skin: colour, lesions, texture, temperature
GI: abdominal examination, bowel sounds
Respiratory: respiration, adventitious sounds
Laboratory tests: renal and hepatic function
Implementation
Discontinue drug at first sign of liver dysfunction.
Provide comfort and safety measures: positioning,
orientation, safety measures, pain medication as needed.
Provide support and reassurance to help L.G. deal with
spasticity and drug effects.
Teach L.G. about drug, dosage, drug effects and symptoms
of reportable serious adverse effects.
Evaluation
Evaluate drug effects: relief of spasticity, improved daily
function.
Monitor for adverse effects: multiple CNS effects, respiratory
depression, rash, skin changes, GI problems (diarrhoea,
hepatotoxicity), urinary urgency or weakness.
Monitor for drug–drug interactions: myocardial suppression
with verapamil or alcohol.
Evaluate effectiveness of teaching program.
TEACHING FOR L.G.
• The drug prescribed for you is a direct-acting skeletal
muscle relaxant called dantrolene (
Dantrium
). This drug
makes spastic muscles relax. Because this drug may cause
liver damage, it is important that you have regular medical
check-ups.
• Common side effects of skeletal muscle relaxants, such as
dantrolene, include:
•
Fatigue, weakness and drowsiness:
Try to pace activities
evenly throughout the day and allow rest periods to
avoid discouraging side effects. If they become too
severe, consult your healthcare provider.
•
Dizziness and fainting:
Change position slowly to avoid
dizzy spells. If these effects should occur, avoid activities
that require coordination and concentration.
•
Diarrhoea:
Be sure to be near bathroom facilities if this
occurs. This effect usually subsides after a few weeks.
• Report any of the following to your healthcare provider:
fever, chills, rash, itching, changes in the colour of your urine
or stool, or a yellowish tint to the eyes or skin.
• Keep this drug and all medications out of the reach of
children.
• Do not overexert yourself when you begin to feel better.
Pace yourself.
• Take this drug exactly as directed and schedule regular
medical checkups to evaluate the effects of this drug on
your body.
