EP is a 26-year-old female resident of a group home for adults with developmental delays.  She has a history of well co

EP is a 26-year-old female resident of a group home for adults with developmental delays.  She has a history of well controlled seizures and depression.  She works in a community workshop and functions largely independently with supervision.

Current medications:

Mirtazepine [Remuron®] 15 mg po at bedtime

Depakote ER®500 mg po bid

She occasionally asks for Tylenol for headaches.

Today her work supervisor is concerned because she seems confused and agitated and too restless to do her job.  This is new behavior for her.  This morning the person giving medications reported that EP was accidently given a dose of tramadol 50 mg intended to another client.  She is hypertensive and tachycardic, and some tremors are noted.

What may be occurring and how should the nurse evaluate the patient and anticipate treatments if any are indicated?

What nursing steps could be done to prevent future mishaps?