Question

A nurse is planning care for a client who has status epilepticus. Which of the following interventions is the nurse's priority to include? 

Turn the client to the lateral position during seizure activity 

Administer diazepam intravenously to the client 

Provide the client oxygen at 6 U/min using a nasal Cannula 

Administer phenytoin IV bolus to the client 

Answer 1

1. B. Administer diazepam intravenously to the client. Status epilepticus is a seizure that lasts longer than 5 minute, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consiousness between episodes is called status epilepticus.

MANGEMENT OF STATUS EPILEPTICUS :

1. ABCDEFG ( ABC's and Don't Ever Forget the Glucose) 2. Airway :lateral decubitus, nasal trumpets, O2, suction 3. IV access. 4, Concurrently search for reversible cause

0-5 MINUTES :

First-line agents Lorazepam0.1 mg / kg IV, max 4mg, repeat once in 4 minute or Midazolam 10mg IM once.

10 to 15 minutes :   

Second- line agents Levetiracetam 60mg / kg IV (maximum 4500mg) or Fosphenytoin or Phenytoin 20mg / kg IV (max 1500mg) or Valporate 40mg / kg IV (3000mg)

Advanced airway management RSI   Preoxygenation :BVM Induction : propofol or "ketofol" Paralytics: Rocuronium if Suggamadex is available or seizure duration >25min; otherwise succinylccholine

15 to 20 min :

Refractory medications in status epilepticus

• Propofol : 2-5mg /kg IV, then infusion of 2-10mg /kg / hour
• Midazolam : 0.2mg /kg IV, then infusion of 0.05- 2mg /kg/ hr
• Ketamine : 0.5-3 mg /kg IV, then infusion of 0.3- 4mg /kg/ hr
• Lacosamide : 400mg IV over 15 minutes, then 200mg q 12h PO /IV
• Phenobarbitol : 15-20mg /kg IV at 50-75 mg / min
• Consider consulting anesthesia for inhaled anesthetic.