Question

Part 3

T.A. is a 37-year-old woman who presents to the emergency department after having a seizure.

Subjective Data
PMH: Seizures, unknown type
Headache
Housewife
Feels weak
No loss of consciousness

Objective Data
Vital signs: T 99.1, P 72, R 18, BP 114/64
Lungs: clear all bases
O₂ Sat = 100%
CV = heart rate regular, positive peripheral pulses
PERRLA

Questions

1. What other questions should the nurse ask about the seizures?
2. What other assessments are necessary for this patient?
3. What are some of the causes of seizures?
4. Develop a problem list from objective and subjective data.
5. What should be included in the plan of care?
6. What other risk factors are associated with this presentation?
7. Based on the readings and the subjective and objective data, this patient most likely had what type of seizure?

Answer 1

Solution 1.

✓ When did you experience a first seizure in your life?

✓ Do you experience some kind of warning or the unusual feeling at the onset or immediately preceding seizure?

✓ What happens during the seizure?

✓ What happens immediately following the seizure?

✓ Is there any diurnal variation?

✓ Are there any known triggering factors?

✓ What is the frequency of seizure?

✓ What has been the maximum seizure-free period since the seizure onset?

✓ Has any sustained injuries related to seizures?

✓ What is the frequency of visit to the emergency department?

✓ About family history of the seizure?

Solution 2.

✓Check for the marks or any ulceration on the side of the tongue/ mucous membrane of oral cavity as can be seen with the seizures.

✓Neurological examinations

*Lab investigations:-

Hyponatremia, hypoglycemia, hypomagnesemia, uremia and hepatic encephalopathy can precipitate the seizures

Checking serum electrolytes along with glucose, calcium, magnesium, blood urea nitrogen, creatinine, and the liver function tests.

Neuroimaging

EEG (electroencephalogram)

Solution 3.

Most often idiopathic,

head trauma,

brain tumors,

intracranial infection,

cerebral degeneration,

high fever,

stroke,

congenital brain malformations etc.

Solution 4.

i)Acute Pain

ii)Fatigue

iii)Activity Intolerance

iv)Impaired Physical Mobility

Solution 5.

• Don't leave the patient unattended.
• Maintain patent airway.
• Ensure the side rails are raised.
• Remove surrounding objects that may cause the injury.
• Administration of medications as prescribed.

Same as like that of management and other interventions we have to give priority to the education of patient.

• Instruct patient and family what to do in case of seizure, what to observe and report.
• Instruct the patient to avoid circumstances that would precipitate seizures; e.g., stress, disruptions in regular sleep patterns and irregular eating etc. Fever, hypoxia, electrolyte disturbance and Cardiac disturbance also bring on a seizure.
• Anticonvulsant medication must be taken as ordered, and physician follow-up is important.
• Refer patient to local Epilepsy Foundation support group for a community resource.

Solution 6.

Many abnormalities of the nervous system can result in seizure activity.

Seizures can also occur in the normal nervous system when there is disturbance in metabolic state.

The cause of epilepsy may be not clearly known (i.e idiopathic) or related to a particular disease state.

Solution 7.

It may be a case of Psychogenic Non-Epileptic Seizures (PNES), Psychogenic Non-Epileptic seizures can occur at any age, but are more common in people leads than age of 55. They occur three times more frequently in women( female) than in men(male). They may arise from various psychological factors, may be prompted by stress, and may occur in response to the suggestion, and are often misdiagnosed as epileptic seizures; however, PNES are psychological (i.e., emotional, stress-related) in origin.