Question

Case Study 5 – Neurological disorders – chronic

Tegan Bailey is a 28-year-old woman with a past medical history of generalised Tonic Clonic seizures following a traumatic brain injury 6 years ago. The seizures have been well controlled up until now with Carbamazepine (Tegretol) 500 mg daily. After participating in a fitness class at her local gym she was found in the change rooms lying on the ground unconscious.  

Questions:

5a.       Discuss the difference between a Tonic Clonic seizure and an Absence seizure                                                            3 marks (1.5 Marks for each type of seizure)

5b.       You are doing a set of observations on Tegan when you notice that her body starts to stiffen and she becomes unresponsive, you suspect she is having another seizure. Outline the nursing interventions that you would perform during and post seizure.                                                                                       3 marks

5c.       As a consequence of this latest seizure activity Tegan is to be commenced on Sodium Valproate 200mg three times a day in addition to her Carbamazepine. Discuss and compare how each drug works.                         4 marks ( 2 marks per drug)

Answer 1

5 a: Discuss the difference between a Tonic Clonic seizure and an Absence seizure.

Tonic-clonic seizures: Also called grand mal seizures, can make a person

• Cry out.
• Lose consciousness.
• Fall to the ground.
• Have muscle jerks or spasms.

As consciousness returns, the person may be confused, drowsy, agitated or depressed. They may have a headache and want to sleep. This drowsiness can last for a numbers of hours. The person may vomit or bite their tongue and can sometimes injure themselves if they hit nearby objects as they fall or convulse.

Tonic-clonic seizures generally last one to three minutes. If the active movements of the seizure last more than five minutes, it is advisable to call an ambulance.

Absence seizure:

Absence seizures, sometimes called petit mal seizures, can cause rapid blinking or a few seconds of staring into space. Absence seizures start suddenly, cannot be interrupted, last a few seconds, and then stop suddenly. The person usually resumes what they are doing. Although these seizures last less than 10 seconds, they can occur many times daily. If they occur frequently, they can be very disruptive, such as in a learning environment.

5b ANSWER:

Nursing interventions during seizure activity

Ø Protect them from injury (remove harmful objects from nearby)

Ø Cushion their head

Ø Look for an epilepsy identity card or identity jewellery – it may give you information about their seizures and what to do

Ø Check the time how long the jerking lasts

Ø Aid breathing by gently placing them in the recovery position once the jerking has stopped

Ø Stay with the them until they are fully recovered

Ø Be calmly reassuring

Ø Don't restrain their movements

Ø Don't put anything in their mouth

Nursing interventions after seizure activity

Ø Stay calm and remain with the person.

Ø Keep them safe and protect them from injury.

Ø Reassure the person until they recover.

Ø Time the seizure, if you can.

Ø Gently roll the person onto their side after the jerking stops.

Ø Call for ambulance if the seizure lasts for 5 or more minutes or longer than what is normal for the person, the person is not responding for more than 5 minutes after the seizure ends and the person has breathing difficulties after the jerking stops

Ø Don't try to move them unless they are in danger

Ø Don't give them anything to eat or drink until they are fully recovered

5c ANSWER:

Sodium valproate is thought to reduce or prevent manic episodes by increasing the amount of a chemical called gamma-aminobutyric acid (GABA) in the brain. GABA blocks transmission across nerves in the brain and has a calming effect.

Carbamazepine works by stopping electrical signals from building up in the nerve cells in the brain. It also reduces the release of a chemical (neurotransmitter) called glutamate. Main mode of action is to block sodium channels during rapid, repetitive, sustained neuronal firing and to prevent post tetanic potentiation. It has been approved in the United States for the treatment of epilepsy since 1974
Carbamazepine (CBZ) is a major first-line AED for partial seizures and generalized tonic-clonic seizures. It is a tricyclic compound.