Question

121L Unfolding Case Study

Austin is a 19-year-old college student with a history of epilepsy since childhood; the cause of his seizures have never been identified. His epilepsy has been well controlled on phenytoin (Dilantin). Today while walking to classes, Austin falls to the ground seizing. His friends call for an ambulance, and Austin is brought into the emergency department (ED). On arrival, Austin is drowsy and confused. Two of his friends arrive in the ED shortly after.

Fill-in
Since the cause of Austin’s seizures is unknown, he would be classified as having ________________________________________ epilepsy.

Select all that apply

Identify other potential causes of seizures:

1. Diabetes
2. Head injuries
3. Fever
4. Lung cancer
5. Brain tumors
6. Central nervous system infections
7. Excessive smoking

The nurse questions Austin’s friends about what happened before, during, and after the seizure. The friends reported that they were just walking to class when Austin fell to the ground, became very stiff, and his arms and legs began convulsing. They tried to hold him so that he would not hurt himself. They also noticed that his mouth was clamped shut, and he had saliva coming from the corner. After the seizure stopped, Austin was breathing heavily, and they saw blood in his mouth.

Fill-in
Based upon the information provided by Austin’s friends, this would be classified as a ______________________________ seizure.

Fill-in
Briefly explain the pathophysiology underlying seizures:

Select all that apply
Identify clinical manifestations associated with generalized seizures:

1. Epileptic cry
2. Tonic-clonic contraction
3. Unintelligible speech
4. Excessive emotions
5. Incontinence of urine or stool
6. Tongue biting

Austin is more alert and asking questions about what happened. The nurse ori- ents him to his environment and explains that he had a seizure; Austin does not remember events leading up to it or whether or not he had an aura. When the nurse questions him about his medications, Austin reports that he is on phenytoin (Dilantin) 200 mg orally twice a day, but he ran out of his medication 2 days ago. The provider orders a Dilantin level.

Fill-in
An aura is a ____________________, _____________________, or______________________ premonitory or warning sensation.

Select all that apply
Identify the most common side effects associated with chronic phenytoin (Dilantin) use:

1. Aplastic anemia
2. Gingival hyperplasia
3. Nausea
4. Nystagmus
5. Agranulocytosis
6. Hirsutism

Matching
Match the generic anticonvulsant medication in Column A with its trade name in Column B.

Column A	Column B
A. carbamazepine	_____ Keppra
B. clonazepam	_____ Neurontin
C. gabapentin	_____ Tegretol
D. levetiracetam	_____ Depakote
E. valproate	_____ Klonopin

Austin’s parents have arrived at the hospital. They are very concerned that Austin did not tell them that he ran out of his medication. They are informed that his low Dilantin level likely led to his seizure. Austin is given a dose of phenytoin (Dilantin) and will be discharged shortly. The nurse spends a significant amount of time re-educating Austin and his parents on epilepsy, medication control, and safety concerns.

Fill-in

Identify three potential nursing diagnoses relevant to the patient with a history of seizures:

1. _________________________________________________________________________

2. _________________________________________________________________________

3. _________________________________________________________________________

True or false
Identify whether the following interventions for epilepsy are true or false:

__________ 1. Adhering to the prescribed medication regimen, with periodic monitoring of drug levels, is essential for controlling seizures.

__________ 2. Alcoholic beverages should be avoided because they can increase the risk of seizures.

__________ 3. At home, patients with epilepsy are advised to purchase padded side rails for their beds.

__________ 4. Patients are advised to avoid sleep deprivation, which may lower the seizure threshold.

Multiple-choice question

A ketogenic diet, which has been found effective in controlling seizures in children, consists of:

1. High-protein, high-carbohydrate, low-fat foods
2. Low-protein, high-carbohydrate, low-fat foods
3. Low-protein, low-carbohydrate, high-fat foods
4. High-protein, low-carbohydrate, high-fat foods

Multiple-choice question

When Austin’s mother asks if there are any other factors that may precipitate a seizure, the nurse’s best response is:

1. “He just needs to take his medication like it is ordered.”
2. “Emotional states, environmental stressors, or fever can trigger a seizure.”
3. “The start of menstruation can cause a seizure to occur.”
4. “He should stop playing video games and watching television because they can precipitate seizures.”

Select all that apply

Identify safety-related interventions relevant for the patient with epilepsy:

1. Educate family and friends about patient care during a seizure
2. Notify all patient contacts about the patient’s diagnosis of epilepsy
3. Inform all health care providers of medications being taken
4. Encourage patients to wear a medical information bracelet

Austin is almost ready for discharge. His friends are with him, and they ask what they should do in the future if he has another seizure. The nurse explains appropriate care for the patient having a seizure.

Multiple-choice question

After educating Austin’s friends about care during a seizure, the nurse determines that they understand the information when one of them states:

1. “We should protect his head, but not attempt to restrain him.”
2. “We should try to open his mouth so he doesn’t bite his tongue.”
3. “We should try to get him in the car to bring him to the hospital.”
4. “We should keep him on his back after the seizure until help arrives.”

Answer 1

ANSWER :

1. SINCE THE CAUSE OF AUSTIN'S SEIZURE IS UNKNOWN , HE WOULD BE CLASSIFIED AS HAVING TONIC-CLONIC EPILEPSY ( .EPILEPTIC SPASM).

REASON:

• IF THE CAUSE IS UNKNOWN IT IS CLASSIFIED AS A BEHAVIOUR ARREST AS THE ONSET IS UNCLEAR AND THE RESULTS OF INVESTIGATIONS LIKE EEG ARE AWAITED.

2.IDENTIFY OTHER POTENTIAL CAUSE OF SEIZURE:

• B.) HEAD INJURIES.
• E.)BRAIN TUMOURS.
• F.)CENTRAL NERVOUS SYSTEM INFECTIONS.

REASONS:

• HEAD INJURIES DUE TO ACCIDENTS OR CONGENITAL BIRTH DEFECT.
• BRAIN TUMOURS AND BRAIN INFECTIONS LIKE MENINGITIS AND ENCEPHALITIS.

3.BASED UPON THE INFORMATION PROVIDED BY AUSTIN'S FRIENDS , THIS WOULD BE CLASSIFIED AS A GRAND-MAL SEIZURE.

REASONS:

• IT IS A GENERALIZED SEIZURE.
• LOSS OF CONSCIOUSNESS OCCURS .
• STIFFNESS OF THE BODY ( TONIC PHASE) FOLLOWED BY JERKY MOVEMENTS ( CLONIC PHASE) EACH PERTAINING TO 30 TO 60 SECONDS DURATION.
• AUSTIN GOES INTO DEEP SLEEP ( AFTER SEIZURE PHASE)
• BLOOD FROM MOUTH MAY BE DUE TO ACCIDENTS LIKE TONGUE-BITING.

4. PATHOPHYSIOLOGY UNDERLYING SEIZURE:

• SEIZURE OCCURS DUE TO AN IMBALANCE IN THE EXCITATION AND INHIBITION IN THE BRAIN.
• THE FACTORS RESPONSIBLE FOR THE IMBALANCE MAY BE GENETIC OR ACQUIRED.
• ABNORMAL SYNAPTIC CONNECTIVITY IN CORTICAL DYSPLASIA OCCURS.

5. IDENTIFY CLINICAL MANIFESTATIONS ASSOCIATED WITH GENERALIZED SEIZURES:

• B.) TONIC-CLONIC CONTRACTION.
• E.) INCONTINENCE OF URINE OR STOOL.
• F.) TONGUE-BITING.

REASONS:

• BEGINS WITH THE STIFFENING OF THE BODY (TONIC) FOLLOWED BY JERKY MOVEMENTS( CLONIC).
• URINARY INCONTINENCE OCCURS DUE TO SEIZURE.
• TONGUE -BITING OCCURS DURING THE SEIZURE WHICH IS FOLLOWED BY HEAVY BREATHING.

6.AN AURA IS A FEELING, EXPERIENCE OR MOVEMENT ,PREMONITORY OR WARNING SENSATION.

REASON:

AN AURA IS A WARNING SIGN BEFORE A SEIZURE.