Question

Michael, 23, is brought to the emergency room by ambulance. He is alert, confused and uncooperative. He is also unable to follow simple commands or answer simple questions. His girlfriend reports, “We were at his house, studying. He just made this really strange sound. Suddenly he is on the floor shaking and his eyes are rolled back in his head. I turned him on his side. I don’t know what is going on with him, but I did call his father and he said he would meet us here at the hospital.” Vital signs are temperature 99.5° F, pulse 92/min, respirations 25/min, and BP 142/84.

1. What could the nurse say to the girlfriend who is most likely to be very stressed by the experience of seeing her boyfriend have a seizure and Why would it be important to calm her down and elicit information from her

2. What emergency interventions does the nurse use

3. What medications will the health care provider most likely order for status epilepticus... Describe the nursing implications (administration, side effects, drug-level monitoring) for these medications

4. What are some of the social implications for this young college student who has new-onset seizures

5. What should the nurse teach the patient and family about epilepsy?

Answer 1

1)

I can understand how difficult it is for you to talk about this situation but, for the better treatment of your boy friend I need to know more about his health status and recent medical history.

2) Emergency interventions does the nurse use

• Assess your patient for signs and symptoms of seizure activity, such as his report of an aura or twitching of muscle groups, especially in his face or hands.
• Have an oral airway, oxygen, and suction readily available. Keep his bed in a low position with the side rails up. Consider padding them.
• If he has a seizure, stay with him to protect him from injury and observe seizure activity. If he's in a chair or out of bed, ease him to the floor. If he's in bed, remove the pillows, raise the side rails, and put the bed in a flat position. Loosen any restrictive clothing.
• Provide Anti epilepsy medications as ordered by Docter.

3)

PHENYTOIN(DIPHENYLHYDANTOIN) IV/IM ROUTES

T1/2-12-24 hours progressively increase up to 60 hr when plasma concentration raises above 10 ug/ml as metabolizing enzymes get saturated

Adverse effect-

• GUM HYPERTROPHY
• HIRSUTISM
• HYPERSENSITIVITY REACTION
• MEGALOBLEASTIC ANAEMIA
• HYPERGLYCAEMIA
• DROWSINESS, HALLUCINATION
• HYPOTENTION

PHENOBARBITONE

60 mg 1-3 times a day in adult, can be injected IM/IV

GAMfacilitatory

GABA- mimetic

ADVERSE EFFECT

• SEDATION ACTION
• LONG TERM ADMINISTRATION BEHAVIORAL ABNORMALITIES CONFUTION
• MEGALOBLEASTIC ANAEMIA

NURSES RESPONSIBILITIES

• MONITOR VITAL SIGNS
• PROVIDE OXYGEN AS ORDERED BY DOCTER
• PROVIDE CALM AND QUIT ENVIRONMENT
• PROVIDE COMFORTABLE POSITION
• PROVIDE COMMUNICATIVE AWARENESS
• INSTRUCT THE SIDE EFFECT OF ANTI EPILEPSY MEDICATIONS AND ITS PRECAUTIONS
• PROVIDE MEDICATION AND ASSES THE RESPONSE TO MEDICATION
• PREPARE PATIENT FOR DIAGNOSTIC PROCEDURES LIKE EEG

4)

Social implications

• Look for a support groups.
• Ask your doctor or other health care professionals for help.
• Look for a local Epilepsy Foundation OR social workers.
• Check with the nearest epilepsy center. Maybe they have a support group, educational sessions, or can connect you with other families.
• Yet maybe you’re shy or not yet ready to talk in person. You found your way here and now you can talk to people online! Use the comments below or try the forums and chat in the Connect section.

5)

The nurse teach the patient and family about epilepsy

• CARE DURING CONVULTION TO PREVENT INJURY TONGUE BITE AND NOT RESTRAINING FORCEFULY DURING CONVULSION PHASE .
• TO CONTINUE MEDICATION AS DOCTERS ORDER
• TEACH REGARDING MEDICATION SIDE EFFECT AND PRECAUSIONS
• PROPER NUTRITION TO PREVENT MAL NUTRITION
• AVOID STIMULANTS
• REMOVE STIGMA ATTACHED TO THE CONDITION
• PATIENT SHOULD CARRY EMERGENCY MEDICAL IDENTIFICATION CARD
• TEACH TO AVOID FEAR, PARTICIPATE SOCIAL AND RECREATIONAL ACTIVITIES.
• EMPHASIZE REGULAR FOLLOW UP.