Question

Cognitive / Functional Ability Learning Assessment

Patient Profile
T.Y. is a 32-year-old male who presented to the emergency department who was found unresponsive and incontinent. He has a history of seizures. Upon questioning, he is lethargic and oriented to name and date only. He states he hasn’t been sleeping well and has been really stressed lately due to cutbacks at his place of employment. He has been seen in the emergency department for viral influenza 13 days ago. At that time, he had a high fever, malaise, vomiting, and generalized body pain. He was given intravenous fluids and sent home with instructions for symptomatic care.

Objective Data

Physical Examination

• Temperature 98.7° F, pulse 80, respirations 18, blood pressure 102/60
• Lethargic and oriented X 2, name and date only, cooperative
• Symmetric muscle weakness involving all four limbs
• No evidence of diplopia or ptosis
• Normal bowel and bladder function
• No dysphagia

Diagnostic Studies

• 12-lead ECG: Sinus rhythm with a rate of 80 beats/minute with occasional PVCs.
• Labs / Tests pending: Complete blood count (CBC), complete metabolic panel, EEG

Discussion Questions

1. T.Y. reports feeling confused and lethargic and hasn’t been feeling well for a while. The last thing he remembers is he was talking to his friend on the phone. Based on this finding, what is the priority nursing assessment for T.Y.?
2. The health care provider suspects T.Y. likely experienced a seizure. What history data support this diagnosis?
3. What safety precautions should be taken?
4. What medications would you expect them to order for T.Y for long term treatment of SZ? And what PRN medication for status epilepticus?
5. What education regarding anti-seizure meds is appropriate for T.Y. and explain your rationale.
   1. Often patients have two or more anti-seizure medications ordered to treat this condition.
   2. Labs must be frequently monitored to ensure that therapeutic levels are maintained.
   3. Do not discontinue this medication abruptly.
   4. All of the above.

Case Study Progress
T.Y.’s labs return WNL and his continuous EEG is currently running.

6. What education is important prior to the EEG?
7. If T.Y. has another seizure, what is important for the nurse to observe?

Answer 1

Mr.T.Y is admitted to the emergency department as irresponsive with history of seizures. He is lethargic and oriented to name and date only.Moreover he had history of viral influenza 13 days ago.

1. priority nursing assessment-  asess vital signs nuerologial status and gcs score,innorder to find out any nuerologcal impairment.

2.patient's present history states the history of seisures,moreover patient is lethargic and confused this may be after effects of seizures(post ictal stage)

3.saftey prequations

a) Monitor  ABCs (airway, breathing, circulation)

b)Administer oxygen if the individual is in status epilepticus, is cyanotic or is in respiratory distress. Some individuals may require rapid sequence intubation, but one should only use a short-acting neuromuscular blocker to avoid masking of the seizure activity

c)Check finger stick blood glucose and replace if <50 mg/dl.

d)If the patient is intubated and paralyzed, consider EEG monitoring to determine if there is still ongoing seizure activity.

e)All patients with an active seizure should have two large-bore intravenous lines. Administer intravenous glucose and thiamine promptly. If the patient has signs of an infection, get cultures and consider the use of antibiotics.

During the Seizure

1. First, ensure adequate ventilation and place patients on the floor on their left side

2. Loosen clothing around the neck and ensure the airway is patent. If the patient is clenching the teeth, do not force the mouth open with any object as this can cause severe damage

3. Remove all items from the surrounding that can be hazardous. The patient may be oblivious to what's happening and may not even know what he or she is doing.

4. If the patient is confused and wandering, either gently guide him/her away and block access to outside areas

5. Reassure the individual and be comforting.

6. Avoid restraints but make sure the patient is in a bed with padded side rails

7. Place the individual in a lateral position with the neck slightly flexed; this will help the saliva drain from the mouth and prevent the tongue from falling backward

8. Remove all nearby furniture and other hazards from the area

9. Provide verbal assurance as the individual is regaining consciousness

10. Provide the patient with privacy if possible

11. Call for help and start treatment as ordered by the caregiver.

4. Medications

Treatment for seizures often involves the use of anti-seizure medications(anticonvulsants)or antiepileptics Several options exist for anti-seizure medications. The goal is to find the medicine that acts better to the specific type of seizure and that causes the fewest side effects. In some cases, your doctor might recommend more than one medication.

It is necessary to determine the type of seizure in order to focus the diagnostic approach on a particular etiologic factor, to select the appropriate drug therapy, to conduct scientific investigations that require delineation of clinical and EEG phenotypes, and to provide vital information regarding the prognosis

example-

Partial Seizures-Carbamazepine, Phenytoin, Oxcarbazepine, Valproic Acid

Primary Generalized Tonic–Clonic Seizures- Valproic acid, Lamotrigine, Topiramate

PRN medicine for status epilepticus-The benzodiazepines most commonly used to treat status epilepticus are diazepam (Valium), lorazepam (Ativan), and midazolam.

5. answer- all of the above

Some seizure medicines tend to work better for certain kinds of seizures than for others. If one medicine fails, another may work better. A combination of medications may be tried to get better outcome

Taking medication regularly is essential to controlling your seizures.Never stop or change your medication without talking to your doctor, as this could cause a severe seizure.

The fundamental objective of therapeutic drug monitoring (TDM) for antiepileptic drugs (AEDs) is the prevention of seizures and the minimization of negative effects on general well-being, including cognition, mood, and endocrine function