Question

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.  

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

5b. The nursing intervention to be performed during and post seizures are as following

During seizure

• Ensure the place is safe for the victim
• Place the victim in recovery position to avoid aspiration
• Check for airway patency
• Ensure there is no tight garments ,neck belt around the neck
• Reassure the client
• Monitor the duration of the seizure ,to classify it and provide appropriate treatment
• Call for emergency medical help
• Assess for the risk of prodromes

After seizure

• Ensure to make the victim lie in side lying position or recovery position to ease breathing
• Administer oxygen to maintain saturation
• Suction any oral secretions to prevent aspiration
• Monitor vital signs
• Ensure to maintain an intravenous line to administer drugs
• Assess neurological status of the victim (GCS)
• Assess for any paralysis
• Monitor blood glucose levels
• Carry investigation as per the provider order

5c. Sodium Valproate works by inhibiting the action if the GABA and controlling the symptoms .It also stops the activity of the cortical which can lead to seizure symptoms. In simple the sodium channel is blocked resulting in decreased or no symptoms .The carbamazepine is also a sodium channel inhibitor .If the sodium is blocked from release then automatically the neurotransmitters is blocked from being released. As a result theoretical is influx of sodium in the cells and decreasing the seizure episode.