8-30 Seizure Patho

8/10/2019 8-30 Seizure Patho

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CURRENT MEDICAL DIAGNOSIS: Seizures

DEFINITION OF CURRENT MEDICAL DIAGNOSIS: abnormal, unregulae! ele"ri"al !is"#arge #a o""urs $i#in #e brain%s "ori"al gra& maer an!ransienl& inerru's normal brain (un"ion)

SOURCE: *T#e Mer"+ Manual an! Diagnosis an! Treamen**********************************************************************

AT-O-.SIOLOG.:A seizure &'i"all& "auses alere! a$areness,

abnormal sensaions, (o"al in/olunar&

mo/emens, or "on/ulsions 0$i!es'rea! /iolen

in/olunar& "onra"ion o( /olunar& mus"les1)

E'ile's& is a "#roni" brain !isor!er "#ara"erize!

b& re"urren seizures) None'ile'i" seizures are

'ro/o+e! b& a em'orar& !isor!er or sressor)

S&m'omai" seizures are !ue o a +no$n "ause,

$#ile 's&"#ogeni" seizures are s&m'oms #a

simulae seizures in 'aiens $i# 's&"#iari"

!isor!ers) Classi(ie! as generalize! or 'arial)

Generalize! &'i"all& in/ol/es losing

"ons"iousness an! in/ol/es #e "ore2 o( bo#

#emis'#eres) arial seizures o""ur in one "ore2

an! are o(en !ue o sru"ural abnormaliies)

Generalize! seizures ma& (ollo$ 'arial seizures

$#en #e 'arial seizure s'rea!s an! a"i/aes #e

enire "erebrum bilaerall&)

ETIOLOG.:

CLINICAL MANIFESTATIONS

0Signs 3 S&m'oms1:Ma& be 're"e!e! b& an aura 0sensor&, auonomi", or

's&"#i" sensaion) T&'i"all& en! in 456 min)

Generalize! seizures (ollo$e! b& !ee' slee',

#ea!a"#e, "on(usion, mus"le soreness, $#i"# ma&

las minues o #ours) Seizure me!s ma& re!u"e

alerness) Toni"5"loni" seizures &'i"all& begin $i#

an ou"r&, #en loss o( "ons"iousness an! (alling

(ollo$e! b& oni" 0"onra"ion1 an! "loni"

0"onra"ion an! rela2aion alernaion1 moion o(

ne"+, e2remiies, run+ an! #ea!) In"oninen"e,

ongue biing, an! (ro#ing a #e mou#) rolonge!

"on(usion a(er loss o( "ons"iousness)

LA78RADIOGRA-IC FINDING USUALL.

RESENT:

EEG (or ne$ onse) Ani"on/ulsan le/els (or 'aiens

$i# +no$n seizure !isor!ers) -ea! CT o e2"lu!e

mass or #emorr#age) Follo$ u' MRI $#en CT is

neg (or beer imaging) Meaboli" 'anel i( meaboli"

!isor!er sus'e"e! "ause o( seizures) Drug s"reens

MEDICAL MANAGEMENT

0In"lu!e Treamens 3 Me!i"aions1:Eliminaion o( #e "ause i( 'ossible)

Ani"on/ulsans 0&'i"all& a(er 6n! seizure1)

During seizure, loosen "lo#ing aroun! ne"+,

'la"e 'illo$ un!er #ea!) Roll o le( si!e o

're/en as'iraion) I9 a""ess s#oul! be ui"+l&

obaine!, an! loraze'am ;);< o ;)4 mg8+g I9

is gi/en a a rae o( 6 mg8min)

i( seizures "oninue a(er abou = mg is gi/en,

(os'#en&oin 4< o 6; E 0'#en&oin

eui/alens18+g I9 is gi/en a a rae o( 4;; o

4 '#en&oin 4< o 6; mg8+g I9 a a

rae o(


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9aries b& age o( onse5

7e(ore 6: De(e"s, bir# inuries, !isor!ers

6 B : I!io'a#i" seizure !isor!ers

A!uls: Cerebral rauma, ETO-, umors, sro+es

El!erl&: Tumors an! sro+es

******************

ma& be !one o "#e"+ (or unre'ore! use o( !rugs) Tea"# 'aien no o !ri/e or o'erae ma"#iner&

or s$im unil seizure (ree (or mon#s or more)

Famil& mus be aug# seizure 're"auions 0urn

o le( si!e, no#ing in mou#, loosen "lo#ing

aroun! ne"+1 an! $#a is o be e2'e"e! !uring

a seizure)

CLIENT DEVELOPMENTAL STATUS

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For each of the following theorists, ientif! the e"elo#$ental stage of the client accoring to age% Then note theeecte e"elo#$ental tas's for that stage (i%e%, )re#ro*ction an creati"it!+ for Fre*s Genital, post-pubertystage-% Ne&t, note how the client is acco$#lishing these e"elo#$ental tas's while in the hos#ital setting% .ow isthis hos#itali/ation affecting their #s!chosocial stat*s at ho$e0 1o* o nee to incl*e Piaget entr! e"en for a*lts,since cognition can 2e a"ersel! affecte 2! illness, e$entia, $eications, anesthesia, e"elo#$ental eficits, etc%

(The e"elo#$ental tas's nee to 2e incl*e in the conce#t $a#-%

Freud Genital: Puberty and After (age 90)- Energy is directed toward full sexual maturity and function and deelo!ment of s"ills needed to co!e wit# t#eenironment$ Encourage se!aration from !arents% ac#ieement of inde!endence% and decision ma"ing$

&y !atient #as once met t#is stage of deelo!ment% but due to #er Al'#eimersdementia% s#e is no longer at t#e a!!ro!riate stage * feel t#at s#e morea!!ro!riately meets t#e oral stage$ +#e was de!endent and unable to !artici!ate in any of #er care or decision ma"ing$ +#e fits t#e oral stage because#er !rimary need is security and s#e seemed most relaxed and #a!!y once s#e began to feel secure% w#ic# is also w#en s#e began eating$

Eric"son &aturity: , to deat# (age 90)- *ntegrity s .es!air- Acce!tance of wort# and uni/ueness of ones own life$ Acce!tance of deat#$ 1EGA2*3E: +ense ofloss and contem!t for ot#ers$

2#is !atient no longer meets t#is stage due to #er dementia$ * feel s#e #as reerted bac" to t#e infancy stage w#ere trust s mistrust is #er !rimaryissue$ 4ntil s#e #ad learned s#e could trust me% care was ery difficult$ 5nce t#ere was an establis#ed sense of trust% s#e seemed to be almost acom!letely different !atient$

Piaget Formal 5!erations P#ase: 66 to 6 years- 4ses rational t#in"ing$ 7easoning is deductie and futuristic

&s$ 8 definitely no longer meets t#is stage$ From w#at #er family says% s#e used to be a ery rational !erson and #ad a strong% functioning role in t#efamily$ .ue to #er dementia and unfamiliar #os!ital enironment% s#e #as reerted bac" to t#e +ensorimotor stage of infants$ +#e is unable tocom!re#end muc# at t#is !oint% and ot#er t#an ac"nowledging w#ats around #er and t#ose around #er% s#e is not oriented at all$

BRAINSTORMING LISTS

Obe"i/e Daa Sube"i/e Daa Nursing Diagnoses?


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-2 o( !e'ression aien non5/erbal, no (amil& 'resen 0All &ou "an #in+ o(1

Alz#eimers

Demenia C#roni" Con(usion7 48 Ris+ (or Falls

oor a''eie 0no b(as1 Ris+ (or In(e"ionUl"er on le( #i' A"i/i& Inoleran"e

Si(( e2remiies Ris+ (or As'iraionDoesn@ mo/e in be! mu"# Ris+ (or 7lee!ing

An2ious8'oor e&e "ona" Ris+ (or Im'aire! 7loo! Glu"ose Le/el

D&s'#agia De"rease! Car!ia" Ou'u4< s seizure, s as&sole Im'aire! Com(or

RF5 "#roni" sage 4 Rea!iness (or En#an"e! Com(orEe"ion (ra"ion


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3MPGlucose : li"ely #ig# dt 42*% but #er Banso!ra'ole can alsoraise glucose leels$

DC >$ ? $ @$, >$

8*- 9; ? 60 60 60@

=41 60 - >, 6 68reatinine 0$; ? 6$00 0$90 0$

85 0 ? > ;

Glucose , ? 99 6> 60

ClottingFactors(.e$atolog!-

P2P22

*17

+ed 7ateMisc%.e$atologies

8PD

2ro!onin

Li"er F*nctionTests(Che$istr!-

2$ =ilirubinAl"$ P#os$

+G52

Albumin

Misc%Che$istries

8aC $, ? 60$ 9$> $&gC

P#os!#orus

4ric Acid

2otal Protein

A37

!

P8585>

P5

Other8(List Na$ean Nor$al4ange-

=ld 8ulture

*ndicates !atient #as 42*$


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DIA7NOSTIC TESTS

8#est -7ay (.ates 7esults) +ignificanceH EDG (.ates 7esults) +ignificance H

5t#er 7adiogra!#ic +tudies (.ates 7esults)

I 6;>>82 ead


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CU44ENT MEDICATIONS 9O4:S.EET

T4ADE;7ENE4ICNAMES

DOSEO4DE4ED

AND4OUTE

TIME7IVEN

CLASSIFICATIONAND ACTION

DOSA7E4AN7E

4ATIONALE FO4ADMINIST4ATION

SIDEEFFECTS

NU4SIN7IMPLICATIONS

2ylenol

Acetamino!#en,0

mg0$> mBP5

0900 Anti!yretic1ono!ioidAnalgesic: *n#ibits

!rostaglandins andreduces !ain

1o moret#an > G@

#r

For !ainfeerreduction due to

infection andosteoart#ritis

Biertoxicity%

+J+% 2oxice!idermalnecrolysis

Assess !ain and monitorBF2 for signs of toxicity$ 4se

Acetadote for antidote ifneeded$ &onitor for ras#$

As!irin6 mg

8#ew tabP5

0900 1+A*.:*n#ibits !rostaglandin

synt#esis anddecreases !latelet

aggregation$

4! to ;$Gday$

For mild to moderate!ain and inflammationdue to osteoart#ritis

G* bleeding%lier toxicity%

laryngealedema

&onitor for signs of bleeding%BF2s% and serum salicylate

leels$ Gie afterwit# food orwit# antacid to decrease G*

!roblems$

Pro'ac@0 mg60

mB0900 ++7*% Antide!ressant:

*n#ibits reu!ta"e of

serotonin in 81+

KL ,0 mgdaily for

geriatric

Antide!ressant totreat !atient for #istory

of de!ression

1eurole!ticmalignant

syndrome%sei'ures%suicidal

t#oug#ts%torsades de!ointes% ++$

&onitor !atient for increasedris" for bleeding w#ile ta"ing

A+A$

De!!ra00 mg 0900 Anticonulsant:

.ecreases excitabilityof neuron firing

wit#out affectingnormal neuronal

excitability$

4! to 6g!er day for!atient wit#

7F$

For !atients !rimarygenerali'ed tonic-clonic sei'ures$

+uidicalt#oug#ts%+J+% toxice!idermalnecrolysis

&onitor mood c#anges%es!ecially suicidal

tendencies$ Assess for ras#(+J+)$ Assess for sei'ure

actiity$

Banso!ra'ole >0 mg 0900PP*Antiulcer:=inds to en'yme in

acidic gastric ! and!reents final

trans!ort of C intogastric lumen$

For treatment ofGE7. Pseudomembranouscolitis

Bowers &g% raises glucoseleels$


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4O9AN;>==A3 Criteria for E"al*ation of Conce#t Ma##ing an Scoring 4*2ric4e"ise ?>;=@;=

Criteria E&e$#lar! Satisfactor! Nees I$#ro"e$ent Unsatisfactor! Score

2#e following criteria will be used to ealuatestudent !erformance of com!etencies related toconce!t ma!!ing$

B POINTS

=% E&ceeseectations aso*tline in thelearning acti"it!criteria%>% Consistentl! oesall or al$ost all ofthe following8

POINTS

=% Meetseectations 2! f*ll!aressing thelearning acti"it!criteria%>% Does $ost or$an! of thefollowing8

= POINT

=% Does not f*ll!$eet eectations2! inco$#letion orfail*re to f*ll!aress the learningacti"it! criteria%>% Does $ost or$an! of thefollowing8

? POINTS

=% Does not $eeteectations 2aseon the learningacti"it! criteria%>% The assign$ent isnot s*2$itte%% Consistentl! oesall or al$ost all ofthe following8

I% Clinical Pre#;Pre

6$ +im8#art Pre-8linical &anager includesdiagnosis section$ +im8#art 5rder EntryMgeneral orders

include actiity and mobility% alerts% codestatusN nutrition orders (diet and fluids)

>$ +im8#art Admission istory com!leted inPatient 8#arting section (all areas)

@$ Pat#o!#ysiology s#eet is com!leteaccording to assigned text sources releant to client admission$

$ .eelo!mental status notes Eri"son%Freud% Piaget stages% ex!ected tas"s% #ow client meets in #os!ital$

) Bab and diagnostic test s#eets com!letedwit# inter!retation of results for indiidualclient$

a% All areas are

co$#letel! anacc*ratel! recorewith *#ates note

2% Ientifies all la2an;or iagnosticres*lts for s#ecificclient

a% So$e areas are

not aresse, no*#ates are note

2% Ientifies alla2nor$al la2 an;oriagnostic res*ltsfor s#ecific client

a% Inacc*ratel!

recors an;or$isinter#rets ata

2% Inacc*ratel!recors an;or$isinter#rets la2an iagnosticres*lts for s#ecificclient

a% Fails to re#ort #re

8-30 Seizure Patho

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