SEIZURE DISORDER

BACKGROUND This is an interesting case since it is one of the most common case in Airport Medical Centre. It is most frequently diagnosed in young children or in geriatric patients, but may develop in people of any age. Through adequate knowledge and understanding of the disease will give an idea on how we could give appropriate nursing care for our clients through (1) elimination of factors that precipitate seizures, (2) identify cause of seizure, (3) prevention of further injury during seizure attack (4) to help the client and the family in health teaching regarding patients with seizures .

CASE PRESENTATION Mr. R.C., a 40 year old man, Indian, was rushed to AMC by EMT team. According to the EMT, patient was reported to have episodes of sudden jerky movements, rolling of eyes and drooling of saliva. Mr. R.C. has previous history of stroke and have undergone angioplasty 9 months ago. He also stated that he had epilepsy since a year ago and with episodes of seizure attacks 2 weeks back. No history of alcohol intake as claimed. Patient stated that he is on regular medication such as Warfarin and Pantoprazole daily.

Upon admission to the unit, he is conscious and coherent (GCS 15/15), pupils bilaterally equal and reactive to light, no presence of tongue bite and no external injuries were present. Vital signs were as follows: BP153/98mmHg, HR 99bpm, RR 19cpm, O2sat 99%, body temperature of 36.8C and blood sugar of 95mg/dl. No signs of focal neurological deficits seen. ECG revealed sinus rhythm. Patient complains of continuous, localized and aching pain at back side of head (pain score of 3/10).

Investigations

ECG monitoring

Digoxin can cause a multitude of dysrhythmias, due to increased automaticity (increased intracellular calcium) and decreased AV conduction (increased vagal effects at the AV node)The classic dysrhythmia associated with digoxin toxicity is the combination of a supraventricular tachycardia (due to increased automaticity) with a slow ventricular response (due to decreased AV conduction), e.g. atrial tachycardia with block.

Differential Diagnosis It is important to identify and treat any injury or disease process that may be producing seizures, such as: head trauma,infection (e.g., encephalitis, meningitis), anddrug intoxication or withdrawal.

Conditions that produce symptoms similar to those that occur during seizures must be ruled out, such as the following:

Breath-holding spells: bluish tint to the skin (cyanosis), loss of consciousness, loss of muscle toneMeniere's disease: vertigo, visual phenomena, speech impairment, altered consciousnessMigraine: aura, loss of consciousness, nausea, photophobia, muscle weaknessMovement disorder: tics, chorea, tremorSyncope: sudden loss of muscle tone and posture, loss of consciousness, vertigo, nausea, muscle spasm

TREATMENTIntervention Rationale Outcome

1.) Administered high flow 02 at 10lpm via NRBSeizure activity increases oxygen consumption and demand.Patient was able to maintain O2sat 98-100%.

2.) Administered medications as ordered to stop seizures.

a.) Diazepam

b.) Dilantin

Diazepam may be given IV at 5mg/min rate to control seizure activity by enhancing neurotransmitter GABA. Cardiovascular and respiratory depression may occur if diazepam is used in conjunction with phenobarbital.

Dilantin may be given at 50mg/min rate to decrease cellular influx of sodium and calcium and blocking neurotransmitter release. Caution must be maintained to avoid giving phenytoin any faster than prescribed rate because of its pH, and ECG must be monitored for dysrhythmias while administering this drug.Patient tolerated the procedure well. ECG rhythm reveals sinus rhythm. Vital signs stable all throughout the therapy.

OUTCOME & FOLLOW-UP

1. Sustains no injury during seizure activity a.) Complies with the treatment regimen and identifies the hazards of stopping the medication.b.) Can identify appropriate care during seizure2. Exhibits knowledge and understanding if epilepsy a.) Identifies the side effects of medicationsb.) Avoids factors or situations that may precipitate seizures (e.g. flickering lights, hyperventilation, alcohol)c.) Follows healthy lifestyle by getting adequate sleep and eating meals at regular times to avoid hypoglycemia. 3. Absence of complications

DISCUSSIONThe goals of treatment to stop seizures as quickly as possible to ensure adequate cerebral oxygenation, and to maintain the patient in a seizure-free state. An airway and adequate oxygenation are established. An IV line is established preferably at hand(wrist), and blood samples are obtained to monitor serum electrolytes, glucose, and phenytoin levels. Vital signs and neurological signs are monitored in continuing basis. Safety is also considered a priority when patient is having seizures. Provide a safe environment by padding side rails and removing clutter which may be harmful to the patient. Protect the patients head during a seizure. If seizure occurs while ambulating or from chair, cradle head or provide cushion/support for protection against head injury.

LEARNING POINTS/TAKE HOME MEASSAGESThe nurse initiates ongoing assessment and monitoring of respiratory and cardiac function because of the risk for delayed depression of respiration and blood pressure secondary to administration of antiseizure medications to halt the seizures. Nursing assessment also includes monitoring and documenting the seizure activity and the patients responsiveness.

REFERENCESDelmars Critical Care Nursing

Medical Surgical Nursing by Joyce Black

http://www.nsgmed.com/neuro/epilepsy-nursing-assessment-nursing-diagnosis-goal-interventions-patient-education/

Submitted by:Timi N. Reyes1231095-7-2015