Note whether patient fell, expressed vocalizations, drooled, or had automatisms (lip-smacking, chewing, picking at clothes). Helps localize the cerebral area of involvement. Provide neurological or vital sign check after seizure (level of consciousness, orientation, ability to comply with simple commands, ability to speak; memory of incident; weakness or motor deficits; blood pressure (BP), pulse and respiratory rate). Documents postictal state and time or completeness of recovery to normal state. May identify additional safety concerns to be addressed. Reorient patient following seizure activity. Patient may be confused, disoriented, and possibly amnesic after the seizure and need help to regain control and alleviate anxiety . Allow postictal “automatic” behavior without interfering while providing environmental protection. May display behavior (of motor or psychic origin) that seems inappropriate or irrelevant for time and place. Attempts to control or prevent activity may result in patient becoming aggressive or combative. Investigate reports of pain . May be result of repetitive muscle contractions or symptom of injury incurred, requiring further evaluation or intervention. Detect status epilepticus (one tonic-clonic seizure after another in rapid succession). This is a life-threatening emergency that if left untreated could cause metabolic acidosis, hyperthermia , hypoglycemia , arrhythmias, hypoxia, increased intracranial pressure, airway obstruction, and respiratory arrest. Immediate intervention is required to control seizure activity and prevent permanent injury or death. Note: Although absence seizures may become static, they are not usually life-threatening. Carry out medications as indicated: Specific drug therapy depends on seizure type, with some patients requiring polytherapy or frequent medication adjustments.

AEDs raise the seizure threshold by stabilizing nerve cell membranes, reducing the excitability of the neurons , or through direct action on the limbic system, thalamus , and hypothalamus . Goal is optimal suppression of seizure activity with lowest possible dose of drug and with fewest side effects. Cerebyx reaches therapeutic levels within 24 hr and can be used for nonemergent loading while waiting for other agents to become effective. Note: Some patients require polytherapy or frequent medication adjustments to control seizure activity. This increases the risk of adverse reactions and problems with adherence. Adjunctive therapy for partial seizures or an alternative for patients when seizures are not adequately controlled by other drugs. Potentiates and enhances effects of AEDs and allows for lower dosage to reduce side effects. Used to abort status seizure activity because it is shorter acting than Valium and less likely to prolong post seizure sedation. May be used alone (or in combination with phenobarbital ) to suppress status seizure activity. Diastat, a gel, may be administered rectally, even in the home setting, to reduce frequency of seizures and need for additional medical care. May be given to restore metabolic balance if seizure is induced by hypoglycemia or alcohol. Monitor and document AED drug levels, corresponding side effects, and frequency of seizure activity. Standard therapeutic level may not be optimal for individual patient if untoward side effects develop or seizures are not controlled. Monitor CBC, electrolytes , glucose levels. Identifies factors that aggravate or decrease seizure threshold. Prepare for surgery or electrode implantation as indicated. Vagal nerve stimulator, magnetic beam therapy, or other surgical intervention (temporal lobectomy) may be done for intractable seizures or well-localized epileptogenic lesions when patient is disabled and at high risk for serious injury. Success has been reported with gamma ray radio surgery for the treatment of multiple seizure activity that has otherwise been difficult to control. Back 1 - Risk for Trauma or Suffocation 2 - Risk for Ineffective Airway Clearance 3 - Low Self-Esteem 4 - Deficient Knowledge 5 - Other Possible Nursing Care Plans Next See Also You may also like the following posts and care plans:

Furnished with heaters, it is the perfect spot to take the night air, chill for a while and take in the spectacularly illuminated city skyline.

Deena Brecher, president of ENA, said it is the organization’s goal to make violence against nurses a felony in all states, have a mandatory reporting structure and provide all nurses with education on mitigating workplace violence.

Nursing school does not prepare nurses for the experience of witnessing pain and suffering. Although nurses value a holistic approach to patient care--one that emphasizes prevention and health maintenance - many of us wait for a crisis to ensue before we take our own medicine. ( 3 ) Not surprisingly, our bodies bear the brunt of our stress. This may be expressed in irregular eating and sleeping, musculoskeletal tension, respiratory problems, substance abuse, and decreased immune system functioning. Too many of us teeter too close to the precipice of chronic illness. It is not surprising that a study by Welch found that 35% of nurses sampled were clinically depressed. ( 5 )

“It means that nurses are finding it difficult to make ends meet and this added to their existing stressful working environment is not conducive to healthy living. With NHS Wales now facing severe staffing shortages and demand currently outstripping the supply, working nurses say they need more colleagues – now! Fair pay and conditions will encourage nurses to stay, motivate others to return and may boost recruitment to the health service.”

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 · Macmillan nurses – who care for the terminally ill – have revealed some of the moving things their patients have told them at the end of their lives.

They are generally more dangerous than other creatures at the time, particularly those with the handgun . Those armed with pipes swing away at Heather Mason when she comes close enough, limping towards her until they're in range. Those with revolvers should be dealt with immediately, as they can attack from quite a ways away and deal a large amount of damage.


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