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Outline
Ms. Cerulean is a 22 year old female admitted via EMS after a seizure witnessed by family members about 20 minutes ago. She has an IV in place.
What initial nursing assessments need to be performed for Mr. Cerulean?
- Full set of Vital Signs
- Neuro check with LOC and pupillary assessment
Upon assessment, Ms. Cerulean is lethargic, localizes to pain, but does not follow commands. She is diaphoretic, and her vitals are stable.
Why is the patient experiencing a decreased level of consciousness at this time?
- She is in a postictal state, a state of low level of consciousness that occurs after a generalized seizure for 10-30 minutes.
Suddenly, the patient begins jerking. Her muscles are cycling back and forth between tight contractions and rhythmic jerking. What is this called?
- This would be called a tonic-clonic generalized seizure
What is/are your priority nursing action(s) at this time?
- Keep the patient safe
- Turn to side
- Nothing in her mouth
- suction available if needed
- Monitor SpO2 and apply oxygen as needed
- Do not restrain
- Pad side rails to prevent injury
What medication(s) would you expect to give to Ms. Cerulean?
- Benzodiazepines – Ativan IV or Valium PR
- Barbiturates – Phenobarbital
- Antiepileptic drugs
- Levetiracetam, fosphenytoin, phenytoin (loading dose + maintenance dose)
Per provider orders, you administer 2mg Ativan IV Push twice in 10 minutes. Ms. Cerulean continues to seize without ceasing. The provider determines that she needs to be intubated for airway protection. Per orders, you administer a loading dose of levetiracetam and fosphenytoin and the EEG technician is on the way to place the EEG electrodes.
What is the name of the condition Ms. Cerulean is in now?
- Because her seizures have not stopped for > 10 minutes, she is now considered to be in status epilepticus
What is the purpose of the EEG?
- To measure brain activity to determine the severity of the seizure. It can also sometimes pinpoint where the seizure is originating
- It can also indicate whether or not seizures are still occurring, even after phenobarbital or a paralytic medication is administered.
- They should have a seizure action plan and know how to keep her safe in the event of a seizure. This includes knowing how to administer medications and when to call 911: seizure lasting longer than 5 minutes, cyanosis or apnea, or back-to-back seizures.
Ms. Cerulean is placed on a phenobarbital IV drip and additional doses of levetiracetam and fosphenytoin are administered q6h per provider orders. After 20 hours, the EEG finally begins to show decreased seizure activity.
What are the risks of a prolonged seizure?
- Prolonged seizures can cause damage to neurons in the brain, leaving long term neurological deficits.
- Because of possible airway compromise, prolonged seizures can also lead to hypoxia, which also can cause brain damage and leave neurological deficits
Three days later, Ms. Cerulean is awake and able to be extubated. She doesn’t appear to have any neurological deficits at this time and is able to ambulate safely in the halls. She will likely be discharged home in the morning.
[faq lesson=”true” blooms=”Application” question=”What education topics should be included in discharge teaching for Ms. Cerulean and her family?”
- Importance of compliance with antiepileptic drugs to prevent breakthrough seizures.
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