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), and
drug 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
tone
Meniere's disease: vertigo, visual phenomena, speech impairment, altered consciousness
Migraine: aura, loss of consciousness, nausea, photophobia, muscle weakness
Movement disorder: tics, chorea, tremor
Syncope: sudden loss of muscle tone and posture, loss of consciousness, vertigo, nausea,
muscle spasm
TREATMENT
Intervention
1.) Administered high flow
02 at 10lpm via NRB
2.) Administered
medications as ordered
to stop seizures.
a.) Diazepam

b.) Dilantin

Outcome
Patient was able to maintain
O2sat 98-100%.
Patient
tolerated
the
procedure
well.
ECG
rhythm
reveals
sinus
rhythm. Vital signs stable all
Diazepam may be given IV at throughout the therapy.
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.
Rationale
Seizure activity increases oxygen
consumption and demand.

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.

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 seizure
2. Exhibits knowledge and understanding if epilepsy
a.) Identifies the side effects of medications
b.) 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
DISCUSSION
The 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 MEASSAGES
The 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.
REFERENCES
Delmars 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. Reyes
123109

5-7-2015