HISTORY COLLECTION

 INTRODUCTION:

Mr. Kunal18 year old Male patient, who had come to the hospital with
complaints of convulsions, fever, headache, tremors, excessive perspiration and
confusion . He was brought to Dhiraj Hospital by ambulance and was admitted here
on 09/04/2018. He is admitted to the Neurology Ward of the hospital for further
investigation, interventions and treatment. Various laboratory investigations were
performed and treatment was prescribed accordingly. He was diagnosed as a case of
Epilepsy. I have selected this patient for my care plan and providing appropriate
nursing care.

 PATIENT PROFILE:

Name : Mr. Kunal

Age : 18 years.

Sex : Male

Marital Status : Unmarried

Hospital Registration No. : I181245569

Ward/Bed No. : Neurology Ward

Address : Dabhoi, Vadodara

Religion : Hindu

Education : Illiterate

Date of Admission : 09/04/2018

1
 NURSING ALERT:

Sensitivity / Allergy / Precaution: Patient is not having any allergy or sensitivity with any
substance.

Weight : 52 kg

Height : 162cm

 SOCIO ECONOMIC STATUS:

A. Housing:

 Type of house : Small house of three rooms made up of bricks.

 Lighting : Proper lighting facilities are available.
 Ventilation : Good ventilation facility is available.
 Water facility : Everyday.
 Sanitation : Poor sanitation and hygiene.

B. Food hygiene practices:

They wash vegetables & food before preparing it. They are maintaining hygienic
practices while preparing the food.

C. Personal hygiene practices:

Patient and his family members are maintaining good personal hygiene by
taking bath every day, brushing the teeth, wearing the clean clothes every day, cutting
nails weekly once and washing the hands before taking food and after toileting.

D. Community resources:

Resources like bus and train are available for transportation; educational
resources are available up to college. There is lack of health resources.
 E. Religious practices:

Client and his family members are strong believers of Hindu religion.

F. Family income and expenditure :

Mr. Kunal is belongs to middle class family. His father is bread winner of his
family. He earns monthly 10000rs. Their family per person monthly expenses are
mentioned below,

 Food – 500/-
 Clothing – 000/-
 Education – 450/-
 Health – 1000/-
 Others – 150/-

 ALLERGIES AND MEDICATION:

 Drugs / Foods / Dyes / Others : Client doesn’t have any kind of allergies
from drug, food and dyes.
 Signs and symptoms : Nil
 Blood reaction : Patient hasn’t received any time blood
transfusion.

 HISTORY OF ILLNESS:

 Chief complaints with duration:

Patient, Mr. Kunal admitted on 09/04/2018 in Neurology Ward of Dhiraj

Hospital with complains of convulsions, fever, headache, tremors, excessive
perspiration and confusion.
 History of present Illness: Onset / treatment taken:

Patient Mr. Kunal admitted on 09/04/2018 in Neurology Ward of Dhiraj

Hospital with complains of convulsions two recent episodes before admission,
fever from two days, headache from one day, tremors from one day, excessive
perspiration before convulsion and confusion after the episode of convulsion.
Patient has undergone some investigations like blood investigations, CT Scan of
brain. He is receiving medications like Inj. Ceftriaxone 2 g I.V. BD, Inj.
 Ranitidine 40mg TDS, Inj. Phenytoin sodium 2ml TDS, Inj. Paracetamol SOS,
Inj. NS 80ml/hr.

 History of past Illness: Illness/ Medications / Any restrictions:

Patient is having history of brain infection before three years and he has
taken treatment from regional hospital.
  FAMILY HISTORY:

Health
status/
Name of
Educational Relationship
Sr.No. Family Age/ Sex Occupation
status with patient H/o
Member significant
Illness

1. Mr. Govardhan Dead - Grandfather - -

2. Mrs. Prema Dead - Grandmother - -

45 Years
3. Mr. Chiman Uneducated Father Labor Healthy
Male

42 years
4. Mrs. Veena Uneducated Mother House Wife Healthy
Female

Mr. Kunal 18 Years

5. 12th Patient Student Epilepsy
Male
 FAMILY PEDIGREE:

Mr. Govardhan, Dead Mrs. Prema, Dead

Mr. Chiman Mrs. Veena

45 years 42 years

Mr. Kunal
18 years
Key words:

: Male dead

: Female dead

: Female

: Male patient 6
 FUNCTIONAL HEALTH PATTERN:

 Inter Personal Relationship:

Patient is maintaining good IPR with her family and health care workers.

 Hygiene:
Patient is shabby due to his disease condition and limitation to perform
daily living activities.

 Activity / Exercises:
Patient is not able to do active exercise due to disease condition.

 Rest / Sleep:
Patients sleep pattern disturbed due to disease condition and
hospitalization.

 Elimination Pattern:
Patient is having normal bowel pattern two times a day and patient is
passing average 1500ml urine per day.

 Cognitive / Perceptual:
Cognitive function is altered.

 Values and Beliefs:

Patient is a believer of Hindu religion.

 Personal Habits:

Patient is vegetarian. He is not having bad habits like consuming alcohol

and smoking cigarette.

7
 DIETARY HISTORY:

 General appearance : Healthy

 Appetite : Decreased
 Diet : Vegetarian.
 Meal pattern : Three times a day
 Need assistant/Feed self : Need of assistant in feeding.
 Any other method of
feeding : Nil
 PHYSICAL EXAMINATION

General appearance:

 Activity : Dull
 Body Built : Healthy
 Hygiene : Poor
 Grooming : Shabby
 Nourishment : Nourished

Mental status:

 Consciousness : Consciousness
 Look : Confused

Anthropometric measurement:

 Height : 162 cm
 Weight : 52 kg

Vital signs:

 Temperature : 100.8oF
 Pulse : 86 beats/ minute
 Respiration : 32 breaths/minute
 Blood pressure : 120/78 mm of Hg.

Head and Face:

 Hair : It is equally distributed on the scalp.

 Color of Hair : Hairs are black in color.
 Scalp : There is presence of dandruff. There is no evidence
of any abnormality like lesion or lump.
 Pediculosis : Absent
 Face : Symmetrical
 Facial Puffiness : Facial puffiness is absent.
Eyes:

 Eye Brows : Symmetrical

 Eye Lid / Lashes : There is no presence of any abnormality like
redness, swelling, discharge or lesions.
 Eye Ball : Eye balls are bilaterally equal in size and shape.
 Conjunctiva : Conjunctiva is pale in color. There is absence of
any infection.
 Sclera : Sclera is healthy white in color.
 Pupil : Both pupil are reacting towards light
 Eye Discharge : Absent
 Use of Glasses : No

Ears:

 Redness : Absent
 Discharge : Not present
 Cerumen : Present
 Lesions : Absent
 Foreign Body : Absent
 Use of Hearing Aids : Patient is not using any hearing aid
 Tympanic membrane : No perforations, lesions and bulging.
 Hearing acuity : Normal

Nose:

 External nares : There is not presence of nasal discharge.

 Patency : Patent
 Nasal Septum : Nasal septum is in midline. There is no any
abnormality like nasal septum deviation.
 Nasal Polyps : Not present.

Mouth:

 Number of Teeth 28
 Dentures : Absent
 Dental Carries : Lower left side is having dental carries.
 Odour of Mouth : Halitosis is present due to poor oral hygiene.
 Gums : Healthy. No evidence of inflammation.
 Palates and Uvula : Visible
 Tonsillar area : No inflammation
Lips:

 Cleft Lips : Absent

 Stomatitis : Absent

Neck:

 Muscles : Normal range of motion is present.

 Thyroid : No thyroid enlargement
 Nodes : No lymph node enlargement
 Vein distension : Jugular vein distention is not present.

Thorax:

 Chest shape : Bilaterally equal and symmetric

 Respiratory Rate
 Thoracic Expansion
 Palpation
 Percussion
: 32 breaths/ minute
: Symmetrical
: Ribs are palpable and normal. No pain is present
while palpation.
: There is no any abnormal fluid or air accumulation

Respiratory system

 Respiratory Rate : 32 breaths per minute

 SpO2 : 99% (with oxygen 2lit by nasal cannula )

Inspect the Chest

 Thoracic Cage- Shape : Bilaterally equal and symmetric

 Chest Expansion : Symmetric

Auscultation

 Adventitious Sound : Abnormal breathing sound is absent.

 Respiratory Pattern : Patient is having breathing difficulty.

Percussion

 Lung Field : While auscultation no abnormal sound is

heard.
 Diaphragmatic Excursion : Normal
Cardiovascular system:

 Pulse : 82 beats/min
 Heart Sound : S1, S2 sound Heard
 Abnormal Heart Sound : Not present
 Murmurs : Not present
 Carotid Pulse Rate : 80 beats/min
 Blood Pressure : 120/78 mmHg

Central and peripheral lymphatic system

 Inspect and Palpate the Leg : No any abnormal lymph node

enlargement at inguinal region.
 Carotid arteries : Palpable
 Radial : Palpable
 Femoral : Palpable
 Poplitel : Palpable
 Posterior Tibial Pulse : Palpable
 Dorsalis Pedis Pulse : Palpable
 Edema : Not present
 Type of Edema : Not present
 Lymph Edema : Absent
 Varicose Veins : Absent
 Venous Ulcer : Absent
 Capillary Refill : 3 seconds

Digestive system

 Abdominal Girth : 30 inch

 Diarrhoea / Constipation : Patient is not having Diarrhoea or
constipation

Inspection

 Size : Abdomen is round in shape

 Symmetry : No any abnormalities
 Scar : Not presence of any surgical scar.
 Lesions : Not presence of lesions.
 Redness : Absent
 Auscultation

 Bowel Sound : Bowel sound is present.

Percussion

 Ascites / Peritonitis : Nil

Gas / Fluid Collection : No any abnormal fluid or air collection

Palpation

 Tenderness : Not having pain on palpation.

 Fluid Collection : Not having fluid collection or evidence
of ascites.
 Mass : There is not presence of abnormal mass.

Musculoskeletal system:

 Gait : Patient is bed ridden.

 Upper Extremities
 Lower extremities
 Muscle strength
 Spine
 Joint Swelling / Pain / Other-
 Weakness / Paralysis / Contracture
: Normal range of motion like flexion,
extension and rotation.
: Normal range of motion like flexion,
extension, pronation, abduction and
adduction present.
: No muscle weakness
: Absence of lordosis, kyphosis or scoliosis
: Nil
: Absent

Genito urinary system:

 Frequency of Urination : Average 1500ml per day

 Colour of the urine : Dark yellow coloured
 Catheter Present : No
 Urethral Discharge : No

Integumentary system:

 Skin Colour : Normal Brown

 Dermatitis : Not present
 Allergies : Not having allergy with any substance
 Lesions / Abrasions : Not present
 Tenderness / Redness : Not present
 Surgical scar : Not present
 Secretion : No any abnormal secretion present.
 NEUROLOGICAL ASSESSMENT

 CONSCIOUSNESS LEVEL ASSESSMENT:

Glasgow coma scale

PATIENT’S
RESPONSE SCALE SCORE
SCORE

Spontaneous 4

To voice 3
Eye Opening
3
(E) To pain 2

None 1

Normal conversation 5

Disoriented conversation 4
Verbal
Response Words, but not coherent 3 5
(V)
No words, only sounds 2
None 1
Normal 6
Localized to pain 5
Withdraws to pain 4
Decorticate posture (an abnormal posture
that can include rigidity, clenched fists,
Motor legs held straight out, and arms bent 3
Response inward toward the body with the wrists 6
(M) and fingers bend and held on the chest)
Decerebrate (an abnormal posture that
can include rigidity, arms and legs held
2
straight out, toes pointed downward, head
and neck arched backwards)

None 1

Total 15 14
 EXAMINATION OF THE HIGHER CEREBRAL FUNCTION:
 Dominant hemisphere:
• Listen to language pattern
• Ask the patient to name objects
• Does the patient read correctly?
• Does the patient write correctly?
• Ask the patient to perform a
numerical calculation
• Can the patient recognise objects?
 Non-dominant hemisphere
• Note patient’s ability to find his
way around the word or his home.
• Can the patient dress himself?
• Note patient’s ability to copy a
geometrical pattern.
 Memory test:
• Immediate memory
• Recent memory
• Remote memory
• Verbal memory
• Visual memory
: Patient’s language pattern was hesitant.
: Instruct the patient to name vegetables
name by giving it’s pictures. Patient is
quite confuse and taking 3-4 second to
give response. Patient has given 4
correct answers out of 5 objects.
: Yes patient can able to read but slowly.
: Yes patient can.
: Asked patient to substarct 3 out of 10
and patient has given correct answer.
: Yes patient is able to reognize object.
Patient can able to recognize maximium
5 numbers of objects name.
: Patient is able to identify way for going
out of hospital.
: No, due to weakness and disease
condition patient is unable to dress
himself.
: Adviced patient to drow one square and
two round and patient able to follow
the command.
: Intact
: Intact
: Intact
: Intact
: Intact
 Reasoning and problem solving:
 Ask patient to reverse 3 or 4 random
numbers
 Ask patient to explain proverbs.
: Patient can able to repeat 2-3
numbers.
: Asked patient to explain
proverb- tit for tat, and patient
has explined it.

 Emotion state:
• Anxiety or excitement : Anxious
• Depression or apathy : Not present
• Emotional behviour : Confused
• Uninhibited behaviour : No any abnormal behviour
present
• Slowness of movement or response: : Present
 MINI MENTAL STATE EXAMINATION:

Maximum Patient’s
Elements Questions
Score Score

5 5 “What is the year? Season? Date? Day of the week? Month?”

Orientation
5 5 “Where are we now: State? County? Town/city? Hospital? Floor?”

The examiner names three unrelated objects clearly and slowly, then asks the patient to name all three of
Registration 3 2 them. The patient’s response is used for scoring. The examiner repeats them until patient learns all of
them, if possible. Number of trials:

Attention
“I would like you to count backward from 100 by sevens.” (93, 86, 79,72, 65, …) Stop after five
and 5 5
answers. Alternative: “Spell WORLD backwards.” (D-L-R-O-W)
Calculation

Recall 3 3 “Earlier I told you the names of three things. Can you tell me what those were?”

Language 2 2 Show the patient two simple objects, such as a wristwatch and a pencil, and ask the patient to name them.

18
and Praxis
1 1 “Repeat the phrase: ‘No ifs, ands, or buts.’”

“Take the paper in your right hand, fold it in half, and put it on the floor.”(The examiner gives the patient
3 3
a piece of blank paper.)

1 1 “Please read this and do what it says.” (Written instruction is “Close your eyes.”)

1 1 “Make up and write a sentence about anything.”

“Please copy this picture.” (The examiner gives the patient a blank piece of paper and asks him/her to
draw the symbol below. All 10angles must be present and two must intersect.)

1 1

30 29 Total
 CRANIAL NEVE EXAMINATION:
SR CRANIAL
FUNCTION METHOD NORMAL FINDINGS CLIENT’S RESPONSE
NO NERVE
Ask client to close eyes
Olfactory Smell reception and identify different mild Client should be able to Client can able to identified aroma of
I
Nerve and interpretation aromas such alcohol, distinguish different smells talcum powder.
powder and vinegar.
Ask clients to read Client should be able to read
Visual acuity and Client can able to read newspaper and
II Optic Nerve newsprint and determine newspaper and determine
fields determine far objects.
objects about 20ft away. far objects.
Extra ocular eye
Client should be able to
movements, lid Client can able to move eyeball and
Oculomotor Assess ocular movements exhibit normal EOM and
III elevation, pupilary able to raise eye lids and close it as
Nerve and pupil reaction normal reaction of pupil to
constrictions and per instructions.
light and accommodation.
lens shape.
Downward and
Trochlear Ask client to move Client should be able to Client can able to move eyes
IV inward eye
Nerve eyeballs obliquely move eyeballs obliquely. downward and inward.
movement
Sensation of face, Elicit blink reflex by Client blinks whenever Sensation was checked by using
scalp, cornea, oral lightly touching lateral sclera is lightly touched; cotton and blunt pin. The sensation on
Trigeminal and nasal mucous sclera; to test sensation, able to discriminate blunt face, scalp, cornea, oral and nasal
V
Nerve membranes. wipe a wisp of cotton over and sharp stimuli. mucous membranes was intact.
Chewing client’s forehead for light Chewing movement was normal.
movements of sensation and use
 jaw. alternating blunt and sharp
ends of safety pin test deep
sensation.

Assess skin sensation as of Client is able to sense and Ophthalmic sensation was intact.
ophthalmic branch above. distinguish different stimuli.

Ask client to clench teeth Client should be able clench Client can able to clench teeth
laterally. properly as per instructions.

Abducens Lateral eye Ask client to move eyeball Client should be able to
VI Client can able to move eye laterally.
Nerve movement laterally move eyeballs laterally.

Ask client to do different

Client should be able to do
facial expressions such as
Taste on anterior different facial expressions
smiling, frowning and Client can able to recognize different
2/3 of the tongue such as smiling, frowning
raising of eyebrows; ask taste like sweet, sour and spicy. Client
VII Facial Nerve facial movements, and raising of eyebrows;
client to identify various can able to make different expression
eye closure, labial able to identify different
taste placed on the tip and and speech is normal.
speech. tastes such as sweet, salty
sides of the mouth: sugar,
and bitter taste.
salt and coffee
Assess client’s ability to Client should be able to hear
Acoustic Hearing and hear loud and soft spoken loud and soft spoken words;
VIII Hearing acuity is intact.
Nerve balance words; do the watch tick able to hear ticking of watch
test on both ears.
 Apply taste on posterior
Taste on posterior
tongue for identification Client should be able to
1/3 of tongue,
(sugar, salt and coffee); identify different taste such
pharyngeal gag Client can able to move tongue
ask client to move tongue as sweet, salty and bitter
reflex, sensation outside and inside. Swallowing and
Glossophary from side to side and up taste; able to move tongue
IX from the ear drum gag reflex are intact. And patient can
ngeal Nerve and down; ask client to from side to side and up and
and ear canal. able to distinguish different taste on
swallow and elicit gag down; able to swallow
Swallowing and the back side of the tongue.
reflex through sticking a without difficulty, gag
phonation muscles
clean tongue depressor reflex should be present.
of the pharynx.
into client’s mouth.
Sensation from Client should be able to
Ask client to swallow;
pharynx, viscera, swallow without difficulty; Swallowing reflex is normal. No
X Vagus Nerve assess client’s speech for
carotid body and has absence of hoarseness in evidence of hoarseness in sound.
hoarseness.
carotid sinus. speech.
Ask client to shrug Client should be able to
Trapezius and Client can able to shrug the shoulders
shoulders and turn head shrug shoulders and turn
Accessory sternocledomastoi and turn head from side to side but
XI from side to side against head from side to side
Nerve d muscle cannot able to resist against nurse’s
resistance from nurse’s against resistance from
movement hand.
hands. nurse’s hands.

Tongue movement
Ask client to protrude Client should be able to
Hypoglossal for speech , sound Client can able to protrude tongue at
XII tongue at midline and protrude tongue at midline
Nerve articulation and midline and move it side to side
move it side to side. and move it side to side.
swallowing.
 EXAMINATION OF MOTOR STATUS:

• Muscle strength : As per Assessment Scale for Muscle Strength- 3/5

• Muscle tonus : No evidence of any abnormality.
• Coordination : No evidence of any abnormality. Tested through
finger nose testing
• Involuntary movement : Not Present.

 Examination of upper limbs motor system:

• Appearance : There is no any abnormality like muscle wasting,
asymmetry or hypertrophy.
• Tone : Decreased due to weakness
• Movement : Normal range of motion present.
• Power : No evidence of any abnormality.

 Examination of upper limbs sensation:

• Pain : Patient is able to identify pain while pressing with pin.
• Light touch : Patient is having sensation to light touch.
• Temperature : Patient is able to identify hot and cold stimuli.
• Joint position sense : Patient can able to specify direction of movement.
• Vibration : Patient can able to feel vibration on applied area.

 Examination of upper limb reflexes:

• Bicep jerk : Present
• Supinatory jerk : Elbow and finger flexion present.
• Triceps jerk : Extension of elbow is present.
• Hoffman’s reflex : Present.
• Abdominal reflex : Abdominal muscles contractions have been seen.

 Sphincters:
• Anal reflex : Present

 Examination of lower limb motor system:

• Appearance : There is no any abnormality like muscle wasting,
asymmetry or hypertrophy
• Tone : Decreased due to weakness
• Movement : Normal range of motion present.
• Clonus : Present
• Power : No evidence of any abnormality.

 Assess deep tendon and plantar reflexes:

• Knee jerk (patellar tendon) : Present
• Ankle jerk (Achilles tendon) : Present
• Plantar response : Flexion is present

23
 Examination of
Coordination : No any evidence of dysdiadokinesia or
ataxia.

 Examination of posture and gait:

• Romberg’s test : No evidence of excessive postural swaying.
• Gait : No evidence of abnormal leg movement, or
instability
 INVESTIGATION

Sr Name Of Normal Patient Value Remark

No. Investigation Value

1. Haemoglobin 12-18 gm% 8.5 gm% Anaemia

2. WBC count 4000- 15000/cumm Increased

11000/cumm

Neutrophils 40-75 % 76 % Increased

3.
Lymphocytes 20-45 % 22% Normal

Eosinophil 0-5 % 06 % Increased

Monocytes 0-5% 03% Normal

Basophils 0-2% 00 % Normal

4. Random blood sugar 70-120 mg% 72 mg% Normal

5. Blood group - B positive Normal

6. HIV - Negative -

7. Hepatitis B - Negative -

8. Serum sodium 135-145 138 mEq/L Normal

mEq/L

9. Serum potassium 3.5-4.5 3.5 mEq/L Normal

mEq/L

10. Serum creatinine 0.8-1.4 mg/dl 0.8 mg/dl Normal

10. Total bilirubin 0.2-1.2 mg/dl 1.1 mg/dl Normal

 DRUG STUDY

Trade name Dose Therapeutic

Sr. and generic classification Mechanism of
Route Indications Side effects Nurses responsibility
no name of the action
drug Frequency

o Anticonv- o Management of o Frequent: Baseline assessment

ulsant generalized tonic- Drowsiness,
o Antiarrhy clonic seizures lethargy, Anticonvulsant:
-thmic. (grand mal), confusion, slurred
complex partial speech, irritability, o Review history of
o Stabilizes seizure disorder
seizures, status gingival
neuronal patients (intensity, frequency,
epilepticus. hyperplasia,
Inj. Phenytoin membranes in duration, LOC).
100 mg o Prevention of hypersensitivity
Sodium motor cortex. o Initiate seizure
seizures following reaction (fever,
1. IV Decreases precautions.
(Dilantin, head rash,
patients influx of o LFT, CBC should be
Novo- trauma/neurosurge lymphadenopathy)
TDS sodium during performed before
Phenytoin) ry , constipation,
generation of beginning therapy and
o Prevention of earl dizziness, nausea.
patients nerve periodically during
post-traumatic o Occasional:
impulses. therapy.
seizures following Headache,
traumatic brain hirsutism, o Repeat CBC 2 wks
injury. coarsening of following initiation of
facial features, therapy and 2 wks
insomnia, muscle following

26
twitching. administration of
maintenance dose.

Intervention/

evaluation

o Observe frequently for

recurrence of seizure
activity.
o Assess for clinical
improvement (decrease
in intensity/frequency
of seizures). Monitor
for signs/symptoms of
depression, suicidal
tendencies, unusual
behavior. Monitor
CBC with differential,
renal function, LFT,
B/P (with IV use).
o Assist with ambulation
if drowsiness, lethargy
occurs.
o Monitor for therapeutic
serum level (10–20
 mcg/ml). Therapeutic
serum level: 10–20
mcg/ml; toxic serum
level: greater than 20
mcg/ml.

Patient/family teaching

o Pain may occur with

IV injection.
o To prevent gingival
hyperplasia (bleeding,
tenderness, swelling of
gums), maintain good
oral hygiene, gum
massage, regular
dental visits.
o Serum levels should be
performed every mo
for 1 yr after
maintenance dose is
established and q3mos
thereafter.
o Report sore throat,
fever, glandular
swelling, skin reaction
 (hematologic toxicity).
o Drowsinessusually
diminishes with
continued therapy.
o Avoid tasks that
require alertness,
motor skills until
response to drug is
established.
o Do not abruptly
withdraw medication
after long-term use
(may precipitate
seizures).
o Strict maintenance of
drug therapy is
essential for seizure
control. arrhythmias.
o Avoid alcohol.
o Report any unusual
changes in29
behaviour.
 Histamine H2 o Short-term o Inhibits the o CNS: confusion, Baseline assessment
Antagonists treatment of active action of dizziness, o Obtain history of
duodenal ulcers histamine at the drowsiness, epigastric/ abdominal
and benign H2-receptor site hallucinations, pain.
patients gastric patients located headache. o Obtain baseline renal
ulcers. primarily in o CV:Arrhythmias.
Maintenance function, LFT.
gastric parietal o GI: constipation,
therapy for cells, resulting in Intervention/
diarrhea, drug-
duodenal and patients induced hepatitis
gastric ulcers after evaluation
inhibition of (nizatidine,
Inj. healing of active
40mg gastric acid cimetidine), o Monitor serum ALT,
Ranitidine ulcers. secretion. nausea. AST levels, BUN,
2. IV o Management of
(Acid Reducer, o GU: psperm creatinine.
GERD. Treatment Therapeutic
Zantac, TDS count, erectile o Assess mental status in
of heartburn, acid Effects:
Zantac) dysfunction elderly.
indigestion, and
o Healing and (cimetidine). o Question present
sour stomach.
prevention of o Endo: abdominal pain, GI
o Management of
ulcers. gynecomastia. distress.
gastric
o Decreased o Hemat:
hypersecretory. Patient/family teaching
patients agranulocytosis,
symptoms of Aplastic anemia, o Smoking decreases
gastroesophageal anemia, effectiveness of
reflux. neutropenia, medication.
o Decreased thrombocytopenia. o Do not take medicine
secretion o Local: pain at IM within 1 hr of
 patientsof gastric site. magnesium- or
acid. o Misc: aluminium containing
hypersensivity o antacids.
reactions, o Transient burning/
vasculitis. o pruritus may occur
with IV administration.
o Report headache.
o Avoid alcohol, aspirin.

Antipyretic Antipyretics, o CNS: Agitation, Baseline assessment

o Inhibits the Anxiety,
Nonopioid analgesics synthesis of Headache, Fatigue o If given for analgesia,
prostaglandins , Insomnia. assess onset, type,
that may serve as o Resp: atelectasis, location, duration of
Inj. mediators of pain dyspnea. pain.
Paracetamol 2ml and fever, o CV: hypertension, o Effect of medication is
primarily in the hypotension. reduced if full pain
3. (Abenol, IV CNS. o GI: response recurs prior
Acephen,Dolo) o Has no Hepatotoxicity, to next dose.
SOS
significant anti- constipation, liver o Assess for fever.
inflammatory enzymes, nausea, o Assess alcohol usage.
properties or GI vomiting.
Intervention/
toxicity. o F and E:
hypokalemia. evaluation
o GU: renal failure
Hemat: o Assess for clinical
 neutropenia, improvement and relief
pancytopenia. of pain, fever.
o MS: muscle Therapeutic serum
spasms, trismus. level: 10–30 mcg/ml;
o Derm: Acute toxic serum level:
Generalized greater than 200
Exanthematous mcg/ml.
Pustulosis, o Do not exceed
Stevensjohnson maximum daily
Syndrome, Toxic recommended dose: 4
Epidermal g/day.
Necrolysis, Rash,
Urticaria. Patient/family teaching

o Consult physician for

use in children
younger than 2 yrs,
oral use longer than 5
days (children) or
longer than 10 days
(adults), or fever
lasting longer than 3
days.
o Severe/recurrent pain
or high/continuous
fever may indicate
 serious illness.
o Advise not to take
more than 4 g/24-hr
period.
o Many non-prescription
combination products
contain acetaminophen.
o Avoid alcohol.

o Pharmac o Infections of o Interferes with o CNS: headache, Baseline assessment

ologic respiratory system, bacterial cell- confusion,
class: bones, joints, and wall synthesis hemiparesis, o Obtain CBC, renal
Third- skin; septicemia and division by lethargy, function tests.
generatio- binding to cell paresthesia, o Question for history of
1 g n wall, causing cell syncope, seizures allergies, particularly
Inj.
cephalos- to die. o CV: hypotension, cephalosporins,
Ceftriaxone I.V.
porin o Active against palpitations, chest penicillins.
4. Sodium
OD o Therape gram-negative pain, vasodilation
Intervention/
(Rocephin) utic and gram- o EENT: hearing
class: positive bacteria, loss evaluation
Anti- with expanded o GI: nausea,
infective activity against vomiting, diarrhea, o Assess oral cavity for
gram-negative abdominal cramps, white patches on
bacteria. oral candidiasis, mucous membranes,
o Exhibits minimal pseudomembranou tongue (thrush).
immunosuppress s colitis, o Monitor daily pattern
ant activity. pancreatitis, of bowel activity, stool
Clostridium consistency.
difficile– o Mild GI effects may be
associated diarrhea tolerable (increasing
o GU: vaginal severity may indicate
candidiasis onset of antibiotic-
o Hematologic: associated colitis).
lymphocytosis, o Monitor I&O, renal
eosinophilia, function tests for
bleeding tendency, nephrotoxicity, CBC.
haemolytic o Be alert for
anemia, superinfection:
hypoprothrombine o fever, vomiting,
mia, neutropenia, diarrhea, anal/
thrombocytopenia, o genital pruritus, oral
agranulocytosis, mucosal changes
bone marrow
depression (ulceration, pain,
o Hepatic: jaundice, erythema).
hepatomegaly Patient/family teaching
o Musculoskeletal:
arthralgia o Discomfort may occur
o Respiratory: with IM injection.
dyspnea o Doses should be
o Skin: urticaria, evenly spaced.
maculopapular or
erythematous rash
o Other: chills,
fever,
superinfection,
pain at I.M.
injection site,
anaphylaxis,
serum sickness
 NURSING THEORY

Introduction:

The goal of nursing is to help persons attain a higher level of harmony within the
body mind and spirit. Attainment of that goal can potentiate healing and health.
This goal is pursued through transpersonal caring guided by carative factors and
corresponding caritas processes. Watsons theory include 10 carative factors.
Carative factors – termed to CARITAS. Caritas – means to cherish, to appreciate,
and to give special attention. It conveys the concept of love.

According to health status of the patient I have applied Watsons theory for
providing nursing care.

36
 Maintained
helping,
Tried to solve trustng and
maximimum caring relation
level of Encouraged
with patient. patient to
problems and
provided expresss his
effective feelings.
comfort.
Provided
Allowed
supportive
patient to
and
follow
protective
spiritual
environment
practices.
.

Patient

Explained
Formed client, how to
humanistic take care of
system of self at
values. maximum
level.

Instillated Assessted
faith and patient to
hope. perform
Provided ADLS.
psychological
support.
 NURSING DIAGNOSIS

 Actual Nursing Diagnosis:

1. Hyperthermia related to infection as manifested by thermometer reading 100.8

°F, warm flushed skin, coated tongue and elevated WBC count.
2. Acute Pain related to headache, fever as evidence by crying, complaining
about pain, holding pain site.
3. Deficit fluid volume related to excessive perspiration and less fluid intake as
manifested by sunken eyes, decreased skin turgor, dry oral mucosa, and
weakness.
4. Imbalanced Nutrition: Less Than Body Requirements related to decrease oral
intake as manifested by fatigue, weakness and decreased haemoglobin level.
5. Impaired Physical Mobility related to disease condition as manifested by
fatigue, weakness, to intravenous infusion, nuchal rigidity and restraining
devices.
6. Activity Intolerance related to fatigue and malaise secondary to infection as
manifested by need help to perform activity of daily living.
7. Knowledge deficit related to treatment and prevention of disease as manifested
by sometimes asking question regarding treatment modality, confused facial
expression.
8. Ineffective therapeutic regimen management related to lack of knowledge of
risk factors, disease process, rehabilitation, home activities, and medications
as evidenced by questioning about illness, management, and care after
discharge.
9. Interrupted Family Process related to critical nature of situation and uncertain
prognosis as manifested by family members are crying, patient is not
responding to family members.

 Potential Nursing Diagnosis:

1. Risk for Injury related to restlessness, abnormal neuromuscular activity and

disorientation.
2. Risk for Ineffective Airway Clearance related to episode of convulsion and
tongue fall.
3. Risk for Infection related to hospitalization as manifested by decrease oral
intake, poor sanitation and lack of aseptic technique.
4. Risk for impaired skin integrity related to bedridden as manifested by dry skin,
decrease mobility, diaphoresis and dehydration.
Sr Assessment Nursing Outcome Planning Rationale Implementation Evaluation
No. Diagnosis
1. Subjective data: Hyperthermia Patient will  Identify the  Determination and  Identified the triggering After provision
related to be maintain triggering management of the factor- thermoregulation of intervention
 Patient says infection as normal body factors. underlying cause disturbance. patient was
that he is manifested by temperature. are necessary to maintaining
having fever. thermometer recovery. normal body
reading 100.8 temperature.
Objective data: °F, warm
flushed skin,
 Thermometer coated
reading tongue and
100.8 °F,
elevated
 Warm WBC count.
flushed skin,
 Coated
tongue
 Elevated
WBC count.

 Monitor the  Heart rate and BP  Monitored patient’s vital

patient’s Vital increase as signs.
signs. hyperthermia  Temperature
progresses. : 100.8oF
 Pulse
: 86 beats/ minute

39
  Respiration
: 32 breaths/minute
 Blood pressure
: 120/78 mm of Hg.

 Adjust and  Room temperature  Adjusted room

monitor may be accustomed temperature near to
environmental to near normal body normal body temperature
factors like room temperature, to by maintaining proper
temperature. maintain body ventilation via turning on
temperature by the fan and opened the
radiation. windows of room.

 Eliminate excess  Exposing skin to  Eliminated excess

clothing and room air decreases clothing and cover.
covers. warmth and
increases
evaporative cooling.
 Give antipyretic  Antipyretic  Administered Inj.
or antibiotic/ medications lower Paracetamol, Antibiotic
antiviral body temperature Inj. Ceftriaxone 1 g I.V.
medications as by blocking the OD.
prescribed. synthesis of
prostaglandins that
act in the
hypothalamus.
Sr Assessment Nursing Outcome Planning Rationale Implementation Evaluation
No. Diagnosis
2. Subjective data: Acute Pain Patient’s  Assess pain  To identify the  Assessed the After provision
related to pain will be characteristics. baseline data. characteristic of pain. of all
 Patient says headache, reduce. Patient was feeling intervention
that he is fever, evidence constant dull pain on the patient’s pain
having by crying, forehead and the region of was reducing.
headache. complaining neck, moderate in nature
about pain, 5/10 on pain scale.
holding pain
site.
Objective data:

 Crying
 Complaining
about pain
 Holding pain
site

 Provide  To reduce pain  Provided fowler’s

comfortable intensity. position to patient to
position to reduce pain because
patient. intracranial pressure will
reduce by the fowler’s
position.
  To alleviate the pain  Provided pillows and back
 Provide comfort intensity. rest to the patient.
devices to the
patient.
 Provide rest  A peaceful and  Provided rest periods to
periods to quiet environment promote relief, sleep, and
promote relief, may facilitate rest relaxation.
sleep, and and reduce the pain.
relaxation.
 Provide  To reduce severity  Provided T. Paracetamol
analgesics as of the pain. stat. to reduce intensity of
ordered, pain and checked for
evaluating the effect and adverse effect.
effectiveness and There is no evidence of
inspecting for any adverse reaction.
any signs and
symptoms of
adverse effects.
Sr Assessment Nursing Diagnosis Outcome Planning Rationale Implementation Evaluation
No.
3. Subjective data: Impaired Physical Patient will  Instruct patient  Rocking from side to  Instructed patient After
Mobility related to be maintain with techniques side helps to start the with techniques that provision of
 Patient says disease condition maximum that initiate leg movement. initiate movement. all
that he is
as manifested by level of movement. interventions
feeling fatigue, weakness, activities. patient was
weakness.  Instruct patient to  Parkinson disease  Instructed patient to gaining
intravenous
get out of chair by causes rigidity get out of chair by maximum
Objective data: infusion.
moving to edge of tremors, bradykinesia moving to edge of level activity.
seat, placing and may result in seat, placing hands
 Fatigue
hands on arm difficulty getting out on arm supports,
 Weakness
supports, bending of a chair. bending forward,
 Intravenou
forward, and then and then rocking to a
s infusion
rocking to a standing position.
standing position.
 Balance may be  Taught the patient to
 Teach the patient adversely affected concentrate on
to concentrate on because of the walking erect and
walking erect and rigidity of the arms use a wide-based
use a wide-based that prevents them gait.
gait. from swinging when
walking normally. A
special walking
technique must be
 learned to offset the
shuffling gait and the
tendency to lean
forward. A conscious
effort must be made
to swing the arms,
raise the feet while
walking, and use a
heel-toe placement of
the feet with long
strides.
 Instruct patient to  Exercise prevents  Instructed patient to
perform daily contractures that perform daily
exercise that will occur when muscles exercise that will
increase muscle are not used, increase muscle
strength: walking, improves strength: walking,
riding a stationary coordination and riding a stationary
bike, swimming, dexterity, and reduces bike, swimming, and
and gardening are muscular rigidity. gardening are
helpful. Adherence to helpful.
exercise and walking
program helps delay
the progress of the
disease.
  Provide warm  Helps relax muscles  Provided warm
baths and and relieve painful baths and massages.
massages. muscle spasms that
accompany rigidity.

Sr Assessment Nursing Outcome Planning Rationale Implementation Evaluation

No. Diagnosis
4. Subjective Imbalanced Patient will  Used to define the extent  Assessed patient’s After
data: Nutrition: Less be  Assess and of the problem and skin turgor- it is provision of all
Than Body maintained communicate the intervention. decreased, patient’ interventions
 Patient nutritional status of
Requirements normal weight reduced patient was
says that he clients and families
related to nutritional average 0.5 kg maintaining
is feeling as recommended:
decrease oral status. within a month, adequate
weakness. intake Record the skin
as swallowing reflex nutritional
Objective manifested by turgor, weight is intact and bowel status.
data : fatigue, measurement, oral sounds are heard.
weakness and mucosal integrity,
 Decrease decreased ability and inability
body haemoglobin to swallow, the
weight level. presence of bowel
sounds.
 Weakness  Ascertain patient’s  Helpful in identifying  Identified patient’s
 Decreased usual dietary specific needs and usual dietary
haemoglob pattern. Include in strengths. Consideration pattern and
in level. selection of food. of individual preferences preferences of
may improve dietary foods.
intake.

 Useful in measuring  Monitored
 Monitor Intake and effectiveness of patient’s intake:
Output and weight nutritional and fluid 2300ml and
periodically. support. output: 1500ml,
weight: 52 kg.

 Encourage and  Helps conserve energy,  Encouraged and

provide for frequent especially when provided for
rest. metabolic requirements frequent rest.
are increased by fever.

 Encourage small,  Maximizes nutrient intake  Encouraged small,

frequent meals with without undue frequent meals
foods high in fatigue/energy with foods high in
protein and expenditure from eating protein and
carbohydrates. large meals, and reduces carbohydrates.
gastric irritation.
Sr Assessment Nursing Outcome Planning Rationale Implementation Evaluation
No. Diagnosis
5. Objective Risk for Injury Patent will be  Influences scope and  Determined After
data : related to maintained  Determine factors intensity of interventions factors related toprovision of
restlessness, free from risk related to individual to manage threat to safety. individual all
 Episode of abnormal of injury. situation, as listed in situation, as
intervention
jerky neuromuscular Risk Factors, and listed in Risk s patient
moments, activity and extent of risk. Factors, and
was
 Unable to disorientation. extent of risk. maintained
maintain free from
balance  Prevents or  Used and pad
risk of
 Use and pad side minimizes injury side rails with injury.
due to
rails with bed in lowest when seizures (frequent bed in lowest
weakness
position, or place bed or generalized) occur position.
 Inability to
up against wall and while patient is in
maintain
pad floor if rails not bed. Note: Most
self care.
available or individuals seize in place
appropriate. and if in the middle of the
bed, individual is unlikely
to fall out of bed.
 Do not leave  To Promotes safety  Constant
the patient alone. measures observation was
maintained by
 nurse.

 Support head, place on  Supporting  Supported head

soft area, or assist to the extremities lessens while and kept
floor if out of bed. Do the risk of physical injury on soft pillow.
not attempt to restrain. when patient lacks
voluntary muscle
control. Note: If attempt
is made to restrain patient
during seizure, erratic
movements may increase,
and patient may injure
self or others
 Instruct patient to  These action assist gait  Instructed patient
swing arms and lift and prevent falls. to swing arms
heels during and lift heels
ambulation. during
ambulation.

 Teach range of motion  Exercising increases  Taught range of

exercises and flexibility and improves motion exercises
stretching to be strength and balance. and stretching to
performed daily. be performed
daily
 HEALTH EDUCATION

WHAT YOU NEED TO KNOW:

Epilepsy is a brain disorder that causes seizures. It is also called a seizure disorder.
A seizure means an abnormal area in your brain sometimes sends bursts of electrical
activity. A seizure may start in one part of your brain, or both sides may be affected.
Depending on the type of seizure, you may have movements you cannot control, lose
consciousness, or stare straight ahead. You may be confused or tired after the seizure. A
seizure may last a few seconds or longer than 5 minutes. A birth defect, tumor, stroke,
dementia, injury, or infection may cause epilepsy. The cause of your epilepsy may not be
known. If your seizures are not controlled, epilepsy may become life-threatening.

DISCHARGE INSTRUCTIONS:

Call 108 for any of the following:

 Your seizure lasts longer than 5 minutes.

 You have trouble breathing after a seizure.

 You have diabetes or are pregnant and have a seizure.

 You have a seizure in water, such as a swimming pool or bathtub.

Seek care immediately if:

 You have a second seizure within 24 hours of the first.

 You are injured during a seizure.

Contact your healthcare provider if:

 You feel you are not able to cope with your condition.

 Your seizures start to happen more often.

 You are confused longer than usual after a seizure.

 You are planning to get pregnant or are currently pregnant.

 You have questions or concerns about your condition or care.

49
Medicines:

 Antiseizure medicine may control or prevent another seizure. Do not stop taking
this medicine. Another person may need to give you rescue medicine to stop a
seizure at home. Ask your healthcare provider for more information about rescue
medicine.

 Take your medicine as directed. Contact your healthcare provider if you think
your medicine is not helping or if you have side effects. Tell him of her if you are
allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you
take. Include the amounts, and when and why you take them. Bring the list or the
pill bottles to follow-up visits. Carry your medicine list with you in case of an
emergency.

Follow up with your neurologist as directed:

You may need tests to check the level of antiseizure medicine in your blood. Your
neurologist may need to change or adjust your medicine. Write down your questions so
you remember to ask them during your visits.

What you can do to prevent a seizure:

You may not be able to prevent every seizure. The following can help you manage
triggers that may make a seizure start:

 Take your medicine every day at the same time. This will also help prevent
medicine side effects. Set an alarm to help remind you to take your medicine
every day.

 Manage stress. Stress can be a trigger for epilepsy. Exercise can help you reduce
stress. Talk to your healthcare provider about exercise that is safe for you. Illness
can be a form of stress. Eat a variety of healthy foods and drink plenty of liquids
during an illness. Talk to your healthcare provider about other ways to manage
stress.

 Set a regular sleep schedule. A lack of sleep can trigger a seizure. Try to go to
sleep and wake up at the same time every day. Keep your bedroom quiet and dark.
Talk to your healthcare provider if you are having trouble sleeping.

 Limit or do not drink alcohol as directed. Alcohol can trigger a seizure,

especially if you drink a large amount at one time. A drink of alcohol is 12 ounces
of beer, 1½ ounces of liquor, or 5 ounces of wine. Talk to your healthcare
provider about a safe amount of alcohol for you. Your provider may recommend
that you do not drink any alcohol. Tell him or her if you need help to quit
drinking.
What you can do to manage epilepsy:

 Keep a seizure diary. This can help you find your triggers and avoid them. Write
down the dates of your seizures, where you were, and what you were doing.
Include how you felt before and after. Possible triggers include illness, lack of
sleep, hormonal changes, alcohol, drugs, lights, or stress.

 Record any auras you have before a seizure. An aura is a sign that you are
about to have a seizure. Auras happen before certain types of seizures that are in
only 1 part of the brain. The aura may happen seconds before a seizure, or up to
an hour before. You may feel, see, hear, or smell something. Examples include
part of your body becoming hot. You may see a flash of light or hear something.
You may have anxiety or déjà vu. If you have an aura, include it in your seizure
diary.

 Create a care plan. Tell family, friends, and coworkers about your epilepsy. Give
them instructions that tell them how they can keep you safe if you have a seizure.

 Find support. You may be referred to a psychologist or social worker. Ask your
healthcare provider about support groups for people with epilepsy.

 Ask what safety precautions you should take. Talk with your healthcare
provider about driving. You may not be able to drive until you are seizure-free for
a period of time. You will need to check the law where you live. Also talk to your
healthcare provider about swimming and bathing. You may drown or develop life-
threatening heart or lung damage if you have a seizure in water.

 Carry medical alert identification. Wear medical alert jewelry or carry a card
that says you have epilepsy. Ask your healthcare provider where to get these
items.

How others can keep you safe during a seizure:

Give the following instructions to family, friends, and coworkers:

 Do not panic.

 Do not hold me down or put anything in my mouth.

 Gently guide me to the floor or a soft surface.

 Place me on my side to help prevent me from swallowing saliva or vomit.

 Protect me from injury. Remove sharp or hard objects from the area surrounding
me, or cushion my head.

 Loosen the clothing around my head and neck.

 Time how long my seizure lasts. Call 108 if my seizure lasts longer than 5 minutes
or if I have a second seizure.

 Stay with me until my seizure ends. Let me rest until I am fully awake.

 Perform CPR if I stop breathing or you cannot feel my pulse.

 Do not give me anything to eat or drink until I am fully awake.

 DISCHARGE PLANNING

Mr. Kunal18 year old Male patient, who had come to the hospital with
complaints of convulsions, fever, headache, tremors, excessive perspiration and
confusion . He was brought to Dhiraj Hospital by ambulance and was admitted here
on 09/04/2018. He is admitted to the Neurology Ward of the hospital for further
investigation, interventions and treatment. Various laboratory investigations were
performed and treatment was prescribed accordingly. He was diagnosed as a case of
Epilepsy. I have selected this patient for my care plan and providing appropriate
nursing care.

 Explain all medications and include the mechanism of action, dosage, route, and
side effects.
 Explain any drug interactions or food interactions.
 Provide referrals and teaching specific to the identified neurological deficits.

Patient was advised to take following medication;

T. Phenytoin Sodium 50 mg TDS

T. Pan 40mg TDS

T. Ceftriaxone 300mg TDS

T. Paracetamol SOS
 CONCLUSION

Mr. Kunal18 year old Male patient, who had come to the hospital with
complaints of convulsions, fever, headache, tremors, excessive perspiration and
confusion . He was brought to Dhiraj Hospital by ambulance and was admitted here
on 09/04/2018. He is admitted to the Neurology Ward of the hospital for further
investigation, interventions and treatment. Various laboratory investigations were
performed and treatment was prescribed accordingly. He was diagnosed as a case of
Epilepsy. I have selected this patient for my care plan and providing appropriate
nursing care. I have selected this patient for my care plan and providing appropriate
nursing care. I have collected history of the patient and have given health education. I
have even maintained good interpersonal relationship with the patient and her family
and have rendered a need based nursing care. As a result, the client’s health status and
level of self esteem improved.
 EVIDENCE

ABSTRACT

Ivermectin Treatment in Patients With Onchocerciasis-Associated Epilepsy:

Protocol of a Randomized Clinical Trial

Background

Many studies have reported an association between epilepsy, nodding syndrome (NS),
and onchocerciasis (river blindness). A high prevalence of epilepsy has been noted
particularly in onchocerciasis hyperendemic areas where onchocerciasis is not or
insufficiently controlled with mass ivermectin distribution. There is evidence that
increasing the coverage of ivermectin reduces the incidence of epilepsy, and anecdotal
evidence suggests a reduction in seizure frequency in onchocerciasis-associated epilepsy
(OAE) patients who receive ivermectin. Finding an alternative treatment for epilepsy in
these patients will have major consequences.

Objective

The goal of the study is to assess whether ivermectin treatment decreases the frequency of
seizures and leads to seizure freedom in OAE patients, including patients with NS. If we
are able to demonstrate such an effect, this would strengthen the argument that
onchocerciasis is causing epilepsy and therefore we should increase our efforts to
eliminate onchocerciasis.

Methods

We will conduct a randomized clinical trial in the Democratic Republic of Congo to

compare seizure freedom in onchocerciasis-infested epilepsy patients who receive
immediate ivermectin treatment with delayed (after 4 months) ivermectin treatment. All
participants will simultaneously receive antiepilepsy drugs (AEDs) according to local
guidelines for epilepsy treatment. The primary endpoint is seizure freedom defined as no
seizures during the 4 month of follow-up. Secondary endpoint is significant (>50%)
seizure reduction compared to baseline seizure frequency. Reduction of seizures will be
compared between ivermectin and nonivermectin arms.

Results

Start of enrollment is planned for August 2017, and we expect to have enrolled all 110
participants by December 2017. Results are expected in June 2018.
Conclusions

If ivermectin treatment in addition to AEDs is able to lead to seizure freedom or

significantly reduces seizure frequency in OAE patients, this will have major
consequences for epilepsy treatment in onchocerciasis-endemic regions. Ivermectin is
donated for free and in non Loa-Loa–endemic regions has negligible side effects.
Reducing the burden of epilepsy will have a major impact on quality of life and
socioeconomic status of families with affected members in Africa.

P I C O T

Patient/
Population/ Intervention Comparison Outcome Time
Problem

Ivermectin
treatment in
addition to August
AEDs is able to 2017 to
Onchocerciasis- Ivermectin and December
Ivermectin lead to seizure
Associated nonivermectin 2017
Epilepsy Treatment freedom or
arms
significantly
reduces seizure
frequency in
OAE patients
 REFERENCES

1. Joanne V Hickey., the clinical practice of neurological neurosurgical nursing., 7th

edition., 2014., Wolters Kluwer.
2. I Clement., text book of neurological and neurosurgical nursing., 1st edition.,
2015., the health science publishers.
3. TP Prema, KF Graicy., Essential of neurological and neurosurgical nursing., 2nd
edition., 2012., Jaypee.
4. Sue Woodward., Neuroscience nursing Assessment and management., 2nd edtion.,
2015.
5. Joys M Black, Jane Hokanson Hawks., MEDICAL SURGICAL NURSING.,
Elsevier., 1st edition., 2012., volume 2.
6. Lewis, chintamani., MEDICAL SURGICAL NURSING., Elsevier., 2nd edition.,
2015., volume 1.
7. Brunner and Siddarth., MEDICAL SURGICAL NURSING., Wolters kluwer., 12 th
edition., 2011., volume 2.
8. Lippincott., MEDICAL SURGICAL NURSING., 8th edition., 2010.
9. https://www.drugs.com/cg/epilepsy-discharge-care.html
10. Colebunders R, Mandro M, Mukendi D, Dolo H, Suykerbuyk P, Van Oijen M.
Ivermectin treatment in patients with onchocerciasis-associated epilepsy: protocol
of a randomized clinical trial. JMIR research protocols. 2017 Aug;6(8).
11. https://en.wikipedia.org/wiki/Epilepsy
12. https://www.medicalnewstoday.com/articles/8947.php
13. https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-
20350093
14. https://nurseslabs.com/4-seizure-disorder-nursing-care-plans/