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Tonic Colonic Seizure Case Study

Vianka Nunez

School of Nursing, Nevada State College

NURS 341: Nursing Care of Children

Instructor: Anna Taber, MSN/Ed, RN, NC

October 26, 2020

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Tonic Colonic Seizure Case Study

J.W. is a Caucasian 5-year-old boy who was admitted to the emergency department

following a 3-minute tonic colonic seizure. J.W. currently lives with his single mother. Their

religious preference is Lutheran. Two years ago, he was diagnosed by his neurologist with

generalized tonic colonic seizures, and prescribed phenobarbital. This condition is caused by an

electrical imbalance in the brain between excitatory and inhibitory mechanisms, causing them to

fire the neurons in the brain when they are not supposed to, or not to fire when they should. This

results in the entire body experiencing tonic contractions, followed by rhythmic colonic

contractions, alternating with relaxion of all muscle groups and a loss of consciousness (Kyle &

Carman, 2021). J.W. has not been able to follow up with his neurologist for the past 15 months

due to the circumstances of his mother being a single mom. Upon assessing J.W., he has been

found to have no family history of seizures or other past medical problems. J.W. appears to be an

appropriate size for his age, following growth and development, and is up to date with his

immunization schedule. With J.W.’s mother being a single mom, it has impacted his seizures, as

they have not been managed how they should. It is difficult for J.W.’s mother to find time to take

him to his appointments when she is his sole financial supporter. Major concerns with J.W. are

knowing if he is taking his phenobarbital medication as prescribed, when the last time he had the

medication, and if his prescription has been refilled.

The seventh caritas process from Jean Watson’s Theory of Human Caring stating “Share

teaching and learning that addresses individual needs and comprehension styles” relates to J.W.’s

situation. When a patient is diagnosed with a disorder, it’s important that they understand the

implications of the disorder and how they can prevent worsening symptoms. Assessing the

patient’s willingness to learn is the key foundation to this caritas process. As for J.W., based on
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his growth and development, he will likely be motivated to learn and want to be included in the

teaching. Incorporating fantasy play and toys will help him be able to express his emotions

toward his disorder in a positive way.

When caring for J.W., the nurse must be considerate of his age, as well as how to

appropriately incorporate teachings that he will be able to understand. Based on J.W. being a

preschooler, he will likely have a vivid imagination, so incorporating fantasy play and toys will

give him a big picture about his seizures, and hopefully help him understand why they happen.

Children who are five years old tend to be more susceptible fear, and this is something the nurse

needs to be mindful of, so as to not instill any additional fear. When talking to J.W., it is

important to not frighten the child, as well as to encourage him to express his feelings on any

fears he may have. When he is able to express his fears, J.W. will become more independent, and

this will help his growth through school-age. During the preschool years, children tend to

experience guilt and may express that it is their fault when things to do not go right. The nurse

should educate J.W. that the seizures he experiences are not his fault, and they are not a result of

any wrongful behavior he may have done. It is important for the nurse to educate J.W.’s mother

to not express frustrated behaviors towards the child when J.W. makes a mistake because this can

cause him to feel like it is his fault. The nurse should educate J.W.’s mother on the importance of

including J.W. in activities to help him gain a sense of independence and self-worth. Having J.W.

become a part of his medication routine for his seizures will, hopefully, help prevent him from

missing a dose. This may also help his mother to keep him on track on when to take his

medication and get his prescription refilled. In addition, the nurse should stress the importance to

J.W.’s mother to keep these medications in a locked and safe place to prevent J.W. from taking

them without her supervision as he gains independence.

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References

Kyle, T., & Carman, S. (2021). Essentials of Pediatric Nursing (4th ed.). Wolter Kluwer.