Seizure New Onset Seizure – seizures. Introduction
Seizure New Onset Seizure – seizures. Introduction Epilepsy is associated with other neurologic disorders such as brain tumor, and individuals with epilepsy are at increased risk for a life-threatening condition called status epilepticus. Early treatment with intravenous medication increases the likelihood of uncomplicated recovery from status epilepticus. In the following case study, you will meet a woman named Cindy Mack and follow her through a hospitalization for uncontrolled seizures. Case Study: Cindy Mack You are the nurse working in the emergency department (ED). An ambulance arrives bearing Cindy, age 20 years, who is experiencing a seizure. She is accompanied by her husband, who tells you, “I was sitting in the dining room when I looked over and saw Cindy sitting in her lounge chair thrashing around. I ran to the kitchen and called 911. She has been jerking like this for almost 25 minutes. Please do something!” Another nurse reassures the patient’s husband and obtains Cindy’s medical history while you begin the admission process. The emergency physician performs a rapid assessment, and a diagnosis of status epilepticus is established. She confirms that Cindy is experiencing generalized tonic-clonic seizure (grand mal) seizure activity. CHIEF COMPLAINT: New onset of seizure activity lasting 25 minutes Initial Assessment As you care for Cindy, you begin documentation in the ED record. Her level of consciousness is decreased, she is difficult to arouse and only moans. Localizes pain but does not follow commands. Oxygen is applied with the use of a 100% nonrebreather mask. Upon admission, Cindy’s blood pressure is 126/70 mm Hg, pulse is 110 bpm, respirations are 18 to 22 per minute, tympanic temperature is 99 °F, and oxygen saturation (SpO2) is 90%. The heart monitor shows sinus tachycardia with a rate of 110 bpm. According to her husband, Cindy weighs 120 pounds. Precautions are initiated to ensure the patient’s safety. EMERGENCY DEPARTMENT RECORD Arrival date: 3-1-xx Time: 17:00 Identification bracelet on the patient verified as to patient’s name and birth date: Patient name: Cindy Mack DOB: 5/16/90 Age: 20 Patient arrived from: Home Patient arrived: per ambulance History informant: Mark Mack Relationship: Husband Contact in case of emergency: Mark Mack Relationship: Husband, Code status: Full code, no living will or durable power of attorney. Husband refuses information at this time. Contact #s: (H) (123) 772-5020 (W) (123) 772-0604 Vital Signs Temperature: 99ºF Tympanic Pulse: 110, Regular Respirations: 22 Blood Pressure: 126/70 SpO2: 90% Additional Data: Weight: 120 pounds (per husband) Height: 5′ 2” Allergies and Adverse Drug Reaction(s): NKA Present Illness: Admitting diagnosis/Chief complaint: Status Epilepticus Symptoms/Complaints and when started: Husband reports seizure started 25 minutes prior to arrival at the ED, husband present when seizure activity began and states, “I looked over and my wife was thrashing and jerking while she was lying in a recliner chair. I have never seen her do that before. She has always been in good health.” Previous Hospitalizations/Surgeries/Medical History Tonsillectomy as a child, age 5 Current Medications: None Primary Diagnosis: Status Epilepticus, etiology of seizure unknown Physician Orders Labs: Complete Blood Count, Basic Metabolic Panel, urinalyses Every hour neurological assessment Start IV of 100 mL NS at 100 mL/hr 100% O2 per non-rebreather mask HCG Stat fingerstick blood glucose Stat Ativan 2 mg IVP if Ativan – Alternations in Cognitive Systems – Cerebral Hemodynamics, and Motor Function Case Study Prompts how would you differentiate among the different types of seizures? Apply to the case. what is the underlying cause of her decreased level of consciousness? What is the best plan of care based on the underlying pathophysiology? I’M STUDYING right now. thank you. =)
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