PLEASE RESPOND TO THE FOLLOWING CLASSMATE'S POST IN 50 WORDS OR MORE:
D.F. is a 37-year-old woman who presents to the emergency department after having a seizure.
Subjective Data
PMH: Seizures, unknown type
Headache
Housewife
Feels weak
No loss of consciousness
Objective Data
Vital signs: T 37 P 72 R 18 BP 114/64
Lungs: Clear all bases O2 sat = 100%
CV = heart rate regular, positive peripheral pulses
PERRLA
1)What other questions should the nurse ask about the seizures?
- Was the seizure witnessed, if so, how long did it last? What were the characteristics of the seizure? How did you present after the seizure or the postictal phase?
- Did it involve contraction of limbs, arching of back, stiffening of body, jerking, lip smacking, rubbing of hands, staring off into space, or body completely flaccid?
2) What other assessments are necessary for this patient?
- History of drugs or alcohol use.
- Are you on any antidepressant or antipsychotic medications?
- Any history of multiple sclerosis?
- History of diabetes?
- History of stroke?
- Have you had any signs and symptoms of an infection?
- Any recent stressors in your life?
- Note any physical signs of injury to patient. Check the patients' body, including the tongue.
- 3)What are some of the causes of seizures?
Causes of seizures may be provoked or unprovoked. Provoked seizures may be from things such as alcohol/drug use, antidepressant or antipsychotic medications, and stress. Unprovoked seizures may be from alcohol withdrawal, traumatic brain injury, metabolic disturbances such as, hypo/hypernatremia, hypocalcemia. In addition, hypoglycemia, infections, neoplasms, and multiple sclerosis may also cause seizures.
4)Develop a problem list from objective and subjective data.
Objective data problem list: Vital signs seem relatively stable. No immediate issues seen here. Respirations are a little on the higher end, but patients O2 sat is 100%.
Vital signs: T 37(98.6) P 72 R 18 BP 114/64
Lungs: Clear all bases O2 sat = 100%
CV = heart rate regular, positive peripheral pulses
PERRLA
Subjective data problem list: Patient has a headache and feels weak, which are common symptom in the postictal phase. Other common symptoms may include difficulty talking, and confusion.
PMH: Seizures, unknown type
Headache
Housewife
Feels weak
No loss of consciousness
5) What should be included in the plan of care?
First and foremost, providing a safe environment is necessary due to D. F’s history of seizures and recent seizure activity. In addition, the plan of care should include obtaining a head CT and MRI if needed. Benzodiazepines, and anti-seizure medications as needed (PRN).
Check urine and tox screen.
Check Blood glucose level.
Check for signs of infection such as temperature, respiratory/viral panel, blood cultures, lactic, procalcitonin, Complete blood count
Check metabolic panel for any electrolyte abnormalities. Hypo/hypernatremia, and hypocalcemia may cause seizures.
6)What other risk factors are associated with this presentation?
Risk factors associated with this presentation include neurological deficits that may present with the postictal phase. This phase may present differently for everyone, but electroencephalogram (EEG) show a slowing or suppression of brain waves following a seizure. Therefore, the postictal phase presents with a variety of cognitive, sensory, and motor deficits. In addition, a patient may experience psychiatric symptoms such as psychosis and postictal depression.
7) Based on the readings and the subjective and objective data, this patient most likely had what type of seizure?
Because the patient did not lose consciousness, she most likely had a focal aware seizure. Depending on other clinical presentations of the patient's seizure, it may or may not have involved motor movement of the body. Generalized seizures affect both sides of the brain and involve loss of consciousness, therefore this type of seizure can be excluded. Focal seizures may either be focal aware (simple partial), or focal unaware (complex partial). Focal seizure may also be motor (involvement of body movement), or non-movement focal seizures.
Hauser, W. A., & Beghi, E. (2008). First seizure definitions and worldwide incidence and mortality. Epilepsia, 49(s1), 8–12. https://doi.org/10.1111/j.1528-1167.2008.01443.xLinks to an external site.
Rhesus Medicine. (2020, November 23). Seizures – Seizure Types | Generalized vs Focal Seizures | Causes of Seizures (Mnemonic) [Video]. YouTube.https://www.youtube.com/watch?v=8kYJughJXbsLinks to an external site.
Pottkämper, J. C. M., Hofmeijer, J., Van Waarde, J. A., & Van Putten, M. J. a. M. (2020). The postictal state — What do we know? Epilepsia, 61(6), 1045–1061. https://doi.org/10.1111/epi.16519Links to an external site.