Neuro Scenario #6: Seizure Management
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Questions and Answers

What should be considered if upper airway obstruction does not improve after initial maneuvers?

  • Increased fluid intake
  • Administer oxygen therapy
  • Immediate transport to the hospital
  • Definitive airway management (correct)
  • What is a potential reason for recent vomiting and diarrhea in a patient with suspected alcohol withdrawal?

  • Communicable disease (correct)
  • Infection from improper food handling
  • Gallbladder disease
  • Dehydration from exercise
  • Which factor increases the likelihood of glycemic control issues in a patient with chronic alcohol use?

  • Sleep apnea
  • Hypertension
  • Liver dysfunction (correct)
  • Skin infections
  • At what point is it recommended to notify the hospital for proper patient treatment preparation?

    <p>While packaging the patient for transport (A)</p> Signup and view all the answers

    What should not be used to rule out a seizure occurrence in a patient?

    <p>Presence of urinary incontinence (D)</p> Signup and view all the answers

    What is the main concern regarding the patient's level of consciousness after the seizure?

    <p>Patient has a decreased level of consciousness. (D)</p> Signup and view all the answers

    What medication allergy is documented for the patient?

    <p>NSAIDs allergy (B)</p> Signup and view all the answers

    How long did the seizure activity last before resolving?

    <p>6 minutes (C)</p> Signup and view all the answers

    What is the patient's history of alcohol use?

    <p>Approximately 48 oz/day for 20 years off and on. (B)</p> Signup and view all the answers

    What symptom was noted regarding the patient just before the seizure occurred?

    <p>The patient was walking unsteadily. (C)</p> Signup and view all the answers

    What treatment should be considered for the patient after the seizure?

    <p>Supplemental oxygen. (A)</p> Signup and view all the answers

    What is the patient's smoking history?

    <p>Smoker, but unknown quantity. (B)</p> Signup and view all the answers

    How did the patient's seizure start?

    <p>While the patient was walking. (B)</p> Signup and view all the answers

    What should be done if a patient has a generalized seizure while receiving a 15L NRB mask?

    <p>Leave the NRB mask in place. (B)</p> Signup and view all the answers

    What is the appropriate action to take after observing a decreased level of consciousness in the patient?

    <p>Reassess the patient's airway and breathing. (D)</p> Signup and view all the answers

    What vital sign change may indicate that the patient is becoming more critical?

    <p>Dusky coloration of the face. (B)</p> Signup and view all the answers

    If more breathing attempts than chest rise are observed, what does this signify?

    <p>The patient may be experiencing respiratory distress. (C)</p> Signup and view all the answers

    What should be monitored closely when a patient shows snoring much louder than before?

    <p>The patient's level of consciousness. (D)</p> Signup and view all the answers

    What is the heart rate recorded in the vital signs?

    <p>120 bpm (B)</p> Signup and view all the answers

    What could be the potential reason for the patient's snoring if they are supine?

    <p>Airway obstruction (A)</p> Signup and view all the answers

    What does the presence of blood in the mouth and a wound on the tongue suggest?

    <p>External injury (D)</p> Signup and view all the answers

    What is the significance of a non-diagnostic 12-lead ECG with no ST changes?

    <p>No acute cardiac events detected (D)</p> Signup and view all the answers

    What respiratory findings were noted upon examination of the chest?

    <p>Mild expiratory wheezes (C)</p> Signup and view all the answers

    What was the recorded systolic blood pressure (BP) in the vital signs?

    <p>168 mmHg (B)</p> Signup and view all the answers

    What was the patient's oxygen saturation level as indicated in the vital signs?

    <p>93% O2 (C)</p> Signup and view all the answers

    What was the recorded end-tidal carbon dioxide (ETCO2) level?

    <p>43 mmHg (C)</p> Signup and view all the answers

    What type of breath sounds were noted in the lung fields?

    <p>Mild expiratory wheezes in lower lobes (C)</p> Signup and view all the answers

    Which vital sign indicates the patient is experiencing tachycardia?

    <p>Heart Rate of 126 bpm (A)</p> Signup and view all the answers

    What was observed regarding the patient's abdomen?

    <p>Soft and non-tender (A)</p> Signup and view all the answers

    How did the patient respond to commands during the extremities examination?

    <p>Unable to follow commands (D)</p> Signup and view all the answers

    What was the patient’s oxygen saturation level?

    <p>92% (A)</p> Signup and view all the answers

    What condition was noted in the pelvic examination?

    <p>Urinary incontinence (A)</p> Signup and view all the answers

    What is indicated by the patient's blood pressure reading of 153/86?

    <p>Hypertensive urgency (D)</p> Signup and view all the answers

    What finding was noted when auscultating the back?

    <p>Clear breath sounds throughout lung fields (A)</p> Signup and view all the answers

    What was the duration of the patient's seizure before it ceased?

    <p>6 minutes (A)</p> Signup and view all the answers

    What position was the patient found in when responders arrived?

    <p>Lying in recovery position (D)</p> Signup and view all the answers

    What is the significance of the patient not having head or neck trauma during the seizure?

    <p>It suggests that c-spine precautions are unnecessary. (C)</p> Signup and view all the answers

    Which symptom indicates the patient's decreased level of consciousness post-seizure?

    <p>Patient moans and produces frothy sputum. (C)</p> Signup and view all the answers

    What does a dusky skin color indicate in this patient?

    <p>Possible hypoxia or compromised circulation (D)</p> Signup and view all the answers

    What precaution is suggested upon identifying the patient's seizure history and decreased level of consciousness?

    <p>Consider medical backup due to high-risk complaint (B)</p> Signup and view all the answers

    What type of seizure did the patient experience?

    <p>Grand mal seizure (A)</p> Signup and view all the answers

    What does the staff's description of the patient starting to seize while standing imply about the seizure's onset?

    <p>The seizure was spontaneous with no warning signs. (B)</p> Signup and view all the answers

    Flashcards

    Grand Mal Seizure

    A seizure where the patient loses consciousness and experiences muscle spasms.

    General Impression

    The first step in assessing a patient's condition, which involves quickly evaluating their overall appearance and any obvious injuries.

    Level of Consciousness (LOC)

    A measure of responsiveness to stimuli, used to assess the patient's level of consciousness.

    C-Spine

    A protective measure to prevent further injury or damage to the spine.

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    Snoring

    A sign of airway compromise that can occur when a patient is lying on their back.

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    Frothy Sputum

    A type of respiratory distress characterized by labored breathing, rapid breathing, and audible wheezing.

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    Recovery Position

    A protective position designed to maintain a safe and open airway.

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    Universal Precautions

    The use of gloves and other protective gear to prevent contact with potentially infectious materials.

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    Tachypnea

    A type of breathing pattern characterized by rapid and shallow breaths.

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    Tachycardia

    An abnormally fast heart rate, typically above 100 beats per minute.

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    Sinus Tachycardia

    A heart rhythm where the electrical activity starts in the sinoatrial node and spreads normally throughout the heart.

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    Urinary Incontinence

    A condition in which the patient involuntarily loses control of their bladder, leading to urination.

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    C-Spine Precautions

    A protective measure taken to prevent further injury to the spine, especially the cervical spine.

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    Cholesterol Medication

    A medication used to treat high cholesterol levels.

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    Generalized Tonic-Clonic Seizure (Grand Mal)

    A type of seizure characterized by loss of consciousness and muscle spasms.

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    Patient Assessment

    The process of evaluating and assessing a patient's condition, including vital signs, medical history, and current symptoms.

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    Decreasing LOC

    A decrease in the level of consciousness (LOC) where the patient does not respond to pain.

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    Louder Snoring

    Snoring that is noticeably louder than before, suggesting airway compromise.

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    Breathing Attempts Without Chest Rise

    More breathing attempts observed than actual chest rise, indicating ineffective breathing.

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    Dusky Face

    Skin turning a bluish color, indicating low oxygen levels in the blood.

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    Less Tachycardic Pulse

    A decrease in heart rate, as indicated by a weaker and slower radial pulse.

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    HR-120

    A heart rate of 120 beats per minute.

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    RR-28

    A respiratory rate of 28 breaths per minute.

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    BP- 168/91

    A blood pressure reading of 168/91 mmHg.

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    Respiratory Distress

    An elevated respiratory rate (RR) and heart rate (HR) with signs of respiratory distress.

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    Sluggish Pupils

    Equal, round, and sluggish pupils that react slowly to light. This can indicate increased intracranial pressure (ICP).

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    BGL- 4.3 mmol/L

    An abnormal blood glucose level of 4.3 mmol/L, which can indicate hypoglycemia or hyperglycemia.

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    Blood in the Mouth and Tongue Wound

    This symptom may occur with generalized seizures but is not always present. It should be reported to the hospital for accurate medical assessment.

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    Urinary and Bowel Incontinence

    This symptom may occur with seizures, but some generalized seizures do not result in incontinence. The absence of incontinence should not rule out a seizure.

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    Early Pre-Notification to the Hospital

    Early notification to the hospital allows for equipment preparation, space clearing, and efficient patient care.

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    Definitive Airway Management

    The use of airway management techniques like blind insertion airways or endotracheal intubation in cases where upper airway obstruction does not improve with initial maneuvers.

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    Study Notes

    Neuro Scenario #6 Seizure

    • Patient Information: 48-year-old male, experiencing a seizure at a non-medical alcohol rehabilitation facility.
    • Seizure Duration: 6 minutes, "grand mal" type.
    • Initial Assessment: Seizure stopped, no head or neck trauma reported by bystanders.
    • Personal Protective Equipment (PPE): Universal precautions, consider droplet/contact.
    • Scene Time: 1 PM.
    • Environment: Summer, early afternoon, cafeteria.
    • Hazards: None apparent.
    • Number of patients: 1.
    • Additional Resources: Consider medical back-up (ambulance or fire).
    • Mechanism of Injury/Illness: Seizure.

    Scene/Bystander Information

    • Staff Member: Observing, directs patient to cafeteria, lands on buttock then ground.
    • Position: Lying in recovery position on the ground, head supported by a blanket, staff member kneeling beside.
    • Level of Activity/Distress: Eyes closed, spontaneous respirations.
    • Skin Color/Condition: Dusky, warm, diaphoretic.

    Initial Approach

    • C-spine: Not required, but if applied, patient snoring noted when rolled on back.
    • Level of Consciousness (LOC): Eyes closed, no response to verbal or gentle stimuli.
    • Moans/Speech: Incomprehensible speech to painful stimuli, starts coughing with frothy sputum. Does not obey commands.

    Airway, Breathing, and Circulation (ABCs)

    • Airway: Patent, small to moderate amount of frothy sputum noted, intermittent snoring respirations.
    • Airway Intervention: Consider suction, manual maneuvers, or NPA if appropriate.
    • Breathing: 24/min, adequate chest rise with deep spontaneous respirations. Supplemental oxygen (N/C or NRB) may be considered.
    • Circulation: Radial pulse present, regular at 124/min.

    Vital Signs

    • Vitals (if applicable): BP, HR, RR, O2 saturation, temperature, blood glucose.
    • Important Note: The exact vital signs often need to be recorded at the scene and reviewed throughout treatment/reassessment.

    Rapid Survey

    • Head: No remarkable findings, if asked for: no tracheal deviation, mild JVD bilaterally.
    • Neck: No remarkable findings, no tenderness.
    • Chest: Breath sounds present to all lung fields with mild expiratory wheezes.
    • Abdomen: Soft. Exam done if requested/asked by others
    • Pelvis: No remarkable findings.
    • Extremities: Upper and lower extremities circulation intact.
    • Back: No remarkable findings. Breathable sounds clear throughout lung fields.

    Other Considerations

    • Blood in the mouth: Potential from generalized seizures (not always present), important to log.
    • Urinary/Bowel Incontinence: Possible with seizures, but may not be observed in all cases.

    Delegated Information

    • Patient History: Facility staff will provide information, if possible, about the patient's medical history, medications, alcohol use, smoking status, last meal, and last drink.
    • Family History: If possible, family history is taken into account.

    Differential Diagnoses

    • Seizure: Common reason for the patient's symptoms.
    • Other neurological conditions: Brain tumor, CVA, or other possible conditions can be considered.
    • Intoxication: Alcohol withdrawal or other potential substances are possible.

    Treatment and Reassessment

    • Ongoing Assessments: Continuous monitoring of the patient's condition is vital. Vital signs are reviewed frequently and recorded.
    • Treatment: Medication and interventions may be required dependent on the patient's condition.
    • Hospital notification: Notification of the hospital may be required, for example, for appropriate medical attention.

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    Related Documents

    Neuro Scenario 6 Seizure PDF

    Description

    This quiz explores the management and assessment of a patient experiencing a grand mal seizure in a rehabilitation setting. Participants will evaluate the scene, the role of bystanders, and considerations for patient safety and care during a seizure incident.

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