Nursing Process: The Patient With Epilepsy PDF

10/24/23, 3:43 PM Realizeit for Student Nursing Process The Patient With Epilepsy Assessment The nurse elicits information about the patient’s seizure history. The patient is asked about the factors or events that may precipitate the seizures. Alcohol intake is documented. The nurse determines whe...

10/24/23, 3:43 PM Realizeit for Student Nursing Process The Patient With Epilepsy Assessment The nurse elicits information about the patient’s seizure history. The patient is asked about the factors or events that may precipitate the seizures. Alcohol intake is documented. The nurse determines whether the patient has an aura before an epileptic seizure, which may indicate the origin of the seizure (e.g., seeing a flashing light may indicate that the seizure originated in the occipital lobe). Observation and assessment during and after a seizure assist in identifying the type of seizure and its management. The effects of epilepsy on the patient’s lifestyle are assessed (AANN, 2016a). What limitations are imposed by the seizure disorder? Does the patient participate in any recreational activities? Have any social contacts? Is the patient working, and is it a positive or stressful experience? What coping mechanisms are used? Planning and Goals The major goals for the patient may include prevention of injury, control of seizures, achievement of a satisfactory psychosocial adjustment, acquisition of knowledge and understanding about the condition, and absence of complications. Nursing Interventions PREVENTING INJURY Injury prevention for the patient with seizures is a priority. Patients for whom seizure precautions are instituted should have pads applied to the side rails while in bed. REDUCING FEAR OF SEIZURES Fear that a seizure may occur unexpectedly can be reduced by the patient’s adherence to the prescribed treatment regimen. Cooperation of the patient and family and their trust in the prescribed regimen are essential for control of seizures. The nurse emphasizes that the prescribed anticonvulsant medication must be taken on a continuing basis and that drug dependence or addiction does not occur. Periodic monitoring is necessary to ensure the adequacy of the treatment regimen, to prevent side effects, and to monitor for drug resistance (Hickey & Strayer, 2020). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUAYD8aTcEKqA9iFsBPwk2RFvtNozNlLKTVk0W5HMqg… 1/4 10/24/23, 3:43 PM Realizeit for Student In an effort to control seizures, factors that may precipitate them are identified, such as emotional disturbances, new environmental stressors, onset of menstruation in female patients, or fever (AANN, 2016a). The patient is encouraged to follow a regular and moderate routine in lifestyle, diet (avoiding excessive stimulants), exercise, and rest (sleep deprivation may lower the seizure threshold). Moderate activity is therapeutic, but excessive exercise should be avoided. An additional dietary intervention, referred to as the ketogenic diet or the Modified Atkins diet, may be helpful for control of seizures in some patients. This high-protein, low-carbohydrate, high-fat diet is most effective in children whose seizures have not been controlled with two anticonvulsant medications and has shown some success in adults with poor seizure control. Dietary therapy is not without risk and requires close monitoring and medical follow-up for possible side effects of therapy such as hyperlipidemia, malnutrition, weight loss, and osteoporosis (Crepeau & Sirven, 2017). Photic stimulation (e.g., bright flickering lights, television viewing) may precipitate seizures; wearing dark glasses or covering one eye may be preventive. Tension states (anxiety, frustration) induce seizures in some patients. Classes in stress management may be of value. Because seizures are known to occur with alcohol intake, alcoholic beverages should be avoided. IMPROVING COPING MECHANISMS The social, psychological, and behavioral problems that frequently accompany epilepsy can be more of a disability than the actual seizures. Epilepsy may be accompanied by feelings of stigmatization, alienation, depression, and uncertainty (Hickey & Strayer, 2020). The patient must cope with the constant fear of a seizure and the psychological consequences (AANN, 2016a). Children with epilepsy may be ostracized and excluded from school and peer activities. These problems are compounded during adolescence and add to the challenges of dating, not being able to drive, and feeling different from other people. Adults face these problems in addition to the burden of finding employment, concerns about relationships and childbearing, insurance problems, and legal barriers. Substance use disorders may complicate matters. Family reactions may vary from outright rejection of the person with epilepsy to overprotection. Counseling assists the patient and family to understand the condition and the limitations it imposes. Social and recreational opportunities are necessary for good mental health. Nurses can improve the quality of life for patients with epilepsy by educating them and their families about symptoms and their management (AANN, 2016a). PROVIDING PATIENT AND FAMILY EDUCATION Perhaps the most valuable facets of care contributed by the nurse to the person with epilepsy are education and efforts to modify the attitudes of the patient and family toward the disorder. The person who experiences seizures may consider every seizure a potential source of humiliation and shame. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUAYD8aTcEKqA9iFsBPwk2RFvtNozNlLKTVk0W5HMqg… 2/4 10/24/23, 3:43 PM Realizeit for Student This may result in anxiety, depression, hostility, and secrecy on the part of the patient and family. Ongoing education and encouragement should be given to patients to enable them to overcome these reactions. The patient with epilepsy should carry an emergency medical identification card or wear a medical information bracelet. The patient and family need to be educated about medications as well as care during a seizure. MONITORING AND MANAGING POTENTIAL COMPLICATIONS Status epilepticus is the major potential complication and is described later in this module. Another complication is the toxicity of medications. The patient and family are educated about side effects and are given specific guidelines to assess and report signs and symptoms that indicate medication overdose. Anticonvulsant medications require careful monitoring for therapeutic levels. The patient should plan to have serum drug levels assessed at regular intervals. Many known drug interactions occur with anticonvulsant medications. A complete pharmacologic profile should be reviewed with the patient to avoid interactions that either potentiate or inhibit the effectiveness of the medications. Educating Patients About Self-Care. Thorough oral hygiene after each meal, gum massage, daily flossing, and regular dental care are essential to prevent or control gingival hyperplasia in patients receiving phenytoin. The patient is also educated to inform all health care providers of the medication being taken, because of the possibility of drug interactions. An individualized comprehensive education plan is needed to assist the patient and family to adjust to this chronic disorder. Written patient education materials must be appropriate for the patient’s reading level and must be provided in alternative formats if warranted. Continuing and Transitional Care. Because epilepsy can be lifelong, health promotion is important. See Chart 61-6 for health promotion strategies for the patient with epilepsy. For many patients with epilepsy, overcoming employment problems is a challenge. State vocational rehabilitation agencies can provide information about job training. The EFA has a training and placement service. If seizures are not well controlled, information about sheltered workshops or home employment programs may be obtained. Federal and state agencies and federal legislation may be of https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUAYD8aTcEKqA9iFsBPwk2RFvtNozNlLKTVk0W5HMqg… 3/4 10/24/23, 3:43 PM Realizeit for Student assistance to people with epilepsy who experience job discrimination. As a result of the Americans With Disabilities Act, the number of employers who knowingly hire people with epilepsy is increasing, but barriers to employment still exist. Patients who have uncontrollable seizures accompanied by psychological and social difficulties should be referred as early as possible to a comprehensive epilepsy center where continuous audio–video and EEG monitoring, specialized treatment, and rehabilitation services are available (AANN, 2016a). Patients and their families need to be reminded of the importance of participating in health promotion activities and recommended health screenings to promote a healthy lifestyle. Genetic and preconception counseling is advised. Evaluation Expected patient outcomes may include: 1.Sustains no injury during seizure activity a.Adheres to treatment regimen and identifies the hazards of stopping the medication b.Can identify appropriate care during seizure; caregivers can do so as well 2.Indicates a decrease in fear 3.Displays effective individual coping 4.Exhibits knowledge and understanding of epilepsy a.Identifies the side effects of medications b.Avoids factors or situations that may precipitate seizures (e.g., flickering lights, hyperventilation, alcohol) c.Follows a healthy lifestyle by getting adequate sleep and eating meals at regular times to avoid hypoglycemia 5.Absence of complications https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUAYD8aTcEKqA9iFsBPwk2RFvtNozNlLKTVk0W5HMqg… 4/4