Management of a Patient with Neurologic Dysfunction
1. List in the correct order of priority the actions that should be taken by the nurse while the patient is actively seizing.
During the seizure, the nurse ought to embrace the course of action highlighted below:
Dos
· Ensure that the patient is accorded some privacy. This could be by way of ensuring that non-medical professionals do not mill around the patient.
· Ensure that any restrictive or tight clothing is loosened, with special attention to any clothing around the patient’s neck.
· The nurse should ensure that the patient’s head is protected by providing sufficient padding.
· The patient should then be turned to the side. The rationale behind this move is the need to minimize the chances of foreign objects getting into the patient’s airways, i.e. aspiration. Aspiration could take place with stomach contents or saliva.
· The nurse should then conduct a breathing pattern assessment and oxygen applied if necessary.
Don’ts
· It is important to note that during the seizure, the patient must not at any point be left alone
· If any of the patient’s extremity is rigid, there must...
The rationale against such a move is that the patient’s tongue could cause airway occlusion after being pushed into the throat.
2. Explain what type of seizure is occurring and describe the three phases of seizure activity? Describe specific nursing care for each stage.
In essence, there are several types of seizure. According to Baker (2006), “the most common are absence, myoclonic, atonic, tonic, clonic, and tonoc-clonic” (693). The type of seizure that J.M. is experiencing is a tonic seizure. According to Baker (2006), some of the characteristics of tonic seizures include, but they are not limited to, muscle contractions that are sustained, autonomic alterations, as well as consciousness impairment. In the present case, J.M. experienced what has been described as violent muscle contractions. In also important to note that the seizure in this case was largely sudden and unexpected and came as the nurse was awaiting a call from radiology for J.M. to attend CT. In the words of Baker (2006), “tonic seizures are abrupt in onset” (693).
The three phases of seizure…
