Neurologic Dysfunction Patient Management

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 be no attempt to forcibly turn the said extremity, including the neck.
· No attempt should be made to force any foreign object into the patient’s mouth at the time of the seizure. 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 activity, according to Engel (2013), include the aura, ictus, and postictal phases. The aura phase is essentially the onset of a seizure and serves as a warning of a possible seizure. As Engel (2013) points out, this stage could begin a few seconds to a seizure. Some of the symptoms at this stage include, but they are not limited to, nausea, panic or related emotions, headache or dizziness, perceived tastes and sounds, etc. In this case, the specific nursing care would be inclusive of loosening the clothing of the person, ensuring adequate ventilation, and being reassuring.
Next, the ictus stage as Engel (2013) observes is the actual seizure that can be observed by outsiders. All the symptoms presented by J.M. in the present case are characteristic of the ictus phase. It is important to note that this phase could either be convulsive or non-convulsive. The specific nursing care in this case would incorporate intravenous access as well as administration of benzodiazepines.
The last phase is the postictal phase. This phase comes after the first two phases defined above. It is characterized by relaxation of the body and the setting-in of the aftereffects. The said aftereffects, as Engel (2013) observes, could include agitation and confusion, paralysis (partial), drowsiness and fatigue, numbness, etc. The specific nursing care would be largely observatory to ensure that desired outcomes are achieved.
3. The ED physician orders the following: Valium (diazepam) 10 mg every 10 to 15 minutes prn for seizures (to a maximum dose of 30 mg). Once seizures stop, administer Dilantin (phenytoin) 10 mg/kg IVPB [The RN will be administering this IV medication], continuous ECG monitoring, VS, GCS, and neuro checks at least every 30 minutes. Explain the rationale for all of the physician’s orders.
While the valium (diazepam) injection is for immediate muscle spam relief, the administration of Dilantin (phenytoin) has longer-term relief effects. Dilantin (phenytoin) is an anticonvulsant and serves as an effective anti-seizure medication. It is important to note that the requirement that a RN administers this IV medication is due to the fact that its infiltration can cause tissue and nerve damage. Continuous ECG monitoring is of great relevance in the identification of irregular heartbeats. GCS and neuro checks at least every 30 minutes would come in handy in assessing J.M.’s state of consciousness.



References
Baker, E. (2006). Neuroscience Nursing: A Spectrum of Care (3rd ed.). New York, NY: Elsevier Health Sciences
Engel, J. (2013). Seizures and Epilepsy (2nd ed.). New York, NY: OUP USA