Question

K.B. is a 21-year-old man with a past medical history (PMH) of seizure disorder controlled with carbamazepine (Tegretol). He was accidentally struck in the head by a pitched baseball while batting in a baseball game. He was unconscious for about 5 seconds, then awakened and was alert and responsive. After a few hours, K.B. returned home with complaints of a "splitting" headache, drowsiness, slight confusion, and some nausea. K.B. was taken to the local hospital emergency department (ED), where a computed tomography (CT) scan revealed a left subdural hematoma. He was been transferred to your medical center 70 miles away, which has a neurosurgeon on call, and is being admitted from the ED to the medical unit.

Think through the following related to K.B.'s condition:

Etiology and pathophysiology

Risk factors

Signs and symptoms

Diagnostic procedures

Medication and treatment

Nursing interventions, including patient education

Potential complications

Complete a concept map

Answer 1

Patients with subdural hematoma are at greater risk in developing Post-traumatic Epileptic Seizures (PTSs). So, based on the data given above, there may be occurence of recurrent seizure disorder due to traumatic brain injury.

ETIOLOGY AND PATHOPHYSIOLOGY:

In Post Traumatic Epilepsy, iron deposition from extravasated blood leads to the deposition of iron and the glutamate accumulation leads to damage by excitotoxicity. Various studies suggest that disruption of the blood-brain barrier is the reason for the reoccurrence of seizure in humans. The etiology factors are a) Severe trauma b) Penetrating head injuries c) hemorrhagic contusion d) Early episode of Seizures e) history of traumatic brain injury and f) coma.

RISK FACTORS: The risk factors include a) age younger than 5 years or older than 60 years b) greater severity of brain injury c) subdural hematoma and d) penetrating wounds.

SIGNS AND SYMPTOMS: The signs and syptoms include a) staring and unresponsiveness b) stiffening or shaking of the body, legs, arms or head c) strange sound d) inability to speak or undrstand.

DIAGNOSTIC PROCEDURES:

Electroencephalogram( EEG) : EEG is the better method to understand and evaluate the patient condition after a seizure attack.

TREATMENT:

a) Prophylactic antileptic medications or anticonvulsants medications can be given to reduce the seizure activity.

For example: Levetiracetam ( effective in patients with subdural hematoma and has less adverse effects than Phenytoin or Carbamazepine).

b) Preventive measures can be taken to avoid further seizural activity such as by wearing helmets and by wearing seat belts.

c) Long-term monitoring: Regular follow-up to review the seizure frequency and medications; for neurophysiological assessment and for monitoring of adverse effect on patient.

NURSING INTERVENTION AND PATIENT EDUCATION: The nursing interventions include

a) safety of the patient is the first and foremost intervention needed to the patient b) Continuous monitoring of vital signs, c) proper medications d) continuous monitoring of seizural activies and e) regular follow up.

In patient education, the following information should be given to the patient. a) alteration of awareness should be included in the teaching plan to avoid swimming and climbing heights. b) They should never be allowed to sit alone during an activities c) Cooking, handling dangerous equipments should be strictly avoided d) Safety precautions should be taught to ensure the safety of the patients if a seizure occurs. e) Advised not to drive.

POTENTIAL COMPLICATIONS: Post traumatic seizure is the main complication with traumatic injury.