Question

Ken, a 46 y/o male who works as a carpenter, was admitted to the ED after having a grand mal

seizure while at a construction site. At this time, Ken is unconscious but breathing on his own

and no further seizure activity is noted. His co-worker stated that Ken fell off a ladder a year and

a half ago and he suffered a severe concussion, however, he has had no further complications

since recovering from that injury. An emergency computerized axial tomography (CAT) scan

reveals an area of scar tissue overgrowth in the frontal lobe. He is transferred to the ICU for

further observation.

Later that afternoon Ken is more alert and anxious about his condition. While completing his

admission history, you ask him if he had had any seizures before this one. He looks down and

reluctantly says “Yes” and tells you that he had another seizure a week ago but was afraid to

mention it at work.

NR304 Neurological Case Study

4. What health history questions should you ask about a patient’s seizure history? Provide at

least 5 questions.

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During you assessment you ask Ken to perform several activities. You have him pat his

knees with both hands, palm side down, then palm sides up, and then repeat this sequence

with rapid alternating movements. You have him touch the thumb to each finger on the

same hand, starting with the index finger, and then reverse the direction. You also have

him use his index finger to touch your finger (which is held out in front of him) and then

touch his nose. As you perform these tests, Ken laughs and asks, “What in the world are

you doing?”

5. How do you explain the reasoning for doing these tests?

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6. While continuing your assessment you note that Ken’s left calf is swollen and tender.

What are you suspicious he might have? How would you test for that? What other

neurological condition might you be concerned about?

Answer 1

4. Seizure health history:

1. Was any warning sign noted before seizure? If so what kind of warning occupied?

2. How often you will seizure episode?

3. What did you do during the seizure?

4. How long did the seizure post?

5. Us anything precipited with seizure?

6. Whether you are taking any medicine for seizure? If so tell about the medicine?

5. Explain reason:

1. This test is hell to assessment the movement and coordinaton.

2. This hell to rule any defect in central and peripheral nervous system.

3. It helped to diagnose the brain leisions.

6. Suspect for:

This calf muscle swelling may be associated with DVT.

Test:

Homan test: This helps to rule out DVT.

How would you test?

Make the patient to lie down.

Keep the knee straight.

Dorsiflexion of foot , when flexing if the patient verbalizes pain in calf indicates DVT.

Other concern:

Early mobility prevents DVT.