Question

D.F. is a 37-year-old woman who presents to the emergency department after having a seizure.

Subjective Data
PMH: Seizures, unknown type
Headache
Housewife
Feels weak
No loss of consciousness

Objective Data
Vital signs: T 37 P 72 R 18 BP 114/64
Lungs: clear all bases
O₂ Sat = 100%
CV = heart rate regular, positive peripheral pulses
PERRLA

1. What other questions should the nurse ask about the seizures?

2. What other assessments are necessary for this patient?

3. What are some of the causes of seizures?

4. Develop a problem list from objective and subjective data.

5. What should be included in the plan of care?

6. What other risk factors are associated with this presentation?

7. Based on the readings and the subjective and objective data, this patient most likely had what type of seizure?

Answer 1

In the present scenario,

D.F. is a 37-year-old woman who presents to the emergency department after having a seizure.

Subjective Data
PMH: Seizures, unknown type
Headache
Housewife
Feels weak
No loss of consciousness

Objective Data
Vital signs: T 37 P 72 R 18 BP 114/64
Lungs: clear all bases
O₂ Sat = 100%
CV = heart rate regular, positive peripheral pulses

PERRLA

*A seizure is a sudden and often dramatic change in behavior caused by brain dysfunction (or)

Paroxysmal time-limited events that result from abnormal or involuntary rhythmic neuronal discharges in the cerebral cortex.

Seizures are unpredictable and often leave a person feeling that they have no control over their body or their life. Not knowing what happens during a seizure can worsen the loss of control and fear of seizures.

1.a.When did you experience a first seizure in your life?

Do you experience some kind of a warning or unusual feeling at the onset or immediately preceding the seizure?

What happens during the seizure?

What happens immediately following the seizure?

Is there a diurnal variation?

Are there any known triggering factors?

What is the seizure frequency?

What has been the maximum seizure-free period since the seizure onset?

Has any sustained injuries related to seizures?

What is the frequency of visit to the emergency department?

Having any familial history of seizure?

2. What other assessments are necessary for this patient?

*Check for marks or ulceration on the side of the tongue or oral mucous membrane as can be seen with seizures

*Neurological examination

*Lab investigations:

Hyponatremia, hypoglycemia, hypomagnesemia, uremia and hepatic encephalopathy can precipitate seizures

Checking serum electrolytes along with glucose, calcium, magnesium, blood urea nitrogen, creatinine, and liver function test

*Neuroimaging

*EEG

3. What are some of the causes of seizures?

Most often idiopathic, head trauma, brain tumors, intracranial infection, cerebral degeneration, high fever, stroke, congenital brain malformations.

4. Develop a problem list from objective and subjective data.

i)Acute Pain

ii)Fatigue

iii)Activity Intolerance

iv)Impaired Physical Mobility

5. What should be included in the plan of care?

• Do not leave the patient unattended
• Maintain patent airway.
• Ensure side rails are raised
• Remove surrounding objects that may cause injury
• Administer medications as prescribed

Same as like that of management and other interventions we have to give priority to the patient education

• Instruct patient and family what to do in case of seizure, what to observe and report.
• Instruct the patient to avoid circumstances that would precipitate seizures; e.g., stress, disruptions in regular sleep patterns and irregular eating. Fever, hypoxia, electrolyte disturbance and Cardiac disturbance also bring on a seizure.
• Anticonvulsant medication must be taken as ordered, and physician follow-up is important.
• Refer patient to local Epilepsy Foundation support group for a community resource.

6. What other risk factors are associated with this presentation?

Many abnormalities of the nervous system can result in seizure activity. Seizures can also occur in the normal nervous system when its metabolic balance is disturbed. The cause of epilepsy may be not clearly known (idiopathic) or related to a particular disease state.

7. Based on the readings and the subjective and objective data, this patient most likely had what type of seizure?

In my view, it is a case of Psychogenic Non-Epileptic Seizures (PNES), Psychogenic seizures can occur at any age, but are more common in people under the age of 55. They occur three times more frequently in women than in men. They may arise from various psychological factors, may be prompted by stress, and may occur in response to the suggestion, and are often misdiagnosed as epileptic seizures; however, PNES are psychological (i.e., emotional, stress-related) in origin.