Question 1: Uses the correct term for chronically recurring seizures.
Answer: Epilepsy
Question 2: Determines if the patient in the scenario has epilepsy.
Answer: J.G. does not have epilepsy. She has only had three previous cases of seizures prior to which she had not experienced any seizures. The current cases were triggered by the cesarean section thus too early to refer to the condition as epilepsy (Ko, 2016).
Question 3: Identifies possible conditions, besides brain injury, that contributes to the lowered seizure threshold for the patient in the scenario.
Answer: Apart from brain injury, lowered seizure threshold can occur as a result of infectious illnesses such as AIDS, meningitis as well as developmental disorders such as neurofibromatosis and autism (Ko, 2016).
Question 4: Describes the pathophysiology of a seizure.
The brain and the nervous systems functions within a delicate and highly balanced environment. This balance exists between the neural excitation and the neural inhibition. In the event or any combination of events that may lead to the loss of this synchronization in inhibition and excitation, then there occurs a paroxysmal discharge which eventually occurs as a seizure. The synapse provides functionality to the ion channels which are the most vital elements of the neurotransmission process and therefore, a seizure can be described as the ultimate malfunction of these ion channels (Ko, 2016).
Question 5: Describes the type of seizure the patient had in the scenario.
Tonic-clonic/convulsive or grand mal seizures are those seizures that last from one to three minutes and are characterized by two shifts; the tonic phase during which the muscles of the body stiffen and the patient loses consciousness with a likely occurrence of falling on the ground if they were on their feet. There is a groan or cry that is let out as due to air the process of pushing out of the lungs and along the vocal cords. The patient may apparently bite the tongue. This is followed by the clonic phase during which the body relaxes and the patient regains consciousness with the legs and arms jerking at rhythmic speed to allow for the relaxation of the joints. The jerking slows and eventually stops but the patient may present with cases of drowsiness, anger, depression or confusion (Ko, 2016).
Question 6: Responds appropriately to how phenytoin works to prevent seizures.
Phenytoin works by facilitating the slow-down of impulses within the brain and therefore eliminating the risk of non-synchronous ion channels action (Kramer & Cash, 2012).
Question 7: Considers appropriate factors when determining which seizure medication a patient should use.
The patient history, severity of the condition, frequency of the seizures, age of the patient, history of suicidal tendencies as well as the cognitive state of the patient would play a key role in determining the medication (Ko, 2016).
Question 8: Describes concerns when a patient has difficulty remembering to take medications.
In some cases, patients may be affected by memory loss and therefore medication adherence which is a vital in seizure management becomes a problem. Irregular use of medication can lead to further dysfunction of the neurotransmission system and the medication could thus become a trigger for the seizure (Kramer & Cash, 2012).
Question 9: Describes strategies to increase likelihood for patient compliance.
Answer: For seizure patients, involving a family member or a close relative in the management and development of the care plan as a caregiver would help increase compliance (Wagner, Smith & Ferguson, 2012).
Question 10: You check the chart and note that J.G.’s last phenytoin (Dilantin) level was 12.7mcg/mL. What action do you expect based on this level?
Answer: Because this level is within normal limits, J.G. would continue therapy as prescribed
Question 11: J.G asks “Will my blood levels stay under control as long as I take the medicine?”
Response: There is no direct correlation between the medication and blood levels but with adherence to the dosage, a majority of the body systems will definitely be within normal range. Unless otherwise, medication adherence until completion of dosage will ensure that the blood levels are within normal levels and beyond that the body will be in a position to automatically sustain the levels within normalcy (Goldenberg, 2010).
Question 12: Describes general information about Dilantin.
Dilantin as an anticonvulsive and antiepileptic medication does not necessarily treat all seizures. It is equally not suitable for all patients especially those with suicidal tendencies and severe depression. However, for moderate cases like in this patient, Dilantin helps in minimizing the frequency and severity of the seizures and in some instances it could lead to a complete recovery with no future episodes of seizures. There is no particular harm for the patient unless the husband and wife observe any new signs within the period of medication (Goldenberg, 2010).
Question 13: J. G states that because she has not had a seizure since she was in hospital, she questions how long she will have to continue taking the phenytoin (Dilatin). Which is your best response?
Answer: “This medication can be stopped after you are seizure free for 6 months”
Question 14: Describes appropriate teaching for husband.
The husband has to provide a caregiver who will be with the mother in the short term if he is at work and cannot forego work. The wife has to be provided with a caregiver who closely related with the mother to provide appropriate social, spiritual and moral support (Epilepsy Society, 2016).
Question 15: Writes an appropriate response to husband's concern about caring for the baby.
He has to ensure that at all times the mother is in the company of someone who can handle the child on behalf of the mother as well as monitor the wellness of the mother (Wagner, Smith & Ferguson, 2012).
Question 16: Describes aspects of the home environment to inspect and why those aspects are important.
The home environment plays a key role in preventing possible cases of injuries to the mother. The presence of rails on the any stair cases, slippery floor, poorly ventilated rooms, broken glasses or windows along the walks paths should be addressed. On the other hand, electronics and appliances should be placed in distances that do not predispose the mother to danger in case of a seizure fall (Epilepsy Society, 2016).
Question 17: Describes appropriate safety measures to minimize risk of injury for the patient in the scenario.
The presence of a caregiver at all times
The patient should ensure that they have enough sleep
The patient should try as much as possible to participate in light exercise and physical activity to facilitate body normal body response to environmental changes. This should occur in the presence of a caregiver or a partner (Epilepsy Society, 2016).
Question 18: You would determine further teaching is needed regarding modifying their home environment to reduce J.G.’s risk of falling if J.G or her spouse states “J.G. will need some new socks to wear so she is not going barefoot indooors.”
References
Epilepsy Society. (2016). Caring for someone with epilepsy | Epilepsy Society. Retrieved from https://www.epilepsysociety.org.uk/caring-someone-epilepsy#.V5cBhNR95kg
Goldenberg, M. M. (2010). Overview of drugs used for epilepsy and seizures: etiology, diagnosis, and treatment. Pharmacy and Therapeutics, 35(7), 392.
Ko, D. Y. (2016). Epilepsy and Seizures: Practice Essentials, Background, Pathophysiology. Retrieved from http://emedicine.medscape.com/article/1184846-overview
Kramer, M. A., & Cash, S. S. (2012). Epilepsy as a disorder of cortical network organization. The Neuroscientist, 18(4), 360-372.
Wagner, J. L., Smith, G., & Ferguson, P. (2012). Self-efficacy for seizure management and youth depressive symptoms: Caregiver and youth perspectives. Seizure, 21(5), 334-339.
