During the initial visit the registered nurse from the Community Nursing Service will elicit information concerning the seizure history from Jessica. While seeking information concerning the history the nurse will seek to know when the client had her first fit, whether there has been any improvement after initial diagnosis and treatment. The nurse will also seek to know whether the client would wish to have her medication changed due to their ineffectiveness.
The patient is then asked concerning the factors that may trigger the seizure. While doing so, the nurse will document on alcohol intake. Other factors that trigger seizures and that the patient might be made aware of are stress, feeling tired, not taking the prescribed antiepileptic medication, not getting enough sleep and missing meals. Concerning alcohol, drinking more than modest amounts in 24 hours has been shown to increase the risk of seizures especially within 6-48 hours after one has stopped drinking.
The nurse will also determine if the patient has an aura (a warning or premonitory sensation) prior to the epileptic fit which in most cases indicates the origin of the seizure for example seeing flashing lights may indicate that the seizure originates from the occipital lobe. Other auras include auditory aura, olfactory aura, gustatory aura, and somatosensory aura all of which come from different parts of the brain as denoted by their nature.
The nurse will also make observations and assessments during and after a fit and assist the client in identifying the type of seizures and the specific management involving the seizure. There are different types of seizures all characterized by different features. For example, the tonic-clonic seizure is vigorous characterized by frothy saliva, tongue biting, and convulsions. As for myoclonic seizures, rapid involuntary twitching of muscles is involved.
The nurse will also assess how the epilepsy is affecting the client’s lifestyle involving the limitations involved in the seizure disorder. It may involve the inability to carry out their work properly due to fear of having a fit (Kwan, Schachter, & Brodie, 2011). The nurse will go further to seek information concerning the client’s recreational program (if they have any), social contacts and whether seizures have made working a positive or stressful experience. Lastly, the nurse will assess whether the client has any coping mechanisms.
The information collected from the assessment will help the nurse intervene appropriately so as to help the client live an almost-normal life. One of these interventions involves letting the client now about certain important considerations ("{{meta.og.title}}", 2016). One of these considerations involves birth control. It is crucial for the client to know that interactions can occur between anticonvulsants and medicines used in birth control and control seizures. Due to the interaction, such medication may be rendered ineffective.
Another important consideration is breastfeeding, planning a pregnancy or being pregnant. The client ought to be informed that the frequency of seizures might change with pregnancy and that they run a greater risk for some complications (Friel, 2010). The doctor might need to change the dosing of the anticonvulsant medication prior and after pregnancy (Jain & Raghavan, 2009). The client needs to know that they should not stop taking seizure medication during pregnancy unless they are directed otherwise by the doctor.
The nurse needs to let the client know that each state has its laws covering people who have seizures. If her seizures are not controlled, then she is not supposed to drive. Many states stipulate that a person should have a seizure for a specified period such as six months to allow for close monitoring. A doctor’s note may be needed showing that the seizures are under control and the person safety is guaranteed while driving. There is also the provision of restricted licenses which allow the person with seizures to drive during a certain time of the day when the seizures are less likely to occur. Apart from driving the client should be advised on keeping off from activities that may cause serious injury including swimming alone, biking and climbing.
The nurse should aid the client in accepting her diagnosis. By doing so, she will be more than willing to comply with the regimen prescribed for her thus allowing maintenance of a healthier state (O’Muircheartaigh & Richardson, 2012). The nurse can ensure this by being honest with the client as much as possible. By touching the patient in a caring way on the shoulder or the arm, the client can feel that she has a good support system. The nurse should accept to any fears or negative feelings that the client might share.
Following assessment of the coping mechanisms, the nurse should act accordingly since behavioral, psychological and social problems which accompany epilepsy may end up being more of a handicap than the real seizures (M.W. et al., 2013). The patient must also cope with the constant fears that come with seizures and their negative consequences. Also, adults face the problem of having a burden in finding employment, legal barriers, insurance problems, and concerns about relationships. Through counseling the client with the spouse or family, they will be in a better position in understanding the conditions and the hindrances revolving around it. Through education, the nurse will be able to improve the quality of life for the client with epilepsy.
The nurse should aim at reducing the client’s fear of seizures occurring unexpectedly. This can be achieved by the patient’s adherence to treatment regimen. Also the cooperation of the family and the patient, as well as their trust in the given regimen, is paramount for the control of seizures. The client and family are advised that the anticonvulsant regimen should be taken continuously without the fear of addiction of drug dependence. Periodic monitoring is also done to assess the adequacy of the treatment regimen as well as to bar side effects.
In a bid to control the seizures, precipitating factors are identified including fever, the onset of menstruation (females), new environmental stressors, and emotional disturbances ("Diagnosis | Epilepsy Action Australia", 2016). A regular and moderate routine is encouraged in rest, diet and lifestyle. Moderate activity is deemed therapeutic, but excessive exercise is prohibited. It is also suggested that classes in stress management could prove to be of great value to the patient. Alcohol being a triggering factor of fits, it should be avoided.
Homecare is also emphasized during the initial visit. This entails some things one of them includes the patient not discontinuing the medication, even in the absence of seizure activity. The nurse should also help the patient make a seizure and medication chart noting any seizure activity and when medications are taken (Begg, Vos, Barker, Stanley, & Lopez, 2008). The patient is also advised that she promptly notify the physician when she is not able to take the medication due to illness. The client should have her ant-seizure serum levels regularly checked. In the case where testing is prescribed the patient should not take any morning medication before going for the blood sampling. Signs of toxicity should be reported to the physician so that doses are adjusted appropriately .
Other information that will be relayed during the initial visit includes advice the client not to use over-the-counter medication before seeking approval from the physician. The patient should take showers rather than bathe in a bathtub so as to avoid drowning in the event of a seizure (Beran et al., 1982). The client should never swim alone. Some of the signs of toxicity that should warrant the notification of the physician so as to adjust the dosage of medication include visual disturbance, confusion, inappropriate sleep, hyperactivity, confusion, lethargy, and dizziness.
In order to enhance home care the nurse will demonstrate to the spouse what he ought to do in the event of a seizure which includes; providing protection and privacy for the patient from on-lookers; if possible the patient should be eased to the floor; the head should be protected with a pad so as to bar injury that may be incurred through hitting a hard surface. The partner or the person who is around should loosen constrictive clothing and keep away any furniture that may cause injury to the patient (Vezzani, French, Bartfai, & Baram, 2011). It also important for the partner to know that he should not try to pry open clenched jaws during a spasm in an attempt to insert anything as this may cause injury to the patient during a spasm. Also, no attempts should be made in trying to restrain the patient during a seizure as the muscular contractions are very strong, and restraint may end up causing injury (Chapman et al., 2009). The nurse will demonstrate how the patient should be positioned (placed on one side and head flexed forward, making the tongue fall forward to allow for drainage of mucus and saliva). If a suction machine is within the vicinity, it should be used to clear secretions.
The nurse will go forward to demonstrate what should be done after the seizure has ended. First, ensure that the patient’s airway is patent and continue by placing the patient on one side so as to bar aspiration. The partner attending to the patient should keep in mind that there is a short period of confusion that follows a grand mal seizure while a short apneic period following a generalized seizure ("Epilepsy Treatment - Epilepsy Australia Ltd", 2016). Upon awakening, the patient should be reoriented to her surroundings. If the patient is agitated in the postictal (after a seizure) phase gentle restraint and calm persuasion should be used.
Since the client is taught the importance of glucose monitoring. Monitoring of blood sugar levels is an important part in the management of diabetes similar to taking medication or making lifestyle changes (Magliano et al., 2009). It allows the client to see the impact of the measures they are taking in controlling their blood sugar levels including taking medication and the changes made to one’s diet. When the glucometer indicates high blood glucose levels, the client can take necessary steps to lower it down through modifying diet and increasing oral hypoglycemic medication.
Daily monitoring of blood glucose levels requires commitment and diligence. The community health nurse should try promoting such commitment by letting the client choose a glucometer that she likes, which meets her lifestyle needs and also one that is easy to use (Shaw & Tanamas, 2012). The client should be advised on choosing the least bothersome glucometer since she will be testing her sugar level frequently. This will prevent any incidences of complications that come about due to being hyperglycemic.
Priorities for the Follow-Up Visit
One of the priorities for the follow-up visit that the community health nurse can undertake is increasing compliance to the anticonvulsant treatment regimen. This can be achieved by modifying beliefs and human behavior. Modification of belief and behavior involves making the patient perceive themselves as being at risk as a result of not adopting a healthy behavior. The nurse can further achieve this by making the patient perceive their medical condition as being serious and also making them believe in the positive effects that come about with the prescribed medication. Lastly, by empowering the patient to see herself as having the requisites skills to carry out the healthy behavior (for example taking prescribed medication or daily monitoring of blood glucose levels).
The second priority would involve promoting and community-based care through teaching self-care to the client and continuing care. Teaching patient self-care involves things like instructing the patient to inform all health care practitioners of the medication she is taking so as to prevent incidences of drug interaction continuing care takes into consideration the fact that epilepsy is a chronic disorder, and the long-term use of costly medication can cause a significant financial burden. As such, the client can affiliate themselves with special groups that offer epilepsy-related services and medication at lower prices. The client and the family need to be constantly reminded of the importance of keeping follow-up appointments. Furthermore, they are reminded of the significance of being part of health promotion activities as a way of promoting a healthy lifestyle.
References
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Beran, R. G., Hall, L., Pesch, A., Ho, P., Lam, S., Leung, P., Fung, M. (1982). Population Prevalence of Epilepsy in Sydney, Australia. Neuroepidemiology, 1, 201–8.
Chapman, D., Cole, R., Cummins, J., Elphinstone, K., Pollard, R., Roberts, K., Whitehead, H. (2009). The experience of epilepsy in Australia. Epilepsia, 50, 24.
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M.W., A., K., R., M., M., M., D. B., J., D., O., S., & G., H. (2013). Absence of neuroinflammation in human and experimental temporal lobe epilesy. Epilepsia, 54, 9.
Magliano, D. J., Peeters, A., Vos, T., Sicree, R., Shaw, J., Sindall, C., Zimmet, P. Z. (2009). Projecting the burden of diabetes in Australia--what is the size of the matter? Australian and New Zealand Journal of Public Health, 33(6), 540–543.
{{meta.og.title}}. (2016). Healthdirect.gov.au. Retrieved 20 April 2016, from http://www.healthdirect.gov.au/epilepsy
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Vezzani, A., French, J., Bartfai, T., & Baram, T. Z. (2011). The role of inflammation in epilepsy. Nature Reviews. Neurology, 7(1), 31–40.
