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1372 UNIT XII / Responses to Altered Neurologic Function

necessary before and during a seizure. Stress the importance of • Taking showers versus tub baths, because of safety issues
safety and keeping the airway patent. during a generalized seizure
Help both the client and family adjust to a diagnosis of • Factors that may trigger a seizure, such as abrupt withdrawal
epilepsy. Address the following topics. from medication, constipation, fatigue, excessive stress,
fever, menstruation, sights and sounds such as television,
• Misconceptions, common fears, and myths about epilepsy flashing video, and computer screens
• The importance of wearing a MedicAlert band or carrying a • Helpful resources:
medical alert card at all times. American Epilepsy Society
• Avoiding alcoholic beverages and limiting coffee intake Epilepsy Foundation

Nursing Care Plan


A Client with a Seizure Disorder
Janet Carlson is a 19-year-old college student who lives with her • Current information about seizures
parents and one younger sister.Although Janet had seizures while • Care during and after a seizure
she was in grade school, they have been controlled with medica- • Medication protocols
tion. However, she had a tonic-clonic seizure yesterday and imme- • Factors and activities that can trigger seizures
diately made an appointment with her family physician.She is cur- • The importance of follow-up care
rently taking phenytoin (Dilantin) 300 mg/day as a maintenance • Refer client and her family to a local epilepsy support group.
medication to prevent seizures. • Recommend that she purchase and wear a MedicAlert bracelet.
ASSESSMENT EVALUATION
Evita Farias, RN, completes a health history for Ms. Carlson. During Ms. Carlson is instructed to continue taking Dilantin 300 mg/day.
the history, she tells Ms. Farias that she has been under stress be- She states the importance of nutrition, rest, and measures to re-
cause of difficulties in completing her course requirements this se- duce stress. She also discusses the importance of maintaining the
mester. She has not been sleeping as many hours per night, and proper blood levels of her medication, stating that too little or too
sometimes she forgets to take her medication. Janet’s serum much of the medication could cause problems. Ms. Carlson recog-
phenytoin level is 8 mg/mL.Therapeutic level is 10 to 20 mg/ml. nizes that the seizure problems had recurred during a busy time in
school during which she had forgotten to take her medication.
DIAGNOSES
She is now wearing a MedicAlert bracelet. Ms. Farias provides the
• Risk for injury, related to recurrence of generalized tonic-clonic
Carlsons with the telephone number of the Epilepsy Foundation
seizure activity and low serum phenytoin levels
of America.
• Deficient knowledge, related to activities that may trigger
seizure occurrence, the effect of stress on seizures, and medica- Critical Thinking in the Nursing Process
tion information 1. If you were Ms. Carlson’s nurse, would your teaching differ if
EXPECTED OUTCOMES she were living alone? If so, how?
• Will verbalize precipitating and triggering factors related to the 2. Ms. Carlson tells you that although she knows she should not
onset of seizures. drive a car, she often drives her friend to work.How would you
• Will verbalize the relationship between emotional and physical approach this problem?
stress and seizures. 3. Ms. Carlson states that “it’s embarrassing to wear a MedicAlert
• Will verbalize the importance of taking anticonvulsant medica- bracelet.” How would you respond, and what recommenda-
tions. tion(s) would you make?

PLANNING AND IMPLEMENTATION See Evaluating Your Response in Appendix C.


• Teach client and her family the following:

TRAUMATIC BRAIN INJURY

Traumatic brain injury (TBI) is a leading cause of death and INCIDENCE AND PREVALENCE
disability in the United States. The National Head Injury Foun-
dation defines TBI as a traumatic insult to the brain capable of The CDC estimates that each year 1 million people in the
causing physical, intellectual, emotional, social, and voca- United States are treated and released from hospital emergency
tional changes. A TBI may be classified as a penetrating (open) departments as a result of TBI, 230,000 people are hospitalized
head injury (e.g., resulting from a knife, bullet, or baseball bat) and survive; and 50,000 people die. Additionally, more than
or a closed head injury (a blunt injury to the brain that does not 80,000 are discharged with TBI-related injuries, and 5.3 mil-
result in an open skull fracture). lion Americans are living today with a TBI-related disability.