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Nursing Manual
Seizures (Epilepsy)
In persons with developmental disabilities,
common issues that complicates the management of epilepsy include:
- Damage to the central nervous
system.
- Seizures that do not respond
to treatment (medically intractable epilepsy).
- Seizures that are more difficult
to diagnose as many individuals are unable to give subjective data about
their seizures.
- Under or over reporting of seizures
because they may be difficult to recognize by others.
- Multiple seizure types.
- Injuries due to falls from seizures.
- Aspiration during a seizure.
- Treatment with more than one
antiepileptic drug (polypharmarcy).
- Antiepileptic drug (AED) side
effects; both short and long term,
may cause severe health problems.
- Drug side effects that may mimic
symptoms seen during illness.
- Restricted lifestyle or concern
over physical appearance leading to refusal of treatment such as wearing
a helmet.
Nursing Assessment
(Includes record reviews, history, assessment and staff interview)
Record Review/History
- Physician has written the diagnosis
- History of hospitalizations or
emergency treatment for seizures
- Person takes medication for epilepsy
- Person has received an injury
during a seizure
- Person has aspirated during a
seizure
- Person is non-compliant with
their medication regimen
- Person is at risk for dehydration
- Person wears protective gear
for prevention of injuries during seizures
- Person has PRN urgent medication
for serial or prolonged seizures
- Person takes other medications
that may interfere with the antiepileptic medications
- Person has challenging behaviors
that may complicate the monitoring and treatment of epilepsy
- Person has a seizure protocol
Assessment
- Ask the person if they have a
warning prior to the seizure. If they are non-verbal, do people around
them notice a consistent change in behavior or demeanor? Can they protect
themselves from injury by sitting or lying down?
- Does the person receive injuries
during their seizures that need medical attention? Do they complain of
a headache and/or muscle aches after a seizure? Have they ever bitten their
tongue or cheek during a seizure?
- Do they continue to be lethargic
for hours after the seizure? Do they need to have their daily routine changed
to allow for rest?
- Assessment for antiepileptic
medication side effects. Most common side effects that are usually associated
with all of the AEDs are: lethargy, GI upset, ataxia, visual disturbances,
blood disorders, elevated liver function tests and decrease in cognitive
function.
Staff Interview
- Reports of unusual behavior or
activity that are episodic, of short duration and out of context with what
is going on in the environment.
- A written or narrative description
of the unusual behavior or activity in detail (what happened before, during
and after the event).
- General function and alertness
of the individual.
Health Care Plan/Nursing Care
Plan
- Is based on professional assessments
of the person's health care:
- Identifies
- Measurable and appropriate
goals
- Specific interventions
- By whom and how frequently
the data will be monitored
- Refers to an individualized seizure
protocol that contains:
- What this person's usual
seizure activity looks like for each kind of seizure
- Interventions during the
seizure; interventions that promote safety i.e. water precautions
and a helmet; and PRN seizure medications.
- Reminders for the staff
to call 911 if they believe the person appears gravely ill or if
they are concerned about their health and safety.
Goals
- Number of seizures/month/year
within the range set by physician or ISP team
- Accurate identification and recording
of seizures
- Minimize side effects from the
antiepileptic drugs
- Antiepileptic drug levels that
remain within target range as recommended by physician
- No injuries or aspiration/pneumonias
or drowning
- Minimize impact on quality of
life (i.e. going to work daily, no lethargy during at the work site)
- Person remains compliant with
medication regimen and laboratory tests
Interventions
- Giving Medications on time
- Keeping accurate description
of seizures and counts
- Monitoring for side effects
- Monitoring anticonvulsant blood
levels
- Keeping the environment as safe
as possible
- Water safety precautions (such
as 1:1 continual observation in pool/tub, wear lifejacket, use shower only,
no tub baths, etc). Precautions must be considered when bathing/swimming
if there has been a seizure in past 12 months, or seizure medications have
been changed within the last six months.
- Monitoring for compliance with
safety devices and keeping them in good repair
- Individualized seizure protocol
and staff training
Evaluation
- Analysis and review of interventions
on appropriate data collection records used by RN or staff
- Review person is and staff's
training needs
- Review and continue to monitor
person's response
Red Flags (Issues that should
prompt a review)
- Increase in number or intensity
of seizures
- Physician changing antiepileptic
medications
- Injuries or aspiration during
a seizure
- Increase in lethargy and cognitive
impairment
- Dehydration
- Refusal of medications and use
of protective gear
- Change in description of seizures
- Multiple seizure descriptions
or ill-defined seizure descriptions
- Abnormal lab tests
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