Nursing Care Plan for Seizures Patient

Introduction

Seizures affect communities globally, either directly as a patient or indirectly as a caregiver. Care of seizures patient is essential from a fundamental standpoint of humaneness and protection of patients, which is a primary mandate of caregivers. Some of the risk factors towards seizure patients include the possibility of trauma resulting from seizures. Another risk factor is the possibility of airway obstruction. Apart from these physiological risks, the psychological threat of low self-esteem also exists, leading to non-adherence to treatment or other adverse psychological effects. Risks that might lead to poor treatment outcomes include knowledge deficit and general non-compliance. These risk factors are discussed below.

Trauma
Elements of the risk associated with trauma from seizures include body weakness and inability to attain balance. Reduction of muscular and optical coordination is another element of the associated risk, as is the reduction of sensation and alteration of consciousness.
The desired results of a care plan structured to avoid trauma to the patient include developing a situation where the patient can verbally state the factors that would lead to trauma or aspiration (Lynda Juall Carpenito, 2017). The patient should also be empowered to take action towards the elimination of these factors. The patient should also identify steps to follows if a seizure occurs and the potential remedies for environmental risks. The nursing plan should also allow the patient to effect relevant lifestyle changes and appropriate behavior to ensure self-protection from possible injury during the period of seizure (Austin, 2015). The patient should also adapt his environment to specific safety standards, such as keeping his bed in a low vertical position to minimize injury from a possible fall. An effective treatment regime should also form part of the plan, including a stock of specific medication to prevent seizure occurrence or post-seizure stabilization (Hickey & Strayer, 2020). Apart from adequately preparing the patient to avoid seizures or avoid injury, an effective nursing plan should also adequately prepare caregivers for their role.

Some of the therapeutic interventions to minimize the risk of trauma include:

Determine the seizure warning signs and the typical seizure order of events. The significant other (SO) should receive training on detecting these signs and how to respond to them (American Association Of Neuroscience Nurses & American Nurses Association, 2019). Determination of seizure warning signs allows the patient to avoid injury and notify helpers immediately. By enlightening the SO, they also feel less helpless when the seizure occurs.

Seizures patients should use beds with side barriers and in the lowest position. Configuring the patient’s bed this way significantly reduces the consequent injury if the seizure occurs with the patient in bed. If the seizure occurs with the patient in bed, it is likely for a fall to result.

Recording pre-seizure activity is essential. The location and time spent on motor activities and the associated recurrence rate (Ackley et al., 2020). The SO should also record resulting seizure components such as falling, drooling, or lip-smacking. The recorded data helps to pinpoint the involved cerebral area.

After each seizure, the caregiver should record the vital signs such as motor function, blood pressure, memory, and pulse rate (DeVries-Rizzo, 2016).  The collected data gives a record of the duration to the attainment of the normal state and allows for identifying extra safety concerns.

Antileptic drugs (AEDs)may be administered to the patient. AEDs increase the seizure threshold of the patient. AEDs work by lowering neuron excitability or by directly acting upon the hypothalamus. The patient should consume the minimum possible dosage of these drugs since some are associated with dangerous reactions and side effects (Hickey & Strayer, 2020). Administration of glucose or thiamine helps impact metabolic balance, mainly where the seizure resulted from hypoglycemia or alcohol intake. Administration of Lorazepam is helpful in abortion of seizure activity due to its short time of action. It should be noted, though, that Lorazepam results in long periods of post-seizure sedation.

Caregivers should ensure the provision of patients with a neutral and non-obstructive environment for postictal behavior.

Seizure patients may manifest motor or psychic activities, which may cause discomfort to nearby persons. Efforts to contain the patient may escalate the situation as the patient may react violently.

 

Risk of Airway Obstruction

A significant risk that may occur to the patient during a seizure is tracheobronchial obstruction. This risk entails blockage of the airways through which the patient’s body is supplied with oxygen. The desired outcome of activities addressing airway obstruction of the seizure patient is the prevention of aspiration.

Maintain in lying position, flat surface; turn head to side during seizure activity.

During seizure activity, the caregiver or first aid giver should maintain the patient in lying orientation on a flat place; the patient’s head should also be turned sideways to prevent blockage of airways (“Epilepsy,” 2016). This technique allows for non-risky drainage of secretions.

Provide and insert plastic airway or soft roll as indicated and only if the jaw is relaxed. The first aider should insert a soft and appropriately sized object into the patient’s mouth if the patient’s jaw is open (Gonsalves, 2016). This roll prevents biting of the tongue. Insertion of a plastic duct can also aid in avoiding tongue biting and allow for delivery of respiratory action externally.

The first aid giver should loosen the patient’s clothes in the neck, chest, and abdominal areas to ease breathing by reducing the force required for chest expansion.

Reduced self-esteem

Seizure patients may suffer from low self-esteem due to how the condition manifests. During the period of seizure, the patient may display specific seemingly improper actions which may cause other people to treat him differently. Also, in some communities, seizure patients are stigmatized. Persons on whom the patient depends may abandon them, further injuring the patients’ esteem (Shawahna, 2020). The necessitation of social changes from the seizure condition can also negatively impact the patient’s self-esteem.

Possible therapeutic actions towards the risk of reduced self-esteem include:

Analysis of possible public responses to the patient’s condition should occur in collaboration with the patient. The caregiver should encourage the patient to divulge his condition to relevant people.

Divulging information about their condition allows the patient to avoid self-esteem destroying concealment, which is intertwined with denial. Rather than help the patient, concealment of the condition blocks any possible progress and denies neighbors the chance to adapt their mentality to the patient’s condition (Izadi Laybidi & Mehdinejad, 2018). The end effects of concealment are greater negativity of public response when the seizure occurs.

The nurse or caregiver should also speak with the patient regarding previous and current successes of the patient. By talking about wins and other positive aspects of the patient, the patient can see their condition as manageable (“Enhancing Patient Well-being: Apply Positive Psychology in Nursing Practice,” 2019). Speaking with the patient about successes also helps the patient shift focus away from the negative feelings of guilt and self-consciousness, which affect many seizure patients.

The nursing caregiver should also avoid being overprotective of the patient. Overprotection may manifest in disallowing the patient from participation in even certain social and motor activities that the patient can manage. If such activities are slightly risky, the nursing caregiver can monitor so that a fast response to any onset of a seizure is made possible. Participation in social activities alleviates the feeling of limitation that may arise from restriction from social activities.

Deficient knowledge

The patient or close caregivers may lack the know-how on how to handle seizure diagnosis. This lack of know-how may stem from a lack of educational exposure or non-interaction with associated resources. Deficiency of knowledge may also arise from misinterpretation of information or specific impairment of remembrance.

Typical manifestations of knowledge deficiency include questions and statements of concern asked by the patient or close caregiver. A high rate of seizure occurrence or inability to control self is another manifestation of insufficient knowledge. Inability to adhere to instructions on the administration of drug regimens is another sign of knowledge deficiency.
The expected outcomes of a nursing plan intended towards dealing with a patient’s deficient knowledge include the ability of the patient to explain their disorder orally. The patient should also understand the different triggering factors which increase the risk of seizure to a level where they can comfortably verbalize the factors (Buelow et al., 2018). Another desired outcome is for the patient to actively engage in the associated learning process by taking personal responsibility for their learning. The patient should also follow the instructions on drug administration accurately and initiate the required behavioral changes. Identification of signs of a seizure by the patient is another objective of a nursing plan that addresses a knowledge deficit by the patient.

Possible approaches to solve the deficiency of knowledge include:

Discussion of the importance of keeping healthy by consuming healthy food, participating in a certain level of exercise, and minimizing intake of alcohol and stimulant drugs like caffeine (Catheryne Waterhouse & Woodward, 2021). Engaging in moderate physical activities has the potential of moderating seizure-triggering factors. Engaging in these activities also improves their general sense of wellness of the patient and improves their self-esteem.

Nurses and close caregivers should also discuss the importance of strictly following drug administration instructions while reviewing the prescribed medication interactively. These discussions should also guide the patient when a dosage is missed (Barley, 2016). By understanding the importance of sticking to the medication prescription instructions, patients are better positioned to commit themselves to follow the instructions. The patient should be explicitly informed of the risk of worsening the condition from sudden medication withdrawal. Withdrawal of anticonvulsants, for example, may lead to status epilepticus. The nurse should also provide treatment-specific information, such as when a missed dosage may be effectively administered.

Non-compliance

Another risk factor for seizure patients is non-compliance with instructions and medication prescriptions. That may arise from financial challenges, denial of the illness and opposing perspectives, and fear of adverse effects of the therapy.

The possibility of non-compliance is observable in the patient since the onset of medication. One of the ways to detect possible non-compliance is the patient portraying certain behaviors that suggest failure to comply. Such conduct includes verbal communication of negativity towards the therapy and treatment (Torn & Greasley, 2016). Other pointers of non-compliance have the patient not honoring appointments for periodic checkups and observable development of complications by the patient. To aid such a patient, the following approaches are helpful:

The caregiver should gather information to understand the reason for the patient’s non-adherence. Some reasons might be beyond the patient’s control, such as the inability to afford medication. The patient might also lack the ability to understand the prescription instructions or just be experiencing forgetfulness. Elevated side effects and significant requisite lifestyle changes might also present difficulty of compliance to the patient (Lynda Juall Carpenito, 2017). Nurses are enabled to initiate requisite input once they understand the patient’s reason for non-compliance. The collected information also helps in tailoring the care plan to the patient’s needs.

The caregiver should provide information about issues such as steady blood level and half-life of the medication. Additional information includes instructions on the steps to follow in case of missed doses and how to replace lost or used up drugs. Schedules of checkups and follow-ups should be explicitly stated, and explain the importance of communicating sudden medication termination to health personnel. Effective communication of this information will enable the patient to clearly understand the implications of failure to follow treatment instructions. The possible consequences include the sudden development of life-threatening conditions.

Conclusion

Effective management of seizure patients involves complete spectrum care ranging from physical therapy to psychological care. Patients who suffer from seizures may experience stigma and feelings of unworthiness and low self-esteem due to how the condition manifests. Primarily, seizures patients are at risk of bodily injury like falling from highly elevated beds. They also are at risk of choking if bogy airways get blocked during a seizure. Therefore, nursing care should cultivate awareness of seizures in the patient and close caregivers to prevent or manage seizures.

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