Seizure Case Study Answers 1
Seizure Case Study Answers 1
Patient report: your patient was admitted for new onset seizures. Cat and MRI of brain were
normal. Electrolyte panel is pending. No family history of seizures. Patient has started a new
job working 11p-7 am shift and not sleeping well. Patient recently started Wellbutrin for
depression and is on no other meds. No known allergies. Vitals have been stable. Plan for d/c in
am. The nurse is in the room doing her initial assessment and the client yells out and their
extremities become stiff.
1. Why did the patient yell out? The patient’s diaphragm contracted as the tonic part of the
seizure started (increased tone). This forced any air in the lungs out at a rapid rate and
caused the yell.
The patient has a tonic/clonic seizure. What symptoms or
patient behaviors does the nurse observe?
Tonic: increased muscle tone (stiffening) through-out the body. After this one could
expect to see the following:
Clonic: rapid contracting of the muscles with increased tone
These above symptoms can go on for seconds or minutes or can stop (if
patient does not come too and symptoms repeat themselves, this would be
called status epilepticus and is a true emergency).
Patient will not breath well d/t tonic/clonic symptoms affecting the
diaphragm and pt. may become cyanotic.
Pt may drool, loose bowel or bladder control, bite their tongue or harm
themselves should they fall, hit something with a body part such as a bed
rail. Their eyes may deviate laterally to one side and stay there during
seizure activity.
3. What medication(s) does the nurse give? How much and which route?
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Phenytoin (Dilantin): loading dose can be up to 1000mg
No more than 50 mg/minute and give via pump
Give only with NS
Telemetry d/t CV s/e
Damaging to vein if extravasation occurs……use large vein
Fosphenytoin (Cerebyx) alternative to phenytoin
Few CV s/e
Can be given with IV dextrose
Converts to phenytoin once in body
150 mf of fosphenytoin = 100 mg phenytoin
Give at rate of 100-150mg/min and IVPB
Monitor lab values to see if patient has a therapeutic dose in their system
Usually done 6-12 hours after loading dose
Monitored there-f=after (2 weeks after initial dose)
3. The seizure has stopped and the patient is postictal and incontinent and has snoring
respirations. What is postictal: Postictal is the immediate time period after a seizure
occurs and patient is usually very lethargic or can even be combative. They usually do
not remember the event. This phase can last for hours as they gradually become more
alert and what nursing interventions does the nurse perform?
Position patient in recovery position to keep airway open
Obtain vitals and oxygen
Talk to patient in calm voice and explain what happened
Keep safe
Care for patient if they were incontinent
Prepare to give above preventative meds
Patient may need oxygen
4. When checking the chart what pertinent information does the nurse look for?
Abnormal labs (electrolyte panel is pending) or EEG or CT scans
Known triggers to see if this is what precipitated current sz
Current and any new medications
5. Document what you would write in the patient chart regarding the above incident.
Document as if this were a real patient chart.
Refer to your book. There is a chart with all this info:
Seizures: Nursing Observations and Documentation.
6. The nurse notifies the doctor (practice your SBAR report with a peer). What orders will
you anticipate the provider to order and why?
Give Phenytoin product as stated above/order
Labs: electrolyte profile (Na+/ glucose), possibly CBC if infection suspected,
Diagnostics: CT or MRI if not previously done or repeat if patient has a
concurrent problem (TBI, CVA, etc.)
EEG if not previously done
During your SBAR to the physician you will report pt recently started Wellbutrin
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and you know this med can cause/trigger a seizure. Thus
you anticipate physician to D/C this med
7. The client’s family arrives a few hours later. The nurse is explaining what happened
earlier in the shift. The family starts to ask about the various tests the patient has had and
will be having. Explain these tests and why they are being done.
CT or MRI: will r/o any pathology. No consent unless contrast used
EEG to evaluate where seizure is originating in brain
Explain some abnormal labs can be a trigger for a seizure
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