An older client was recently discharged from the hospital for evaluation of seizure activity

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An older client was recently discharged from the hospital for evaluation of seizure activity. His history
reveals that he has late-stage Alzheimer’s disease, Parkinson’s disease, hypertension, and type II
diabetes mellitus, which is controlled by diet. He lives at home, where his wife and daughter take care
of him. His discharge medications include phenytoin (Dilantin), 100 mg BID; hydrochlorothiazide
(HydroDIURIL), 50 mg QD; levodopa (Sinemet), 25/100 TID; and haloperidol (Haldol), 1 mg before bed.
The client has been referred for home care nursing follow-up.
Questions:
• On the initial home visit by the nurse, what assessments should be made?
• The wife and daughter need teaching about his antiepileptic medication. What teaching
should be included?
• During the initial home visit, the client experiences a generalized seizure. What action
should the nurse take?

 

Sample Solution

The nurse should conduct a comprehensive assessment focusing on the following areas:

  • Seizure Activity:
    • Frequency, duration, and characteristics of recent seizures.
    • Presence of any triggers identified during hospitalization.
    • Review discharge summary for details of the seizure event that led to hospitalization.
  • Medications:
    • Review all medications, including dosages and administration schedule.
    • Assess adherence to the new medication regimen (phenytoin).
    • Identify any potential drug interactions (particularly with haloperidol, which can lower seizure threshold).
  • Neurological Function:
    • Evaluate mental status and cognitive function considering late-stage Alzheimer’s disease.
    • Assess for any changes in Parkinson’s disease symptoms like tremors, rigidity, or bradykinesia.
  • Safety and Fall Risk:
    • Evaluate the home environment for potential hazards that could increase risk of injury during a seizure.
    • Assess client’s mobility and gait for fall risk.
  • General Health:
    • Monitor vital signs (blood pressure, heart rate, temperature).
    • Assess for signs of dehydration or electrolyte imbalances, which can contribute to seizures.
    • Review blood sugar control and management of type II diabetes.

Teaching about Antiepileptic Medication (Phenytoin):

  • Importance of taking medication as prescribed: Explain how the medication helps prevent seizures.
  • Medication side effects: Discuss common side effects like drowsiness, dizziness, and gum hyperplasia.
  • Signs and symptoms to report: Inform the client and family members about potential serious side effects like rash, fever, or easy bruising that require immediate medical attention.
  • Importance of maintaining a consistent schedule: Explain the importance of taking the medication at the same time(s) each day for optimal effectiveness.
  • Drug interactions: Briefly discuss potential interactions with other medications, including over-the-counter drugs or herbal supplements. Advise them to consult the doctor or pharmacist before starting any new medications.

Action During a Seizure:

If the client experiences a seizure during the visit, the nurse should remain calm and take the following actions:

  1. Ensure safety: Gently move any objects that could harm the client during the seizure. Loosen any tight clothing around the neck.
  2. Protect airway: Turn the client on their side to maintain an open airway and prevent aspiration.
  3. Monitor seizure activity: Note the time the seizure starts and ends, as well as the characteristics of the seizure.
  4. Do not restrain the client: Allow the seizure to run its course.
  5. Do not put anything in the client’s mouth: This can cause choking.
  6. Stay with the client until the seizure ends and they regain consciousness.
  7. After the seizure: Talk to the client in a calm and soothing voice once they regain awareness.
  8. Document the seizure: Record the details of the seizure, including duration and characteristics.
  9. Contact emergency services if: The seizure lasts longer than 5 minutes, the client doesn’t regain consciousness after the seizure, there is difficulty breathing, or if it’s the first seizure the client has experienced.

Following these steps will ensure the safety of the client during a seizure and facilitate appropriate medical intervention if necessary.

 

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