Initial Home Visit Assessments

Upon arriving at the client’s home for the initial visit, the nurse should conduct a comprehensive assessment to gather information about the client’s current condition, medication regimen, and home environment. This assessment should include the following:

1. Neurological Assessment:

   • Assess the client’s level of consciousness, orientation, and ability to communicate.
   • Evaluate the client’s motor function, including muscle strength, coordination, and gait.
   • Check for any signs of focal neurological deficits, such as weakness, numbness, or sensory disturbances.

2. Medications:

   • Review the client’s medication list, including dosages, administration schedules, and potential side effects.
   • Assess the client’s understanding of his medications and their purpose.
   • Identify any potential interactions between the client’s medications.

3. Home Environment:

   • Evaluate the safety of the client’s home environment, identifying any potential hazards that could contribute to falls or injuries.
   • Assess the availability of assistive devices, such as grab bars, ramps, or a raised toilet seat.
   • Discuss the client’s daily routine and identify any potential challenges or concerns.

Teaching about Antiepileptic Medication

The nurse should provide education to the client’s wife and daughter regarding his antiepileptic medication (phenytoin, Dilantin), including the following:

1. Purpose of Medication:

   • Explain that phenytoin is an antiepileptic medication used to prevent seizures.

2. Dosage and Administration:

   • Clearly instruct on the dosage and administration schedule of phenytoin, emphasizing the importance of consistent adherence to the prescribed regimen.
   • Advise the caregivers to avoid administering phenytoin with grapefruit or alcohol, as these substances can affect the medication’s absorption and metabolism.

3. Potential Side Effects:

   • Inform the caregivers about the potential side effects of phenytoin, such as drowsiness, dizziness, nausea, and gum overgrowth.
   • Explain that if any concerning side effects develop, they should contact the healthcare provider immediately.

4. Importance of Monitoring:

   • Emphasize the importance of regular monitoring for seizure control and potential side effects.
   • Encourage the caregivers to keep a seizure log to track the frequency and duration of seizures.
   • Advise them to report any changes in the client’s condition or behavior to the healthcare provider promptly.

Management of a Generalized Seizure

During the initial home visit, if the client experiences a generalized seizure, the nurse should take the following actions:

1. Protect the Client from Injury:

   • Clear the area around the client to prevent falls or injuries.
   • Gently loosen any tight clothing around the client’s neck.
   • Do not attempt to restrain the client.

2. Observe the Seizure:

   • Note the time of seizure onset and duration.
   • Observe the client’s movements, including the type and extent of motor activity.
   • Check for any loss of consciousness, incontinence, or tongue biting.

3. Post-Seizure Care:

   • Once the seizure has subsided, gently place the client in a comfortable position on their side with their head turned slightly to the side to prevent aspiration.
   • Check for any injuries and provide first aid if needed.
   • Reassure the client and family members.

4. Seek Medical Attention:

   • If the seizure lasts for more than five minutes or if the client is not fully conscious after the seizure, call for emergency medical assistance immediately.
   • Inform the healthcare provider about the seizure occurrence and provide details about the observed symptoms.

5. Document the Seizure:

   • Document the seizure in the client’s medical record, including the time of onset, duration, and observed symptoms.
   • Inform the healthcare provider about the seizure during the next follow-up visit.