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SEIZURE DISORDERS

Seizures (convulsions) are the result of uncontrolled electrical discharges from the nerve cells of the cerebral cortex
and are characterized by sudden, brief attacks of altered consciousness, motor activity, and/or sensory phenomena.
Seizures can be associated with a variety of cerebral or systemic disorders as a focal or generalized disturbance of
cortical function. Sensory symptoms arise from the parietal lobe; motor symptoms arise from the frontal lobe.
The phases of seizure activity are prodromal, aural, ictal, and postictal. The prodromal phase involves mood or
behavior changes that may precede a seizure by hours or days. The aura is a premonition of impending seizure activity
and may be visual, auditory, or gustatory. The ictal stage is characterized by seizure activity, usually musculoskeletal.
The postictal stage is a period of confusion/somnolence/irritability that occurs after the seizure.
The main causes for seizures can be divided into six categories:
Toxic agents: Poisons, alcohol, overdoses of prescription/nonprescription drugs (with drugs the leading cause).
Chemical imbalances: Hyperkalemia, hypoglycemia, and acidosis.
Fever: Acute infections, heatstroke.
Cerebral pathology: Resulting from head injury, infections, hypoxia, expanding brain lesions, increased intracranial
pressure.
Eclampsia: Prenatal hypertension/toxemia of pregnancy.
Idiopathic: Unknown origin.
Seizures can be divided into two major classifications (generalized and partial). Generalized seizure types include
tonic-clonic, myoclonic, clonic, tonic, atonic, and absence seizures. Partial (focal) seizures are the most common type
and are categorized as either (1) simple (partial motor, partial sensory) or (2) complex.

CARE SETTING
Community; however, may require brief inpatient care on a medical or subacute unit for stabilization/treatment of
status epilepticus.

RELATED CONCERNS
Cerebrovascular accident (CVA)/stroke
Craniocerebral trauma (acute rehabilitative phase)
Psychosocial aspects of care
Substance dependence/abuse rehabilitation

Patient Assessment Database


ACTIVITY/REST
May report: Fatigue, general weakness
Limitation of activities/occupation imposed by self/significant other (SO)/healthcare
provider or others
May exhibit: Altered muscle tone/strength
Involuntary movement/contractions of muscles or muscle groups (generalized tonic-clonic
seizures)

CIRCULATION
May exhibit: Ictal: Hypertension, increased pulse, cyanosis
Postictal: Vital signs normal or depressed with decreased pulse and respiration

EGO INTEGRITY
May report: Internal/external stressors related to condition and/or treatment
Irritability; sense of helplessness/hopelessness
Changes in relationships
May exhibit: Wide range of emotional responses

ELIMINATION
May report: Episodic incontinence
May exhibit: Ictal: Increased bladder pressure and sphincter tone
Postictal : Muscles relaxed, resulting in incontinence (urinary/fecal)

FOOD/FLUID
May report: Food sensitivity nausea/vomiting correlating with seizure activity
May exhibit: Dental/soft-tissue damage (injury during seizure)
Gingival hyperplasia (side effect of long-term phenytoin [Dilantin] use)

NEUROSENSORY
May report: History of headaches, recurring seizure activity, fainting, dizziness
History of head trauma, anoxia, cerebral infections
Prodromal phase: Vague changes in emotional reactivity or affective response preceding
aura in some cases and lasting minutes to hours
Presence of aura (stimulation of visual, auditory, hallucinogenic areas)
Postictal: Weakness, muscle pain, areas of paresthesia/paralysis
May exhibit: Seizure characteristics: (ictal, postictal)
Generalized seizures:
Tonic-clonic (grand mal): Rigidity and jerking posturing, vocalization, loss of
consciousness, dilated pupils, stertorous respiration, excessive salivation (froth),
fecal/urinary incontinence, and biting of the tongue may occur and last 2–5 min.
Postictal phase: Patient sleeps 30 min to several hours, then may be weak,
confused, and amnesic concerning the episode, with nausea and stiff, sore
muscles
Myoclonic: Short abrupt muscle contractions of arms, legs, torso; may not be symmetrical;
lasts seconds
Clonic: Muscle contraction with relaxation resembling myoclonic movements but with
slower repetitions; may last several minutes
Tonic: Abrupt increase in muscle tone of torso/face, flexion of arms, extension of legs;
lasts seconds
Atonic: Abrupt loss of muscle tone; lasts seconds; patient may fall
Absence (petit mal): Periods of altered awareness or consciousness (staring, fluttering of
eyes) lasting 5–30 sec, which may occur as many as 100 times a day; minor
motor seizures may be akinetic (loss of movement), myoclonic (repetitive
motor contractions), or atonic (loss of muscle tone). Postictal phase: Amnesia
for seizure events, no confusion, able to resume activity
Status epilepticus: Defined as 30 or more minutes of continuous generalized seizure
activity or two or more sequential seizures without full recovery of
consciousness in between, possibly related to abrupt withdrawal of
anticonvulsants and other metabolic phenomena. If absence seizures are the
pattern, problem may go undetected for a period of time because patient does
not lose consciousness
Partial seizures:
Complex (psychomotor/temporal lobe): Patient generally remains conscious, with
reactions such as dream state, staring, wandering, irritability, hallucinations,
hostility, or fear. May display involuntary motor symptoms (lip smacking) and
behaviors that appear purposeful but are inappropriate (automatism) and include
impaired judgment and, on occasion, antisocial acts; lasts 1–3 min. Postictal
phase: Absence of memory for these events, mild to moderate confusion
Simple (focal-motor/Jacksonian): Often preceded by aura (may report deja vu or fearful
feeling); no loss of consciousness (unilateral) or loss of consciousness
(bilateral); convulsive movements and temporary disturbance in part controlled
by the brain region involved (e.g., frontal lobe [motor dysfunction], parietal
[numbness, tingling], occipital [bright, flashing lights], posterotemporal
[difficulty speaking]). Convulsions may march along limb or side of body in
orderly progression. If restrained during seizure, patient may exhibit combative
and uncooperative behavior; lasts seconds to minutes

PAIN/DISCOMFORT
May report: Headache, muscle/back soreness postictally
Paroxysmal abdominal pain during ictal phase (may occur during some partial/focal
seizures without loss of consciousness)
May exhibit: Guarding behavior
Alteration in muscle tone
Distraction behavior/restlessness

RESPIRATION
May exhibit: Ictal: Clenched teeth, cyanosis, decreased or rapid respirations; increased mucous
secretions
Postictal: Apnea

SAFETY
May report: History of accidental falls/injuries, fractures
Presence of allergies
May exhibit: Soft-tissue injury/ecchymosis
Decreased general strength/muscle tone

SOCIAL INTERACTION
May report: Problems with interpersonal relationships within family/socially
Limitation/avoidance of social contacts

TEACHING/LEARNING
May report: Familial history of epilepsy
Drug (including alcohol) use/misuse
Increased frequency of episodes/failure to improve
Discharge plan DRG projected mean length of inpatient stay: 4.4 days
considerations: May require changes in medications, assistance with some homemaker/maintenance tasks
relative to issues of safety, and transportation
Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES
Electrolytes: Imbalances may affect/predispose to seizure activity.
Glucose: Hypoglycemia may precipitate seizure activity.
Blood urea nitrogen (BUN): Elevation may potentiate seizure activity or may indicate nephrotoxicity related to
medication regimen.
Complete blood count (CBC): Aplastic anemia may result from drug therapy.
Serum drug levels: To verify therapeutic range of antiepileptic drugs (AEDs).
Toxicology screen: Determines potentiating factors such as alcohol or other drug use.
Skull x-rays: Identifies presence of space-occupying lesions, fractures.
Electroencephalogram (EEG) may be done serially: Locates area of cerebral dysfunction; measures brain activity.
Brain waves take on characteristic spikes in each type of seizure activity; however, up to 40% of seizure patients
have normal EEGs because the paroxysmal abnormalities occur intermittently.
Video-EEG monitoring, 24 hours (video picture obtained at same time as EEG): May identify exact focus of seizure
activity (advantage of repeated viewing of event with EEG recording).
Computed tomography (CT) scan: Identifies localized cerebral lesions, infarcts, hematomas, cerebral edema, trauma,
abscesses, tumor; can be done with or without contrast medium.
Magnetic resonance imaging (MRI): Localizes focal lesions.
Positron emission tomography (PET): Demonstrates metabolic alterations, e.g., decreased metabolism of glucose at
site of lesion.
Single photon emission computed tomography (SPECT): May show local areas of brain dysfunction when CT and
MRI are normal.
Magnetoencephalogram: Maps the electrical impulses/potential of brain for abnormal discharge patterns.
Lumbar puncture: Detects abnormal cerebrospinal fluid (CSF) pressure, signs of infections or bleeding (i.e.,
subarachnoid, subdural hemorrhage) as a cause of seizure activity (rarely done).
Wada’s test: Determines hemispheric dominance (done as a presurgical evaluation before temporal lobectomy).
NURSING PRIORITIES

1. Prevent/control seizure activity.


2. Protect patient from injury.
3. Maintain airway/respiratory function.
4. Promote positive self-esteem.
5. Provide information about disease process, prognosis, and treatment needs.

DISCHARGE GOALS

1. Seizures activity controlled.


2. Complications/injury prevented.
3. Capable/competent self-image displayed.
4. Disease process/prognosis, therapeutic regimen, and limitations understood.
5. Plan in place to meet needs after discharge.

NURSING DIAGNOSIS: Trauma/Suffocation, risk for


Risk factors may include
Weakness, balancing difficulties
Cognitive limitations/altered consciousness
Loss of large or small muscle coordination
Emotional difficulties
Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]
DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:
Risk Detection (NOC)
Verbalize understanding of factors that contribute to possibility of trauma and/or suffocation and take steps to
correct situation.
Risk Control (NOC)
Demonstrate behaviors, lifestyle changes to reduce risk factors and protect self from injury.
Modify environment as indicated to enhance safety.
Maintain treatment regimen to control/eliminate seizure activity.
CAREGIVERS WILL:
Knowledge: Personal Safety (NOC)
Identify actions/measures to take when seizure activity occurs.

ACTIONS/INTERVENTIONS RATIONALE
Seizure Precautions (NIC)

Independent
Explore with patient the various stimuli that may Alcohol, various drugs, and other stimuli (e.g., loss of
precipitate seizure activity. sleep, flashing lights, prolonged television viewing) may
increase brain activity, thereby increasing the potential
for seizure activity.
ACTIONS/INTERVENTIONS RATIONALE
Seizure Precautions (NIC)

Independent
Discuss seizure warning signs (if appropriate) and usual Enables patient to protect self from injury and recognize
seizure pattern. Teach SO to recognize warning signs and changes that require notification of physician/further
how to care for patient during and after seizure. intervention. Knowing what to do when seizure occurs
can prevent injury/complications and decreases SO’s
feelings of helplessness.

Keep padded side rails up with bed in lowest position, or Minimizes injury should seizures (frequent/generalized)
place bed up against wall and pad floor if rails not occur while patient is in bed. Note: Most individuals seize
available/appropriate. in place and if in the middle of the bed, individual is
unlikely to fall out of bed.

Encourage patient not to smoke except while supervised. May cause burns if cigarette is accidentally dropped
during aura/seizure activity.

Evaluate need for/provide protective headgear. Use of helmet may provide added protection for
individuals who suffer recurrent/severe seizures.

Use tympanic thermometer when necessary to take Reduces risk of patient biting and breaking glass
temperature. thermometer or suffering injury if sudden seizure activity
should occur.

Seizure Management (NIC)

Maintain strict bedrest if prodromal signs/aura Patient may feel restless/need to ambulate or even
experienced. Explain necessity for these actions. defecate during aural phase, thereby inadvertently
removing self from safe environment and easy
observation. Understanding importance of providing for
own safety needs may enhance patient cooperation.

Stay with patient during/after seizure. Promotes patient safety.

Turn head to side/suction airway as indicated. Insert Helps maintain airway and reduces risk of oral trauma but
plastic bite block only if jaw relaxed. should not be “forced” or inserted when teeth are
clenched because dental and soft-tissue damage may
result. Note: Wooden tongue blades should not be used
because they may splinter and break in patient’s mouth.
(Refer to ND: Airway Clearance/Breathing Pattern,
ineffective, risk for)

Cradle head, place on soft area, or assist to floor if out of Gentle guiding of extremities reduces risk of physical
bed. Do not attempt to restrain. injury when patient lacks voluntary muscle control. Note:
If attempt is made to restrain patient during seizure,
erratic movements may increase, and patient may injure
self or others.

Document preseizure activity, presence of aura or unusual Helps localize the cerebral area of involvement.
behavior, type of seizure activity (e.g., location/duration
of motor activity, loss of consciousness, incontinence, eye
activity, respiratory impairment/cyanosis), and
frequency/recurrence. Note whether patient fell,
expressed vocalizations, drooled, or had automatisms
(e.g., lip-smacking, chewing, picking at clothes).
ACTIONS/INTERVENTIONS RATIONALE
Seizure Management (NIC)

Independent
Perform neurological/vital sign check after seizure, e.g., Documents postictal state and time/completeness of
level of consciousness, orientation, ability to comply with recovery to normal state. May identify additional safety
simple commands, ability to speak; memory of incident; concerns to be addressed.
weakness/motor deficits; blood pressure (BP),
pulse/respiratory rate.

Reorient patient following seizure activity. Patient may be confused, disoriented, and possibly
amnesic after the seizure and need help to regain control
and alleviate anxiety.

Allow postictal “automatic” behavior without interfering May display behavior (of motor or psychic origin) that
while providing environmental protection. seems inappropriate/irrelevant for time and place.
Attempts to control or prevent activity may result in
patient becoming aggressive/combative.

Investigate reports of pain. May be result of repetitive muscle contractions or


symptom of injury incurred, requiring further
evaluation/intervention.

Observe for status epilepticus, i.e., one tonic-clonic This is a life-threatening emergency that if left untreated
seizure after another in rapid succession. could cause metabolic acidosis, hyperthermia,
hypoglycemia, arrhythmias, hypoxia, increased
intracranial pressure, airway obstruction, and respiratory
arrest. Immediate intervention is required to control
seizure activity and prevent permanent injury/death.
Note: Although absence seizures may become static, they
are not usually life-threatening.

Collaborative

Administer medications as indicated: Specific drug therapy depends on seizure type, with some
patients requiring polytherapy or frequent medication
adjustments.

Antiepileptic drugs (AEDs), e.g., phenytoin AEDs raise the seizure threshold by stabilizing nerve cell
(Dilantin), primidone (Mysoline), carbamazepine membranes, reducing the excitability of the neurons, or
(Tegretol), clonazepam (Klonopin), valproic acid through direct action on the limbic system, thalamus, and
(Depakene), divalproex (Depakote), acetazolamide hypothalamus. Goal is optimal suppression of seizure
(Diamox), ethotoin (Peganone), methsuximide activity with lowest possible dose of drug and with fewest
(Celotin), fosphenytoin (Cerebyx); side effects. Cerebyx reaches therapeutic levels within 24
hr and can be used for nonemergent loading while waiting
for other agents to become effective. Note: Some patients
require polytherapy or frequent medication adjustments to
control seizure activity. This increases the risk of adverse
reactions and problems with adherence.
ACTIONS/INTERVENTIONS RATIONALE
Seizure Management (NIC)

Collaborative
Topiramate (Topamax), ethosuximide (Zarontin), Adjunctive therapy for partial seizures or an alternative
lamotrigine (Lamictal), gabapentin (Neurontin); for patients when seizures are not adequately controlled
by other drugs.

Phenobarbital (Luminal); Potentiates/enhances effects of AEDs and allows for


lower dosage to reduce side effects.

Lorazepam (Ativan); Used to abort status seizure activity because it is shorter


acting than Valium and less likely to prolong postseizure
sedation.

Diazepam (Valium, Diastat rectal gel); May be used alone (or in combination with
phenobarbital) to suppress status seizure activity. Diastat,
a gel, may be administered rectally, even in the home
setting, to reduce frequency of seizures and need for
additional medical care.

Glucose, thiamine. May be given to restore metabolic balance if seizure is


induced by hypoglycemia or alcohol.

Monitor/document AED drug levels, corresponding side Standard therapeutic level may not be optimal for
effects, and frequency of seizure activity. individual patient if untoward side effects develop or
seizures are not controlled.

Monitor CBC, electrolytes, glucose levels. Identifies factors that aggravate/decrease seizure
threshold.

Prepare for surgery/electrode implantation as indicated. Vagal nerve stimulator, magnetic beam therapy, or other
surgical intervention (e.g., temporal lobectomy) may be
done for intractable seizures or well-localized
epileptogenic lesions when patient is disabled and at high
risk for serious injury. Success has been reported with
gamma ray radio surgery for the treatment of multiple
seizure activity that has otherwise been difficult to
control.

NURSING DIAGNOSIS: Airway Clearance/Breathing Pattern, risk for ineffective


Risk factors may include
Neuromuscular impairment
Tracheobronchial obstruction
Perceptual/cognitive impairment
Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual
diagnosis.]
DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:
Respiratory Status: Ventilation (NOC)
Maintain effective respiratory pattern with airway patent/aspiration prevented.
ACTIONS/INTERVENTIONS RATIONALE
Airway Management (NIC)

Independent
Encourage patient to empty mouth of dentures/foreign Reduces risk of aspiration/foreign bodies lodging in
objects if aura occurs and to avoid chewing gum/sucking pharynx.
lozenges if seizures occur without warning.

Place in lying position, flat surface; turn head to side Promotes drainage of secretions; prevents tongue from
during seizure activity. obstructing airway.

Loosen clothing from neck/chest and abdominal areas. Facilitates breathing/chest expansion.

Insert plastic airway or soft roll as indicated and only if If inserted before jaw is tightened, these devices may
jaw is relaxed. prevent biting of tongue and facilitate
suctioning/respiratory support if required. Airway adjunct
may be indicated after cessation of seizure activity if
patient is unconscious and unable to maintain safe
position of tongue.

Suction as needed. Reduces risk of aspiration/asphyxiation. Note: Risk of


aspiration is low unless individual has eaten within the
last 40 min.

Collaborative

Administer supplemental oxygen/bag ventilation as May reduce cerebral hypoxia resulting from decreased
needed postictally. circulation/oxygenation secondary to vascular spasm
during seizure. Note: Artificial ventilation during general
seizure activity is of limited or no benefit because it is not
possible to move air in/out of lungs during sustained
contraction of respiratory musculature. As seizure abates,
respiratory function will return unless a secondary
problem exists (e.g., foreign body/aspiration).

Prepare for/assist with intubation, if indicated. Presence of prolonged apnea postictally may require
ventilatory support.
NURSING DIAGNOSIS: Self-Esteem, (specify situational or chronic) low
May be related to
Stigma associated with condition
Perception of being out of control
Possibly evidenced by
Verbalization about changed lifestyle
Fear of rejection; negative feelings about body
Change in self-perception of role
Change in usual patterns of responsibility
Lack of follow-through/nonparticipation in therapy
DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:
Self-Esteem (NOC)
Identify feelings and methods for coping with negative perception of self.
Verbalize increased sense of self-esteem in relation to diagnosis.
Verbalize realistic perception and acceptance of self in changed role/lifestyle.

ACTIONS/INTERVENTIONS RATIONALE
Self-Esteem Enhancement (NIC)

Independent
Discuss feelings about diagnosis, perception of threat to Reactions vary among individuals, and previous
self. Encourage expression of feelings. knowledge/experience with this condition affects
acceptance of therapeutic regimen. Verbalization of fears,
anger, and concerns about future implications can help
patient begin to accept/deal with situation.

Identify possible/anticipated public reaction to condition. Provides opportunity to problem-solve response, and
Encourage patient to refrain from concealing problem. provides measure of control over situation. Concealment
is destructive to self-esteem (potentiates denial), blocking
progress in dealing with problem, and may actually
increase risk of injury/negative response when seizure
does occur.

Explore with patient current/past successes and strengths. Focusing on positive aspects can help alleviate feelings of
guilt/self-consciousness and help patient begin to accept
manageability of condition.

Avoid overprotecting patient; encourage activities, Participation in as many experiences as possible can
providing supervision/monitoring when indicated. lessen depression about limitations.
Observation/supervision may need to be provided for
such activities as gymnastics, climbing, and water sports.

Determine attitudes/capabilities of SO. Help individual Negative expectations from SO may affect patient’s sense
realize that his/her feelings are normal; however, guilt of competency/self-esteem and interfere with support
and blame are not helpful. received from SO, limiting potential for optimal
management/personal growth.
ACTIONS/INTERVENTIONS RATIONALE
Self-Esteem Enhancement (NIC)

Independent
Stress importance of staff/SO remaining calm during Anxiety of caregivers is contagious and can be conveyed
seizure activity. to the patient, increasing/multiplying individual’s own
negative perceptions of situation/self.

Refer patient/SO to support group, e.g., Epilepsy Provides opportunity to gain information, support, and
Foundation of America, National Association of Epilepsy ideas for dealing with problems from others who share
Centers, and Delta Society’s National Service Dog similar experiences. Note: Some service dogs have ability
Center. to sense/predict seizure activity, allowing patient to
institute safety measures, increasing independence and
personal sense of control.

Discuss referral for psychotherapy with patient/SO. Seizures have a profound effect on personal self-esteem,
and patient/SO may feel guilt over perceived limitations
and public stigma. Counseling can help overcome
feelings of inferiority/self-consciousness.

NURSING DIAGNOSIS: Knowledge, deficient [Learning Need] regarding condition, prognosis,


treatment regimen, self-care, and discharge needs
May be related to
Lack of exposure, unfamiliarity with resources
Information misinterpretation
Lack of recall; cognitive limitation
Possibly evidenced by
Questions, statement of concerns
Increased frequency/lack of control of seizure activity
Lack of follow-through of drug regimen
DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:
Knowledge: Illness Care (NOC)
Verbalize understanding of disorder and various stimuli that may increase/
potentiate seizure activity.
Adhere to prescribed drug regimen.
Knowledge: Personal Safety (NOC)
Initiate necessary lifestyle/behavior changes as indicated.
ACTIONS/INTERVENTIONS RATIONALE
Teaching: Disease Process (NIC)

Independent
Review pathology/prognosis of condition and lifelong Provides opportunity to clarify/dispel misconceptions and
need for treatments as indicated. Discuss patient’s present condition as something that is manageable within
particular trigger factors (e.g., flashing lights, a normal lifestyle.
hyperventilation, loud noises,video games, TV viewing).

Review possible effects of hormonal changes. Alterations in hormonal levels that occur during
menstruation and pregnancy may increase risk of
seizures.
Discuss significance of maintaining good general health,
e.g., adequate diet, rest, moderate exercise, and avoidance Regularity and moderation in activities may aid in
of exhaustion, alcohol, caffeine, and stimulant drugs. reducing/controlling precipitating factors, enhancing
sense of general well-being, and strengthening coping
ability and self-esteem. Note: Too little sleep or too much
alcohol can precipitate seizure activity in some people.
Review importance of good oral hygiene and regular
dental care. Reduces risk of oral infections and gingival hyperplasia.

Identify necessity/promote acceptance of actual


limitations; discuss safety measures regarding driving, Reduces risk of injury to self or others, especially if
using mechanical equipment, climbing ladders, seizures occur without warning.
swimming, and hobbies.

Discuss local laws/restrictions pertaining to persons with


epilepsy/seizure disorder. Encourage awareness but not Although legal/civil rights of persons with epilepsy have
necessarily acceptance of these policies. improved during the past decade, restrictions still exist in
some states pertaining to obtaining a driver’s license,
sterilization, workers’ compensation, and required
reportability to state agencies.
Teaching: Prescribed Medication (NIC)

Review medication regimen, necessity of taking drugs as


ordered, and not discontinuing therapy without physician Lack of cooperation with medication regimen is a leading
supervision. Include directions for missed dose. cause of seizure breakthrough. Patient needs to know
risks of status epilepticus resulting from abrupt
withdrawal of anticonvulsants. Depending on the drug
dose and frequency, patient may be instructed to take
missed dose if remembered within a predetermined time
frame.
Recommend taking drugs with meals, if appropriate.
May reduce incidence of gastric irritation,
nausea/vomiting.
Discuss nuisance and adverse side effects of particular
drugs, e.g., drowsiness, fatigue, lethargy, hyperactivity, May indicate need for change in dosage/choice of drug
sleep disturbances, gingival hypertrophy, visual therapy. Promotes involvement/participation in decision-
disturbances, nausea/vomiting, rashes, syncope/ataxia, making process and awareness of potential long-term
birth defects, aplastic anemia. effects of drug therapy, and provides opportunity to
minimize/prevent complications.
ACTIONS/INTERVENTIONS RATIONALE
Teaching: Prescribed Medication (NIC)

Independent
Provide information about potential drug interactions and Knowledge of anticonvulsant use reduces risk of
necessity of notifying other healthcare providers of drug prescribing drugs that may interact, thus altering seizure
regimen. threshold or therapeutic effect. For example, phenytoin
(Dilantin) potentiates anticoagulant effect of warfarin
(Coumadin), whereas isoniazid (INH) and
chloramphenicol (Chloromycetin) increase the effect of
phenytoin (Dilantin), and some antibiotics (e.g.,
erythromycin) can cause elevation of serum level of
carbamazepine (Tegretol), possibly to toxic levels.

Review proper use of diazepam rectal gel (Diastat) with Useful in controlling serial or cluster seizures. Can be
patient and SO/caregiver as appropriate. administered in any setting and is effective usually within
15 min. May reduce dependence on emergency
department visits.

Encourage patient to wear identification tag/bracelet Expedites treatment and diagnosis in emergency
stating the presence of a seizure disorder. situations.

Stress need for routine follow-up care/laboratory testing Therapeutic needs may change and/or serious drug side
as indicated, e.g., CBC should be monitored biannually effects (e.g., agranulocytosis or toxicity) may develop.
and in presence of sore throat/fever, signs of other
infection.

POTENTIAL CONSIDERATIONS following acute hospitalization (dependent on patient’s age, physical


condition/presence of complications, personal resources, and life responsibilities)
Injury, risk for—weakness, balancing difficulties, cognitive limitations/altered consciousness, loss of large or small
muscle coordination.
Self-Esteem (specify)—stigma associated with condition, perception of being out of control, personal vulnerability,
negative evaluation of self/capabilities.
Therapeutic Regimen: ineffective management—social support deficits, perceived benefit (versus side effects of
medication), perceived susceptibility (possible long periods of remission).