ASSESSMENT SUBJECTIVE: Bigla na lang nanginig ang anak ko as verbalized by the mother.

OBJECTIVE: -rolling back of eyes -jerking movements of upper extremities

DIAGNOSIS Risk for Injury related to

INFERENCE Seizures are disturbances in normal brain function resulting from abnormal electrical discharges in the brain, which can cause loss of consciousness, uncontrolled body movements, changes in behaviors and sensation, and changes in the autonomic system. Majority of seizures happen within the first years of life.

PLANNING After 8 hours of nursing interventions, the patients parents will be able to: - reduce risk factors of seizure -protect the patient from harm -keep patient safe

INTERVENTION Independent: Explore with the patient the various stimuli that may precipitate seizure activity.

RATIONALE Lack of sleep, flashing lights and prolonged television viewing may increase brain activity that may cause potential seizure activity. Enables the patient to protect self from injury. Minimizes injury should seizure occur while patient is in bed. Use of helmet may provide added protection for individuals during aura or seizure activity.

EVALUATION After 8 hours of nursing interventions, the patients parents was able to: - reduce risk factors of seizure -protect the patient from harm -keep patient safe

Discuss seizure warning signs and usual seizure pattern. Keep padded side rails up with bed in the lowest position.

Evaluate need for protective head gear.

Turn head to side or suction airway as indicated. Insert plastic bite block only if jaw are relaxed.

Help maintain airway and reduces risk of oral trauma but should not be forced or inserted when teeth are

clenched because dental or softtissue may damage. Cradle head, place on soft area, or assist to floor if out of bed. Gentle guiding of extremities reduces risk of physical injury when patient lacks voluntary muscle control. Patient may be confused, disoriented after seizure and need help to regain control and alleviate anxiety. Specific drug therapy depends on seizure type, with some patients requiring polytherapy or frequent medications adjustment.

Reorient patient following seizure activity. Collaborative: Administer medications as indicated.

Drug Brand Name: Barbilixir (CAN), Barbita (CAN), Bellatal, Solfoton, phenobarbital sodium, Parenteral: Luminal Sodium Pregnancy Category D, C-IV controlled substance

Drug classes: Barbiturate (long acting), Sedative, Hypnotic, Anticonvulsant, Antiepileptic agent

Mechanism of Action Increased serum levels and therapeutic and toxic effects with valproic acid Increased CNS depression with alcohol Increased risk of nephrotoxicity with methoxyflurane Increased risk of neuromuscular excitation and hypotension with barbiturate anesthetics Decreased effects of the following drugs: theophyllines, oral anticoagulants, beta-blockers, doxycycline, griseofulvin, corticosteroids, hormonal contraceptives and estrogens,

Indication Sedative (oral or parenteral) Hypnotic, shortterm (up to 2 wk) treatment of insomnia (oral or parenteral) Long-term treatment of generalized tonicclonic and cortical focal seizures (oral) Emergency control of certain acute convulsive episodes (eg, those associated with status epilepticus, eclampsia, meningitis, tetanus, and toxic reactions to strychnine or local anesthetics; parenteral) Preanesthetic (parenteral) Anticonvulsant treatment of

Dose, Route, Frequency Gr in am Gr 1 n pm Oral

Nursing Responsibilities Contraindicated with Somnolence, Monitor patient hypersensitivity to agitation, confusion, responses, blood barbiturates, manifest hyperkinesia, ataxia, levels (as or latent porphyria; vertigo, CNS appropriate) if any of marked liver depression, the above interacting impairment; nephritis; nightmares, lethargy, drugs are given with severe respiratory distress; previous residual sedation phenobarbital; addiction to sedative- (hangover), suggest alternative hypnotic drugs (may paradoxical means of be ineffective and may contraception to contribute to further excitement, women using addiction); pregnancy nervousness, psychiatric hormonal (fetal damage, neonatal withdrawal disturbance, contraceptives. syndrome); lactation. hallucinations, Do not administer insomnia, anxiety, intra-arterially; may dizziness, thinking produce abnormality arteriospasm, Bradycardia, thrombosis, hypotension, gangrene. syncope Administer IV Nausea, vomiting, doses slowly. constipation, Administer IM diarrhea, epigastric doses deep in a large pain muscle mass (gluteus Rashes, maximus, vastus angioneurotic edema, lateralis) or other serum sickness, areas where there is morbiliform rash, little risk of

Contraindcations

Side Effect

metronidazole, phenylbutazones, quinidine

generalized tonicclonic and cortical focal seizures (parenteral) Emergency control of acute convulsions (tetanus, eclampsia, epilepticus; parenteral)

urticaria; rarely, exfoliative dermatitis, StevensJohnson syndrome Pain, tissue necrosis at injection site, gangrene; arterial spasm with inadvertent intraarterial injection; thrombophlebitis; permanent neurologic deficit if injected near a nerve Hypoventilation, apnea, respiratory depression, laryngospasm, bronchospasm, circulatory collapse Tolerance, psychological and physical dependence, withdrawal syndrome

encountering a nerve trunk or major artery. Monitor injection sites carefully for irritation, extravasation (IV use). Solutions are alkaline and very irritating to the tissues. Monitor P, BP, respiration carefully during IV administration. Arrange for periodic laboratory tests of hematopoietic, renal, and hepatic systems during long-term therapy. Taper dosage gradually after repeated use, especially in epileptic patients.