1372 UNIT XII / Responses to Altered Neurologic Function
necessary before and during a seizure. Stress the importance of
safety and keeping the airway patent.
Help both the client and family adjust to a diagnosis of
epilepsy. Address the following topics.
• Misconceptions, common fears, and myths about epilepsy
• The importance of wearing a MedicAlert band or carrying a
medical alert card at all times.
• Avoiding alcoholic beverages and limiting coffee intake
Nursing Care Plan
A Client with a Seizure Disorder
Janet Carlson is a 19-year-old college student who lives with her
parents and one younger sister.Although Janet had seizures while
she was in grade school, they have been controlled with medica-
tion. However, she had a tonic-clonic seizure yesterday and imme-
diately made an appointment with her family physician.She is cur-
rently taking phenytoin (Dilantin) 300 mg/day as a maintenance
medication to prevent seizures.
ASSESSMENT
Evita Farias, RN, completes a health history for Ms. Carlson. During
the history, she tells Ms. Farias that she has been under stress be-
cause of difficulties in completing her course requirements this se-
mester. She has not been sleeping as many hours per night, and
sometimes she forgets to take her medication. Janet’s serum
phenytoin level is 8 mg/mL.Therapeutic level is 10 to 20 mg/ml.
DIAGNOSES
• Risk for injury, related to recurrence of generalized tonic-clonic
seizure activity and low serum phenytoin levels
• Deficient knowledge, related to activities that may trigger
seizure occurrence, the effect of stress on seizures, and medica-
tion information
EXPECTED OUTCOMES
• Will verbalize precipitating and triggering factors related to the
onset of seizures.
• Will verbalize the relationship between emotional and physical
stress and seizures.
• Will verbalize the importance of taking anticonvulsant medica-
tions.
PLANNING AND IMPLEMENTATION
• Teach client and her family the following:
TRAUMATIC BRAIN INJURY
Traumatic brain injury (TBI) is a leading cause of death and
disability in the United States. The National Head Injury Foun-
dation defines TBI as a traumatic insult to the brain capable of
causing physical, intellectual, emotional, social, and voca-
tional changes. A TBI may be classified as a penetrating (open)
head injury (e.g., resulting from a knife, bullet, or baseball bat)
or a closed head injury (a blunt injury to the brain that does not
result in an open skull fracture).
• Taking showers versus tub baths, because of safety issues
during a generalized seizure
• Factors that may trigger a seizure, such as abrupt withdrawal
from medication, constipation, fatigue, excessive stress,
fever, menstruation, sights and sounds such as television,
flashing video, and computer screens
• Helpful resources:
American Epilepsy Society
Epilepsy Foundation
• Current information about seizures
• Care during and after a seizure
• Medication protocols
• Factors and activities that can trigger seizures
• The importance of follow-up care
• Refer client and her family to a local epilepsy support group.
• Recommend that she purchase and wear a MedicAlert bracelet.
EVALUATION
Ms. Carlson is instructed to continue taking Dilantin 300 mg/day.
She states the importance of nutrition, rest, and measures to re-
duce stress. She also discusses the importance of maintaining the
proper blood levels of her medication, stating that too little or too
much of the medication could cause problems. Ms. Carlson recog-
nizes that the seizure problems had recurred during a busy time in
school during which she had forgotten to take her medication.
She is now wearing a MedicAlert bracelet. Ms. Farias provides the
Carlsons with the telephone number of the Epilepsy Foundation
of America.
Critical Thinking in the Nursing Process
1. If you were Ms. Carlson’s nurse, would your teaching differ if
she were living alone? If so, how?
2. Ms. Carlson tells you that although she knows she should not
drive a car, she often drives her friend to work.How would you
approach this problem?
3. Ms. Carlson states that “it’s embarrassing to wear a MedicAlert
bracelet.” How would you respond, and what recommenda-
tion(s) would you make?
See Evaluating Your Response in Appendix C.
INCIDENCE AND PREVALENCE
The CDC estimates that each year 1 million people in the
United States are treated and released from hospital emergency
departments as a result of TBI, 230,000 people are hospitalized
and survive; and 50,000 people die. Additionally, more than
80,000 are discharged with TBI-related injuries, and 5.3 mil-
lion Americans are living today with a TBI-related disability.