Writing an essay about the nursing care of a client?
Epilepsy can be defined as a neurological disorder characterized by recurrent unprovoked seizures ( Blume et al, 2001) due to abnormal, excessive or synchronous neuronal activity in the brain (Fisher et al, 2005). The electrical impulses when transmitted to the muscles causes twitching and convulsions. Seizure is an event where there is sudden, excessive and abnormal discharge of electrons in the brain which is accompanied by alteration in sensory and motor functions and level of consciousness.
Epilepsy is a serious neurological condition that affects 1-2% of the population. Moreover, one in twenty children have seizures at any time during childhood and adolescence. Epilepsy becomes more common after the age of 50 years. It can be concluded that the cumulative incidence of epilepsy is 3-5% (Govt. Western Australia, 2008)
Main causes of epilepsy are:
Head injury during birth or in any accident in adult life
Low oxygen during birth
Infections like encephalitis or meningitis
Stroke or any injury to brain
Brain tumors
Abnormal level of some substances like blood sugar and sodium.
However, in 70% of cases of epilepsy the cause cannot be identified. But some triggers for seizures are known, avoiding which will help the patient lead a better life.
Missing medication
Heavy alcohol
Drug use like cocaine
Lack of sleep
Some drugs interfere with medication
Sign and symptoms of epilepsy seizures depend on which part of the brain is affected, according to which it is divided into three types
1. Generalized seizure : All areas of the brain are involved. The patient may cry or make sounds, the body becomes stiff for few seconds to a minute followed by rhythmic movements of arms and legs. Eyes of the patient are generally open and it appears that he is not breathing and turns blue and makes noisy breathing sounds. When the patient regains consciousness gradually he remains confused for some minutes or hours.
2. Partial or focal seizures : In this type, only some area of the brain is involved and depending on the area involved the symptoms differ. For example, if area controlling hands is involved there will be jerky movements of the hands, other areas involved may have symptoms like some repetitive actions e.g. smacking of lips, picking one’s clothes. Sometimes the patient may become confused.
3. Absence or petit mal seizures : It is more common in children, characterized by impairment of consciousness, child staring blankly, some repetitive movements like repeatedly blinking the eyes. These seizures usually last for few seconds and can occur many times in a day.
Epilepsy affects the quality of life of the people who suffer with this condition. The impact it has is much more than the injury the seizures itself causes.
Seizures produces medical injury or injury from unfavorable and unpredictable interaction with the environment. Patients can fall, fracture bones or strike on head.
Burns are also common in epilepsy. A patient holding cigarette at start of seizure may burn his arms or legs without being aware of it. In the kitchen, hot objects can be dangerous. Injuries can occur if patient is driving, climbing ladder or while using power tools. Patients can drown while swimming or bathing.
Aspiration and hypoxia are the major complications though aspiration pneumonia is more often in hospitalized patients who are intubated after having seizures. The main cardiac complication is arrhythmias. Every year, 0.2% people with poorly controlled epilepsy die suddenly.
Patients who did not undergo surgery for epilepsy and continued to have seizures have slow memory loss.
Patients with repeated temporal seizures may cause a change in personality called `Geschwind syndrome’.
Seizures at work are distressing for the co-workers and the patient feels dismissed and is usually moved to a remote office and isolated.
Seizure make schooling difficult due to decreased cognitive abilities, child feels isolated, he cannot participate in sports activities and examination cause stress and sleep deprivation which increase the tendency to seizures ( Blum,D, 1999).
There has always been a social stigma and prejudices among people about patients suffering from seizures. Some believed that they were possessed by devil spirits. They were subjected to forceful sterilization and prohibiting marriage. When a person is diagnosed with seizure, he is immediately prohibited from driving though alcoholics are allowed to drive who are involved in accidents or injuries (Blum,D, 1999).
Earlier the sole emphasis of the treatment was the control of the seizures but recently in the last 5 to 10 years, the attention has been increased to improve the quality of life of people. The quality of life of patient is not good. He cannot perform daily action like driving, sports, memory loss, school difficulties, depression, social isolation and unwanted pregnancy (Blum,D, 1999).
The cost of treatment of epilepsy which includes cost of treatment during and after the seizures, outpatient visits, diagnostic tests like MRI, EEG, medication, lab test, blood tests and blood chemistry. Some of these costs may be covered by healthcare systems but costs to patients like missed work days, unemployment or underemployment (Blum,D, 1999).
The medication have as much impact as the seizures itself. Medication causes changes in cognitive function on a daily basis, it causes the patient to feel sedated and makes them feel that their thinking is foggy. Some medication causes depression, metal blunting, irritability and suicidal tendency. Some medication for epilepsy interfere with birth control medication resulting in unplanned pregnancy (Blum,D, 1999).
The physician, assistant and epilepsy nurse are involved in the primary care of an epileptic patient. The role of epileptic nurse treating epileptic patients is very useful in assessing the symptoms, diagnosis, tests and risk management (Ridsdale et al, 2002). Epilepsy nurse is an important part of the epilepsy care team. They play a pivotal role providing coordinated care and education to patients with complex uncontrolled epilepsy.
Primary care physician are the first level of care who deal with epileptic patients of all types. However, most of the PCPs have very brief formal training in neurology. They receive minimal formal training for its management. Due to increasing work load and reduced time for each patient, it becomes difficult for the PCP to educate and counsel the patient and cover all the issues associated with the condition. The PCPs make the initial diagnosis, begins the treatment and adjust drug doses.
Neurologist specializes in dealing with epileptic patient. He is able to diagnose the specific type of epilepsy and use specific approach to treat the patient’s condition. The neurologist advises neuroimaging tests. However, community based neuroimaging that is available to most neurologists is inadequate to diagnose mesial temporal sclerosis and are referred to tertiary centre for neuroimaging. General neurologists are not trained to differentiate seizures from pseudo-seizures and patients with uncontrolled seizures or patients who have suspicious events; these patients are referred to EEG-video telemetry.
Moreover, it has been noticed that most of the patients with epilepsy do not reach tertiary canters until they have had uncontrolled seizures for 10-20 years. By this time, the patients has suffered huge social damage and insurance companies only pay for direct costs and do not pay indirect costs and noneconomic costs. Most of the patients do not continue with a single insurer for long enough time to cover the cost of epilepsy surgery and later many insurers are reluctant to allow patient access to tertiary care.
The nursing care plan for Jessica is prioritized based on the more serious and complicated health condition at hand. It is prioritized as:
On the initial visit, assess the originator of seizure in the patient.
Rational: medication, lack of sleep, alcohol enhance brain activity which increase the risk of seizure.^8
Supervision of the activities after the seizure
Rational: Improving patient safety.^8
Assess the patients feeling regarding the treatment received and self perception of the treatment performed on the patient
Rational: To judge the acceptance of client’s medical treatment.^8
Assess the patient’s level of knowledge of the severity of the illness and co-occuring uncontrolled diabetic condition.
Rational: To know the extent of client’s knowledge of her condition and to assess if the patient will be cooperative towards the treatment and precautions advised.^8
Explain again the pathophysiology of the disease, its severity, prognosis, treatment and management
Rational: To provide an opportunity to the client to clarify any misconception and the state of the illness.^8
Review the medication, dosage, instructions and reason for discontinuation and non-compliance of the medication as instructed by the doctor.
Rational: It will further assist in understanding the client’s health condition.^8
Discuss the benefits of good general health like adequate diet and appropriate weight for her height especially with regards to diabetes, adequate rest, regular exercise, lifestyle changes, avoidance of food and beverages containing harmful substances especially which may trigger seizures.
Rational: To educate the client about healthy food habits, reduction of weight and regular exercise.^8
To educate the patient about the increased risk of seizures with uncontrolled diabetes due to hyperglycemia in Type 2 diabetes.
Rational: To educate the patient about the severity and correlation of his co-existing conditions.^8
Educate client about driving and using power tools
Rational: Improving patient safety
Improving the life of people suffering with epilepsy and their families requires sustained and coordinated efforts which address the psychological, physiological, cognitive and social dimensions.
There are several other forms of therapies which are used to improve the quality of life of the patient like behaviourial therapy which involves strategies to help people manage their epilepsy and its effects in daily life.
Conclusion
To improve the quality of care for patients suffering with epilepsy, coordinated and sustained efforts are required on few areas like
1. Early identification of epilepsy and other simultaneously occurring medical conditions.
2. Improving treatment for seizures which includes improving seizure medications, ensuring appropriate use of medication and compare effectiveness of different medications. Improving treatment for refractory epilepsies
3. Improving communication between healthcare providers and patients.
4. Developing a national strategy for performance measurement and quality improvement in epilepsy care: Improving practice guidelines and performance metrics
5. Evaluating and accrediting epilepsy centre (England,M Liverman,C Schultz,A Strawbridge,L, 2012)..
References
1. Government of Western Australia Department of health, Neurosciences and the senses health network
2. Blum,D 1999, Total impact of epilepsy: biological, psychological, social and economic aspects, Barrow quarterly, Vol 15 No 1
3. Health care: Quality, access and care, Epilepsy across the spectrum: promoting health and understanding, National academic press
4. Gumnit,R 2010, Caring for patient with seizures: a 21st century approach, Clinical and health affairs, Minnesota medicine
5. Nursing management of seizures, 2006, SCDDSN revision
6. Knight,M 2014, Management of epilepsy in primary care and the community
7. American society of registered nurses, 2008, Epilepsy nurse care, The journal of nursing
8. Epilepsy- 3 Nursing Diagnosis and intervention, reviewed from https://nursing-care-plan.blogspot.in/2014/01/epilepsy-3-nursing-diagnosis-and.html
9. Epilepsy – Nursing management, Nursing diagnosis, goals, interventions, patient education, NSGMED Nursing journal and articles, 2014, reviewed from https://www.nsgmed.com/neuro/epilepsy-nursing-assessment-nursing-diagnosis-goal-interventions-patient-education/
10. England,M Liverman,C Schultz,A & Strawbridge,L, 2012, Epilepsy across the spectrum:Promoting health and understanding. A summary of the institute of medicine report, Epilepsy and behaviour
11. Epilepsy and Nursing care plan, 2011, reviewed from https://www.nursing-help.com/2011/04/epilepsy-and-nursing-care-plan.html
12. Epilepsy, reviewed from https://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Epilepsy
13. Brennan,M & Whitehouse, F,2012, Case study: Seizures and hypoglycemia, American diabetes association, reviewed from https://clinical.diabetesjournals.org/content/30/1/23.full
14 Epilepsy in adults, reviewed from https://www.patient.co.uk/doctor/epilepsy-in-adults
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