Seizure Precautions Safety, Term Paper Example

According to EpilespyFoundation (2014), the number of epileptic incidents in the United States is an estimated over 150,000. The disease is most prevalent in young children and older adults. In addition, the total number of people diagnosed with epilepsy is 1.3 million to 2.8 million people (Epilepsy Foundation, pg.1). These statistics show that the number of epileptic incidents have reached catastrophic heights in the United States. There is a need for more in depth understand on how to treat patients with reoccurring seizures. In the healthcare industry,there is a need for additional seizure educational training. In a study completed by Nouri and Benbadis(2013), results indicated epilepsy related deaths have reached a40% mortality rate to sudden unexpected deaths in epilepsy (SUDEP). The opportunity for nursing students to evaluate and learn the standard seizure precautions safety methods would assist in improving the overall care of seizure patients and saving lives with more education and training.

The patient I cared for, as a student nurse was a 56-year-old male. The patient was transferred by ambulance to the hospital 2 days ago with a left occipital brain mass. His symptoms consisted of reoccurring seizures and decrease level of consciousness. His past medical history is composed of asthma, HTN, seizures and GERD. His EKG is a normal sinus rhythm. His list of medication was composed of Lipitor, symbicort, decadron, Keppra, metroprolol, Flomax, dyazide, protonix, albuterol, Percocet. The patient was admitted as inpatient yesterday for a craniotomy, to remove the tumor from the brain and to complete a biopsy. The seizure observation started with the floor nurse rounds checking patient’s conditions along with checking the vitals of the seizure patient.

The staff nurse taught me to first verify the bracelet on the patient as the correct seizure patient admitted. The staff nurse indicated that we must always document our findings and what actions we took during the patient’s initial treatment analysis. This was based on nursing management best practices for precautionary treatment of seizure patients. The staff nurse indicated we must check to see how many times the patient is having seizures. The patient was comfortable but shared she did not have any seizures in the last few hours. We learned that if the patient has seizures for 2 minutes consecutive we must call for help. Any action taken during the initial assessment, personal observations must be written in the nurses notes. The staff nurse should request any medical consultation needed and follow the seizure activity protocol. The staff nurse informed the student nurses that we must first meet with the seizure specialist to educate the patient on the next step towards the best care prior to surgery. We were given a set of seizure precautions safety rules, which stated the hospital seizure protocols. The hospital protocol was closely resembled the National Institute of Health(NIH) IowaThe Iowa Model of Evidence Based Practice. This NIH model consist of a set of seizure safety guidelines that state:

In order to maximize safety for at-risk seizure patients, which are an evidence, based procedures include the development, approved, and shared best seizure practices among the nursing staff. This seizure model will decrease the risk of unexpected injury death by utilizing a uniform seizure procedure. It is hoped the model includes family education led by staff nurse, an staff nurse teach back sessions quarterly to ensure all staff nurses have the same understanding of seizure treatment standards and tracking outcomes to ensure the seizure protocols are working as planned(Mwose,2012).

During the review of the patient’s medical records, we found that the patient was allergic to sulfur. This was invaluable because the hospital has nursing gloves that have sulfur based ingredients. The staff nurse made sure we understand the consequences of missing or not documenting critical information for the neurosurgeon. We learned how much the hospital staff, physicians, admissions, and treating nurses rely on that information to provide the best care for the seizure patient. There is a consensus in the industry that the combination of video surveillance and staff nursing observation is the best seizure protocol and safety methods. The patients in the epilepsy monitoring hospital unit have found that the best practices are direct nurse observations and use of closed-circuit cameras (Shafer, Buelow, Noe, Shinnar& Barkley, 2012).

The staff nurse informed us to always check the patients chart for symptoms before arriving to hospital. She examined the admission records finding comments by the patient indicating she was dizzy for several days with severe headaches. The patient indicated she was eating too much pork with salt that led to her feeling sick. The emergency team notated the patient arrived to the hospital with an abnormal Electroencephalography (EEG.) The teaching nurse indicated we need to get another reading before the neurological physician visited the patient. We learned how to operation the EEG machine while attaching the electrodes to the patients scalps. The second EEG results confirmed for a second time the patient has an abnormal EEG. The patient was stabilized before the neurological physician arrived for further treatment and evaluation. The neurologist requested a series of test such as non-invasive procedure to view the patient’s brain. It was found the patient has four tumors, which is the primary cause of the epileptic seizures. The decision by the treating neurological surgeon was to remove the tumors from the brain and complete a biopsy. The research supports the hospital protocol for treating the patient with seizures. Several articles shared the same protocol for treating seizure patients (Smith, 2014).

The nursing hospital protocol meets with industry standards for initial treatment of seizure patients. The staff nurse informed the student nurses that the hospital has an additional initial seizure protocol named called epilepticus protocol. The first step is to check for rapid breathing and checking the airway for obstruction. Secondly, record the patient’s vitals to determine the patient’s condition. The third step is to monitor the patient 02 saturation along with an EKG. The fourth step is to establish a pick line for any medicine needed intravenously. Finally, check the patients’ blood pressure. The ordering of medication will be done by the treating physician. This is a useful guideline that nurses and physicians use during the initial assessment stages of treating seizures patients based on status epilepticus protocol (Massachusetts General Hospital, 2007).

The student nurses were separated by wings to determine which patients to provide care. I was assigned with a staff nurse that handled advanced illnesses such as the uncontrolled seizure patients that were monitored prior to surgery. The staff nurse proceeded to follow hospital seizure protocol to consult with the hospital dietician because they would be a chance the patient could choke on her food during surgery. The dietician ordered a light meal including jello, soup, and orange juice for the patient to ensure nothing would block the airway in case of seizure during surgery. This demonstrated that the staff nursing protocols set in place were effective in ensuring the patient has a positive outcome during and after surgery. We were taught the difference between a patients allergic reaction to medication versus a true seizure attack by the patient.

The article titled”The Effect of an Advance Practice Nurse-modulated computer-based education on nursing staff knowledge of delirium” by Mwose(2012) focused on standardized seizure precautions safety standards on a national basis. The seizure precautions safety guidelines should include evidence-based directives for staff nurses and hospital personnel, in addition to a national Standard Operating Procedures (SOP) developed nationally for all hospitals.The article indicated the model would be use by National Institute of Health(NIH) to perform a gap analysis for the industry of best practices for standard seizure protocols. The NIH has adopted the Iowa Model of Evidence Based Practice for the foundation to build the national standards. The knowledge assessment would be more effective because the nurses that deliver the seizure care would be involved with the knowledge assessment. The staff nurse taught the student nurses the hospital protocol; however, the next hospital might have a very different set of seizure precautions standards. This is why a national uniform code for seizure precautions safety standards would a step forward to providing quality care for seizure patients. The article believes that a uniform standards would increase seizure awareness while decreased poor patient outcomes.

The next article, titled “Sudden Unexpected Death” by Nouri and Benbadis(2013), discussed the benefits of seizure precaution safety protocols similar to the Prolonged Seizure Activity. This is the proper nursing intervention that followings when the patient has continued seizures for more than 2 minutes.The article suggest that will the increase number of sudden unexpected death in epilepsy(SUDEP) which adopts the policy never leave the patient during seizure activities. In a study,by Nouri and Bendais (2013) found that patient left unattended were susceptible to death, however, the industry needs to adopt two methods or protocols. The video EEG monitoring should be a standard protocol to the nursing observations guidelines to ensure the patient care is consistent during stages of seizure incidents. The study found that in 133,371 video observing the patient, there were only 14 deaths, which contributed to SUDEP deaths.

The last article is “Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation” by Tourigny-Ruel,Diksic,Mok and McGillivray(2014), discussed the precautions protocol for seizures patients can mean the difference between life or death while under the care of the treating nurse. The article noted that the industry has some barriers with protecting seizure patients however; the reeducation of the nurses and staff can make a difference in improving patient outcomes. In addition, there are drugs that are a safer treatment plan for seizure patients. According to Tourigny-Ruel et al., 2014,a study performed concerning seizure protocol and safety indicated that the treatment of seizures with midazolam is an effective and safer treatment plan for epilepsy. The article explained that the most important part of the seizure treatment is nurses monitoring the effects of the preventative medications for epilepsy. In summary, the article discussed the need for reeducation of staff to ensure the patient care would improve while addressing safer and more effective treatments for epileptic patients.

I feel that the staff nurse did a wonderful job explaining the importance of initial assessment to the student nurses. The staff nurse made sure we were actively involved with the next steps, documentation and ensuring that we understood why was followed the seizure protocols. In a learning environment, sometimes the little things are overlooked. The nurse shared how many people have been treated incorrectly because they did not verify this was the same person admitted. I found that the staff nurse was very through during her initial assessment. In addition, the reviewing the patient’s previous history was not a nursing protocol that really existed within my own limited knowledge. The staff nurse showed us the important of reviewing the patients records prior to visiting the patient’s room. However, she did share the hospital has the technology where all records are shared in the hospital database. The staff nurse taught us that the most important thing we can remember understands the pasts past medical history.

References

Nouri, S., &Benbadis, S. (2013, Sep).Overview: Sudden unexpected death in Epilespy. Medscape. Retrieved October 22, 2014 http://emedicine.medscape.com/article/1187111-overview

Massachusetts General Hospital. (2007). Status Epilepticus Protocol. Retrieved October 20, 2014 from http://www2.massgeneral.org/neurology/epilepsy/protocols/status_epilepticus_protocol.html

Mwose, J.M. (2012). The Effect of an Advance Practice Nurse-modulated computer-based education on nursing staff knowledge of delirium. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, Vol. 26(3), E1-E11

Shafer,P.,Buelow,J.,Noe,K.,Shinnar,R……Barkely,G.L.(2012). A consensus-based approach to patient safety in epilepsy monitoring units: Recommendations for preferred practices. Epilespy& Behavior, Vol. 25, (3), 449-456

Smith, K.C. (2014).The management of seizures in brain tumor patients. Journal of Neuroscience Nursing. Vol. 42(1), 28-37

Tourigny-Ruel, D, Diksic, D., Mok E., &Mcgillivray, D. (2014). Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation. Canadian Journal of Emergency Medicine (CJEM).16(4), 304-313.