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Posted: May 31st, 2023
An older client was recently discharged from the hospital
An older client was recently discharged from the hospital for evaluation of seizure activity. His history reveals that he has late-stage Alzheimer’s disease, Parkinson’s disease, hypertension, and type II diabetes mellitus, which is controlled by diet. He lives at home, where his wife and daughter take care of him. His discharge medications include phenytoin (Dilantin), 100 mg BID; hydrochlorothiazide (HydroDIURIL), 50 mg QD; levodopa (Sinemet), 25/100 TID; and haloperidol (Haldol), 1 mg before bed. The client has been referred for home care nursing follow-up.
Questions:
On the initial home visit by the nurse, what assessments should be made?
The wife and daughter need teaching about his antiepileptic medication. What teaching should be included?
During the initial home visit, the client experiences a generalized seizure. What action should the nurse take?
On the initial home visit by the nurse, the following assessments should be made:
Assess the client’s vital signs, including blood pressure, pulse, respiratory rate, and temperature.
Conduct a neurological assessment, including level of consciousness, orientation, motor function, and sensory function.
Assess the client’s skin integrity, including any pressure ulcers or other wounds.
Evaluate the client’s nutritional status and hydration level.
Assess the client’s medications for interactions, side effects, and adherence.
Evaluate the client’s home environment for safety hazards and accessibility.
Assess the caregiver’s physical and emotional well-being and ability to provide care.
The nurse should provide the wife and daughter with the following teaching about the client’s antiepileptic medication:
Explain the purpose of the medication and how it works to prevent seizures.
Teach them about the possible side effects of the medication, such as dizziness, drowsiness, and confusion.
Instruct them to monitor the client for any signs of adverse reactions or changes in behavior and to report them to the healthcare provider immediately.
Teach them about the importance of adhering to the prescribed dosage and schedule.
Instruct them to avoid abrupt discontinuation of the medication, as it may lead to an increase in seizure activity.
Instruct them to keep a record of the client’s seizures, including the date, time, duration, and any triggers or associated symptoms.
Provide them with information on emergency management of seizures, including how to protect the client from injury and when to seek emergency medical assistance.
If the client experiences a generalized seizure during the initial home visit, the nurse should take the following action:
Ensure that the client is in a safe position and protect him from injury by removing any nearby objects that could cause harm.
Observe and document the seizure activity, including the date, time, duration, and any associated symptoms.
Administer any emergency medication that has been prescribed for the client, such as diazepam or lorazepam, if appropriate.
Provide emotional support to the client and his family members and explain what is happening during the seizure.
After the seizure has ended, assess the client’s vital signs and neurological status.
Contact the healthcare provider immediately to report the seizure and obtain further instructions.