An older client was recently discharged from the hospital for evaluation of seizure activity.

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?
ANSWER
On the initial home visit by the nurse, what assessments should be made?
The nurse should perform a comprehensive assessment of the client, including:
Neurological assessment: Evaluate the client’s level of consciousness, orientation, memory, and motor function. Assess for any signs or symptoms of seizure recurrence, such as confusion, weakness, or speech difficulties.
Medication review: Review the client’s current medication list, including dosages, frequency, and potential side effects. Ensure that the client is taking his medications as prescribed and address any concerns or questions about his medications.
Psychosocial assessment: Evaluate the client’s emotional and social well-being. Assess for signs of depression, anxiety, or stress. Discuss the client’s coping mechanisms and social support network.
Home safety assessment: Evaluate the client’s home environment for potential hazards that could increase the risk of falls or injuries. Identify any modifications or adaptations that may be needed to enhance safety.
Caregiver assessment: Assess the physical and emotional well-being of the client’s caregivers. Provide education and resources to support their role in caring for the client.
The wife and daughter need teaching about his antiepileptic medication. What teaching should be included?
The nurse should provide education to the client’s wife and daughter about phenytoin (Dilantin), including:
Purpose of the medication: Explain that phenytoin is an antiepileptic medication used to prevent seizures.
Dosage and frequency: Emphasize the importance of taking the medication as prescribed and at the same time each day.
Potential side effects: Discuss common side effects of phenytoin, such as drowsiness, dizziness, and nausea. Advise the caregivers to report any concerning side effects to the healthcare provider.
Medication interactions: Inform the caregivers about potential interactions between phenytoin and other medications or supplements.
Storage and handling: Provide instructions on proper storage and handling of phenytoin, including keeping it out of reach of children and storing it at room temperature.
Missed doses: Advise the caregivers to contact the healthcare provider if a dose is missed.
Importance of adherence: Emphasize the importance of adhering to the medication regimen to prevent seizure recurrence.
Signs of seizure: Educate the caregivers on how to recognize signs of a seizure, such as muscle stiffness, jerking movements, and loss of consciousness.
Emergency action plan: Instruct the caregivers on what to do in case of a seizure, including calling for emergency medical assistance and maintaining a safe environment for the client.
Follow-up care: Inform the caregivers about the importance of regular follow-up appointments with the healthcare provider to monitor the client’s seizure control and medication management.
During the initial home visit, the client experiences a generalized seizure. What action should the nurse take?
If the client experiences a generalized seizure during the initial home visit, the nurse should follow these steps:
Ensure safety: Protect the client from injury by removing any hazards from the surroundings. Do not try to restrain the client’s movements.
Observe and document: Observe the seizure characteristics, including its duration, type of movements, and level of consciousness. Document the seizure in the client’s records.
Position the client: After the seizure subsides, gently position the client on their side in the recovery position. Check for breathing and airway patency.
Assess the client: Evaluate the client’s level of consciousness and orientation. Assess for any injuries sustained during the seizure.
Contact emergency services: If the seizure lasts longer than five minutes, the nurse should call 911 or the local emergency medical service.
Provide reassurance: Reassure the client and caregivers that seizures can be managed with proper treatment. Provide emotional support and answer any questions they may have.
Document and report: Document the seizure incident in detail, including the client’s condition before, during, and after the seizure. Report the incident to the healthcare provider and follow their instructions.