Unformatted text preview: CONCEPT MAP WORKSHEET
DESCRIBE DISEASE PROCESS AFFECTING PATIENT
(INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)
A generalized tonic-clonic seizure, formerly known as grand mal seizure, is defined as a seizure that has a tonic phase
followed by clonic muscle contractions. Among patients, families, and observers, they are most feared of seizure types. They
are usually associated with impaired awareness or complete loss of consciousness. According to the recent classification from
the International League Against Epilepsy (ILAE), they are categorized under seizures belonging to generalized in onset.
Generalized onset seizures are further categorized into motor and non-motor (absence) seizures. A generalized tonic-clonic
seizure is a motor seizure and the most common type seen in patients with epilepsy. Generalized tonic-clonic seizures arise
within and rapidly involve bilateral cortical, subcortical, and brainstem networks of the brain.A focal seizure-originating from
either left or right hemisphere - can rapidly spread and evolve into a bilateral tonic-clonic seizure (previously known as a
secondary generalized seizure), which can be difficult to differentiate from a primary generalized tonic-clonic seizure. DIAGNOSTIC TESTS
(REASON FOR TEST AND RESULTS)
*EEG --> records electrical activity in
order to identify the origin of the seizure
*MRI --> to determine any brain
abnormalities that may have caused
CT scan --> detects brain malformation
that may have caused the seizure; can
determine extent of trauma if trauma
occurred with the seizure
General labs and chemistry panel -->
will determine if an infection is the
underlying cause of the seizure PATIENT INFORMATION
Jackson Weber is a 5 year old
Caucasian male. He was diagnosed
with generalized tonic-clonic
seizures 2 years ago. He has been
taking oral phenobarbital as
prescribed by his neurologist since
he was diagnosed. Due to his
seizure diagnosis today, my initial
assessment focused on his
neurological status, including his
eye movements, pupil reaction, and
orientation. These were all normal
upon assessment. ANTICIPATED PHYSICAL
The first sign of a tonic-clonic seizure is
that a child cries out or groans loudly,
then falls down. The child may lose
consciousness at this point or later in the
In the tonic phase of the seizure, the
child becomes rigid, their teeth clench,
they may stop breathing and turn blue,
and saliva or foam may drip from their
mouth. Their heart rate and blood
pressure rise and they may sweat or
tremble. In the clonic phase of the seizure, the
child’s arms and legs jerk quickly and
ANTICIPATED NURSING INTERVENTIONSrhythmically; their pupils contract and
dilate. At the end of this phase, the child
relaxes and may lose control of their
bowel or bladder.
Before the seizure even occurs, the patient should be placed on seizure precautions. This would include padded side rails,
having the bed in the lowest position, removing restrictive clothing, and help with activities
bathroom. Once the seizure begins, the nurse should immediately record the time and start
of the seizure.
call for help, lower the patient to the ground and prevent any physical injury, and then place
any airway complications. Next steps would include placing the patient on the appropriate
may last2 for
nasal cannula or 10 liters on a non-rebreather mask. The nurse can then expect to administer
seizures such as phenoarbital like in this scenario. Finally, once the seizure has ended, call the provider reporting the findings in
an SBAR format, follow any orders from the provider, and then monitor for any more seiures. vSim ISBAR ACTIVITY
Your name, position (RN), unit you are
working on SITUATION
Patient’s name, age, speciﬁc reason for visit BACKGROUND
Patient’s primary diagnosis, date of
admission, current orders for patient ASSESSMENT
Current pertinent assessment data using head
to toe approach, pertinent diagnostics, vital
signs STUDENT WORKSHEET
Pediatric Unit/ER Jackson Weber
5 year old Caucasian male
3 minute tonic-clonic seizure last night Generalized tonic-clonic seizure
Current orders are cardiac apnea monitor, continuous pulse oximetry, titrate
O2 per nasal cannula to keep SpO2 > 93% while awake
Phenobarbital 300mg IV loading dose
Phenobarbital level x 1 after loading dose
Oral 15 mg of Phenobarbital to be taken every 12 hours
Basic metabolic panel x 1
Vital signs every two hours
Neuro checks every two hours
obvious airway obstruction. Chest
moving equally. Normal elasticity of the skin. Color is normal, not sweating.
Breath sounds are clear and equal bilaterally. Regular heart sounds without
murmurs. Normal neurological findings, including PERRLA and good eye
Post-seizure vital signs -->
Child status - ECG: Sinus rhythm. Heart rate: 117. Pulse: Present. Blood
pressure: 130/88 mmHg. Respiration: 4. Conscious state: Unconscious.
SpO2: 89%. Temp: 36.7 C RECOMMENDATION
Any orders or recommendations you mayhave
for this patient Continue to keep the patient on seizure precautions and continue to monitor
vital signs and neurological status. Administer any seizure medications in
appropriate doses and time frame. Educate the patient and the parents
appropriately. PATIENT EDUCATION WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE MEDICATION:
1. Barbiturate; anticonvulsant; sedative-hypnotic PROTOTYPE:
1.Phenobarbital SAFE DOSE OR DOSE RANGE, SAFE ROUTE
1. 3 to 5 mg/kg/day in 1 to 2 divided doses. PURPOSE FOR TAKING THIS MEDICATION
Phenobarbital is a barbiturate, nonselective central nervous system depressant which is primarily used as a sedative hypnotic and
also as an anticonvulsant in subhypnotic doses.
Phenobarbital Tablets and Elixir are administered orally and are contained in DEA Schedule IV. Barbiturates are substituted
pyrimidine derivatives in which the basic structure common to these drugs is barbituric acid, a substance which has no central
nervous system (CNS) activity. CNS activity is obtained by substituting alkyl, alkenyl, or aryl groups on the pyrimidine ring.
Phenobarbital is used to control seizures. Phenobarbital is also used to relieve anxiety. It is also used to prevent withdrawal
symptoms in people who are dependent ('addicted'; feel a need to continue taking the medication) on another barbiturate
medication and are going to stop taking the medication. Phenobarbital is in a class of medications called barbiturates. It works by
in the brain.
WHILE TAKING THIS MEDICATION
Phenobarbital may be habit-forming. Never share phenobarbital with another person, especially someone with a history of drug
abuse or addiction. Keep the medication in a place where others cannot get to it. Selling or giving away this medicine is against
Do not change your phenobarbital dose without your doctor's advice. Tell your doctor if the medicine does not seem to work as
well in treating your condition.
If you are taking phenobarbital to treat seizures, keep taking the medicine even if you feel fine.
Do not stop using suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to
safely stop using phenobarbital.
Store at room temperature away from moisture, heat, and light.
Keep track of the amount of medicine used from each new bottle. Phenobarbital is a drug of abuse and you should be aware if
anyone is using your medicine improperly or without a prescription.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not
take extra medicine to make up the missed dose. Date: 5/26/2020
5 years old
Code Status: Full code Student Name: Peter Rantz
PCP Length of Stay:
NKA Clinical Worksheet Assigned vSim: Isolation:
N/A Jackson Weber IV Type:
Potassium Chloride in
5% dextrose/58 mL/hr Critical Labs:
Clorine : 97mEq/L
HCO3: 28mEq/L Other Services:
Neurologist Why is your patient in the hospital (Answer in your own words and include the History of present Illness)?:
Patient was admitted after suffering from a 3 minute tonic-clonic seizure last night. Patient had another seizure episode while in the hospital today. Health History/Comorbities (that relate to this hospitalization):
History of tonic-clonic seizures Shift Goals/ Patient Education Needs:
1. Administer phenoarbital when Jackson is alert and able to swallow to manage seizures during hospital visit
2. Monitor patient's neurological status and vital signs for any recurring seizures
3. Educate Jackson and his mother about seizures, in regards to medication regimen, maintain neurologist appointments, and what to do during seizures going forward
4. Establish another appointment with Jackson's neurologist or provide resources so he can see one after being discharged
Path to Discharge:
Jackson is stable and neurological status remains normal. He has not had any more seizures. His mother and him are now well educated on the importance of his medication regimen and
the interventions for during a seizure, and will reconnect with Jackson's neurologist after being discharged. Path to Death or Injury:
Jackson continues to have tonic-clonic seizures and may suffer some form of physical head trauma. Also, recurring seizures can result in status epileptics which has life-threatening
What are you on alert for with this patient? (Signs & Symptoms) Clinical Worksheet
Management of Care: What needs to be done for this Patient Today? 1. 1. 2. 2. 3. 3.
4. What Assessments will focus on for this patient?
(How will I identify the above signs &Symptoms?) 5. 1. 6. 2. Priorities for Managing the Patient’s Care Today
1. 3. 2.
3. List Complications may occur related to dx, procedure, comorbidities: 4. 1.
What nursing or medical interventions may prevent the above Alert or complications?
4. What aspects of the patient care can be Delegated and who can do it? ...
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