2 Status epilepticus is a medical emergency requiring immediate treatment 3 The

2 status epilepticus is a medical emergency requiring

  • Walden University
  • NURS 6501N
  • Notes
  • marcusqrnp
  • 74
  • 100% (2) 2 out of 2 people found this document helpful

This preview shows page 26 - 28 out of 74 pages.

seizures without intervening consciousness. 2. Status epilepticus is a medical emergency requiring immediate treatment. 3. The longer the seizure activity lasts, the more difficult it is to control the seizure. IV. Diagnosis A. Obtain a thorough history from the patient, the family, and/or the observers of the event B. Twenty-four-hour continuous EEG is an important test for supporting the diagnosis of epilepsy, differentiating between types of seizures, and providing a guide to prognosis. 1. Focal abnormalities indicate partial seizures 2. Generalized abnormalities indicate primary generalized seizures 3. A normal EEG does not rule out a seizure C. CT scan or MRI of the head—performed for all new-onset seizures, especially after age 30, because of the possibility of an underlying neoplasm
Image of page 26
MRI preferred over CT scan to identify specific lesions in non- emergent cases D. Lumbar puncture (if indicated) is performed to assess for an infectious process after CT scan or MRI has been used to rule out expanding mass that may increase intracranial pressure (ICP). E. Twenty-four-hour EEG to document seizure activity F. Blood analysis 1. Complete blood count 2. Glucose, liver, and renal function tests 3. Venereal Disease Research Laboratory test 4. Electrolytes 5. Magnesium 6. Calcium 7. Antinuclear antibody 8. Erythrocyte sedimentation rate 9. Arterial blood gases G. Urinalysis, drug screen H. Serum prolactin rises two to three times above normal for 10-60 minutes after occurrence of 80% of tonic-clonic or complex partial seizures V. Management A. Initial management is supportive B. Most seizures are self-limiting 1. Maintain open airway 2. Place patient in left lateral decubitus position 3. Protect the patient from injury 4. Administer oxygen if the patient is cyanotic 5. Do not force airways or objects (e.g., tongue blade) between the teeth until the muscles have relaxed because this may cause the tongue to occlude the airway or teeth to break off and cause a partial obstruction 6. Start with intravenous (IV) normal saline 7. Perform ECG, and monitor respiration and blood pressure C. For status epilepticus: 1. Benzodiazepines are first-line treatment, as these are able to rapidly control seizures 2. Lorazepam (Ativan), 0.1 mg/kg (4-8 mg with a maximum dose of 10 mg) at 2 mg/minute; IV diazepam (Valium), 0.1 mg/kg at 5 mg/minute (maximum, 20 mg); or midazolam (Versed), 0.1- 0.3 mg/kg IV for a maximal dose of 10 mg (if IV lorazepam is not available) 3. If IV access is not available, nurse practitioner may prescribe midazolam 10 mg IM in patients greater than 40 kg or 5 mg IM for body weight between 13 and 40 kg 4. Monitor for respiratory depression after medications are given; intubation may become necessary 5. Increase normal saline if the patient becomes hypotensive 6. Phenytoin (Dilantin) should be administered simultaneously with lorazepam or diazepam and saline at 50 mg/minute until a loading dose of 20 mg/kg is reached a. Fosphenytoin (Cerebyx) does not irritate the veins and can be given with all common IV solutions; it may be administered more quickly than phenytoin (150 mg/minute vs. 50
Image of page 27
Image of page 28

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture