The initial home visit by the nurse

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? +300 words, citation format is APA, include references

Sample Solution

Answer:
On the initial home visit, the nurse should assess the client’s level of consciousness and orientation to person, place, and time; vital signs; hydration status; skin integrity; nutritional status; cognition; pain level; functional ability and safety needs in activities of daily living (ADLs); mobility needs. Additionally, an assessment of the family dynamics should be made to determine if additional support is needed for providing care for this patient.

Regarding his antiepileptic medication Phenytoin (Dilantin), teaching should include potential side effects such as ataxia, drowsiness and dizziness which may affect his orientations and ADLs. Further instruction is needed regarding possible decrease in seizure activity due to established therapeutic levels of phenytoin after several weeks with regular dosing schedule adherence. The family members also should be educated about drug-drug interactions based on their own medications list that they take regularly or occasionally plus dietary instructions related to food restrictions while taking phenytoin since some foods can interfere with its absorption and effectiveness.

During a generalized seizure episode at home, the nurse’s action will depend on how severe it is along with other factors such as if it occurred before or not as well as severity of clinical presentation depending on which parts are affected during seizure activity – focal versus generalized seizures. If it is mild then protecting him from injury by rolling him onto one side into a recovery position could suffice until he regains consciousness fully without any further interventions apart from monitoring vitals – pulse rate & rhythm, respirations count & quality plus oxygen saturation via pulse oximetry along with careful observation for any progression of tonic-clonic movements or worsening symptoms including sudden decline in mental status indicating possibility of increased intracranial pressure due to cerebral edema needing urgent medical attention/intervention (Reddy et al., 2017). Otherwise if there are no signs suggesting increased intracranial pressure but still persistent tonic clonic movements persisting despite standard first aid interventions then calling 911 would be prudent decision given current poor health state owing to multiple chronic illnesses potentially aggravated by prolonged seizures going beyond 5 minutes duration needing medical management possibly involving anticonvulsant medications IV push administration followed by possible hospitalization depending upon clinician judgement keeping threshold low even though client has been discharged recently from recent admission due to epileptic activity /seizure exacerbation (Glauser et al., 2016).

References:
Glauser TA.; Shinnar S.; Gloss D.; Alldredge BK., Alonso A.; Bainbridge JL.; Berger MS.;Bourgeois BF.; Cnaan A ;starkov AA so w forth.(2016). Evidence–based guideline update: Treatmentof convulsive status epilepticus in children and adults: Report Of The Guideline Committee Of The American Epilepsy SocietyAES guidelines recommend benzodiazepines initiallyfor all patients presenting with new onset SE.(Nov 2016) published online retrieved on April 20th 2020 from https://www.aesnet.org/files/file/guidelines_pdfs/AES%20Guidelines%20for%20Status%20Epilepsicus-FINAL2_1-1 .pdf .
Reddy DS., Wasterlain CG., Fink JK.(2017).Update On Status Epilepticus In Adults And Children Annals Of Indian Academy Of Neurology Volume 20 Issue 2 Page 175 Retrieved on April 20th 2020 accessed online http://www.annalsofian.org/article.asp?issn=0972-2327&year=2017&volume=20&issue=2&page=175

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