Epilepsy

Epilepsy Nursing Diagnosis Interventions and Care Plans

Epilepsy NCLEX Review Care Plans

Nursing Study Guide for Epilepsy

Epilepsy is a neurological disorder that involves abnormality of brain activity. The patient with epilepsy may experience periods of unusual sensation or behavior, as well as seizures.

He/she may not be aware of what is happening while the seizure is ongoing. The diagnosis of epilepsy requires the occurrence of at least two seizures that are unprovoked.

A single episode of seizure does not immediately mean that the patient has epilepsy.

Epilepsy can manifest in a simple blank stare that lasts for a few seconds, or a seizure wherein a patient experiences repeated twitching of legs or arms.

The treatment of epilepsy is focused on controlling seizures.

Signs and Symptoms of Epilepsy

  • Blank stare for a few seconds
  • Temporary confusion
  • Loss of awareness or consciousness
  • Jerky movements of the arms and/ or legs that are uncontrollable

The signs and symptoms of epilepsy may also depend on the type of seizure that is occurring.

Focal seizures happen when the abnormal activity occurs in only one area of the brain. The symptoms of focal seizures include tingling sensation, dizziness, changes in taste, vision, hearing, or feeling, or an involuntary jerky movement of a part of the body. 

Some focal seizures may only trigger impaired awareness, but others may cause complete loss of consciousness.

Staring into space or performing a repetitive movement such as chewing, swallowing, or hand rubbing can be considered a complex partial seizure.

Generalized seizures occur when the abnormal activity happens in all areas of the brain.

These involve tonic seizures (muscle stiffening), clonic seizures (repeated, jerking muscular movements), tonic-clonic (combination of tonic and clonic, where in there is loss of consciousness, tongue biting, or loss of bladder control), myoclonic (sudden and brief twitching or jerking of the limbs), atonic seizures (loss of muscular control), and absence seizures (lip smacking, eye blinking, or staring into space, usually in children).

Causes of Epilepsy

About 50% of epilepsy cases have an unknown cause. Some cases can be attributed to genetics, where in a specific type of epilepsy runs in the family. Stroke, brain tumors, and other brain conditions may cause epilepsy.

Developmental disorders like autism, as well as prenatal injury may result to epilepsy in children. Infectious diseases like viral encephalitis, AIDS, and meningitis can lead to epilepsy.

Complications of Epilepsy

  1. Fall and injury. During a seizure, the patient is at a higher risk of fall that can lead to bone fracture or head injury.
  2. Car or machinery accidents. It is dangerous for an epilepsy patient to drive or operate machinery when a seizure results to loss of muscular control or loss of consciousness/ awareness.
  3. Drowning. Patients with epilepsy are at higher risk of drowning due to a possible seizure happening while they are bathing or swimming.
  4. Emotional problems. Depression may arise from the loss of consciousness or control during seizures. The patients may also suffer from anxiety or suicidal ideation.
  5. Pregnancy problems. Anti-epileptic drugs impose a high risk for unborn babies to develop birth defects. Both mother and baby are placed in great danger should a seizure occur during pregnancy.
  6. Status epilepticus. Having a seizure for more than 5 minutes may result to permanent brain damage and eventual death. This can also happen if there is an increased frequency of seizures with complete loss of consciousness.

Diagnosis of Epilepsy

  • Neurological exam – to assess the patient’s cognition, motor capacity, and behavior
  • Neuropsychological test – to assess the patient’s speech, memory, and thinking skills
  • Blood test – to check for any infections or other risk factors that are related to epilepsy
  • Electroencephalogram (EEG) – to record the brain’s electrical activity by placing electrodes on the scalp
  • Imaging – CT scan to visualize any abnormalities in the brain, like bleeding, cysts, or tumor; functional MRI to measure the blood flow in the brain; PET scan to visualize active areas of the brain by injecting a low-dose radioactive fluid
  •  A CT scan uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal abnormalities in your brain that might be causing your seizures, such as tumors, bleeding and cysts.

Treatment of Epilepsy

  1. Anti-epileptic medications. These medications are used to prevent the occurrence of seizures. Common anti-epileptic drugs include clonazepam (for all types of seizures), carbamazepine (generalized tonic-clonic seizures), levetiracetam (focal seizures), and lamotrigine (adjunctive therapy for most types of seizures, except myoclonic seizures).  
  2. Epilepsy surgery. Failure to prevent or control seizures may require a surgical procedure to treat epilepsy. This involves the removal of the part of the brain that causes seizures, provided that the said area will not affect any important sensory function. However, reduced cognitive ability may result from this surgical intervention for epilepsy.
  3. Supportive medications. Patients with epilepsy may also need anti-depressants, anxiolytics, or other psychopharmacologic agents to help them cope and live their daily lives optimally.

Nursing Care Plans for Epilepsy

  • Nursing Diagnosis: Risk for Trauma/Injury related to loss of sensory coordination and muscular control

Desired Outcome: The patient will be able to prevent trauma or injury by means of  maintaining his/her treatment regimen in order to control or eliminate seizure activity.

InterventionRationale
Explore the usual seizure pattern of the patient and enable to patient and caregiver to identify the warning signs of an impending seizure.To empower the patient and his/her caregiver to recognize a seizure activity and help protect the patient from any injury or trauma. To reduce the feeling of helplessness on both the patient and the caregiver.  
Place the bed in the lowest position. Put pads on the bed rails and the floor.To prevent or minimize injury in a patient during a seizure.
Advise the caregiver to stay with the patient during and after the seizure.To promote safety measures and support to the patient. To ensure that the patient is safe if the seizure recurs.
Administer anti-epileptic drugs as prescribed.To prevent the occurrence of seizures and treat epilepsy. Common anti-epileptic drugs include: clonazepam (for all types of seizures)carbamazepine (generalized tonic-clonic seizures)levetiracetam (focal seizures) lamotrigine (adjunctive therapy for most types of seizures, except myoclonic seizures).
During seizure, turn the patient’s head to the side, and suction the airway if needed. Avoid inserting anything in the mouth during seizure activity.To maintain a patent airway     Avoid inserting the plastic bite block when the teeth are clenched to prevent any dental damage. Do not use wooden tongue depressors as they can break or splinter, causing oral damage.  
Epilepsy Nursing Care Plan
  • Nursing Diagnosis: Deficient Knowledge related to new diagnosis of epilepsy as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
  • Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of epilepsy and its management.
InterventionsRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. decreased cognitive ability).To address the patient’s cognition and mental status towards the new diagnosis of epilepsy and to help the patient overcome blocks to learning.
Explain what epilepsy is, its types, and related signs and symptoms. Avoid using medical jargons and explain in layman’s terms.To provide information on epilepsy and its pathophysiology in the simplest way possible.
Educate the patient about safety measures related to epilepsy and seizure activity. Create a plan for Activities of Daily Living (ADLs) with the patient and the caregiver, especially including important activities such as driving, operating machinery, swimming, and bathing.To help the patient avoid alcohol intake that may lead to preventing further damage to the pancreas. To encourage the patient to live his/her daily life optimally, while ensuring that he/she is safe from injury if a seizure occurs.
Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to manage epilepsy. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Encourage the patient to wear his medical bracelet at all times, which indicates that he/she has a seizure disorder.To enable to patient to receive an expedited care during an emergency situation.
Epilepsy Nursing Care Plan

Other nursing diagnoses:

  • Risk for Ineffective Airway Clearance
  • Noncompliance
  • Situational Low Self-Esteem

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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