Epilepsy Nursing Diagnosis and Nursing Care Plans

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Epilepsy Nursing Care Plans Diagnosis and Interventions

Epilepsy NCLEX Review and Nursing Care Plans

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 Diagnosis for Epilepsy

Epilepsy Nursing Care Plan 1

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.

Epilepsy Nursing InterventionsRationale
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 2

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.

Epilepsy Nursing 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 3

Risk for Ineffective Airway Clearance

Nursing Diagnosis: Risk for Ineffective Airway Clearance related to neuromuscular dysfunction, tracheobronchial stenosis, and impairment of perception or cognition secondary to epilepsy.

As a risk nursing diagnosis, Risk for Ineffective Airway Clearance does not have existing signs and symptoms since it has not yet developed in the patient, and safety precautions will be initiated.

Desired Outcome: The patient will continue strengthening his breathing pattern with no airway patent or aspiration.

Epilepsy Nursing InterventionsRationale
Keep track of the patient’s breathing rate, rhythm, depth, and effort.  This intervention provides baseline information for assessing air circulation sufficiency.  
Determine the patient’s capacity to cough successfully.  Infectious respiratory tract diseases can alter the amount and type of mucus produced. An unproductive cough impairs airway clearance and limits the ability of secretions to expel openly.    
If an aura occurs, guarantee that the patient’s mouth is unoccupied with dentures or foreign objects and that chewing gum and sucking lozenges are avoided if epilepsy occurs without warning.  This method minimizes the danger of aspiration or foreign bodies embedded in the pharynx.  
Retain the patient’s lying position on a flat surface, but turn his head to the side during episodes of epilepsy.  Maintain the patient’s lying position, but turn their head to the side, with their mouth pointing to the surface. This method allows them to breathe easier and prevents saliva from obstructing their airway. During an epileptic seizure, the patient may become unconscious. However, do not panic and ask for help if necessary.
Remove tight clothing from the chest, neck, and abdominal regions.  This technique helps with respiration or chest expansion.  
Provide and incorporate a plastic airway or soft roll only if the patient’s jaw is not tightened.    If implanted before the jaw becomes tightened, these devices may inhibit tongue biting and expedite suctioning or respiratory support if necessary. An airway adjunct may be suggested if the patient is unresponsive and unable to promote a stable tongue position after the epilepsy episode has stopped.  
As needed, do the suction.      This intervention reduces the possibility of aspiration or suffocation.
As considered necessary, closely monitor the patient’s oxygen level.  This intervention may alleviate cerebral hypoxia caused by reduced circulation or oxygenation due to vascular spasms during epilepsy.
Prepare for or facilitate intubation if necessary.The existence of postictal prolonged apnea may necessitate respiratory support.
If the patient is experiencing any of the following symptoms, call an ambulance:
It is the patient’s 1st episode of epilepsy. If the patient has severely injured themselves.

The patient has breathing difficulties after epilepsy has ended.

If one episode of epilepsy quickly follows another, with no temporary relief.

If the episode of epilepsy lasts two minutes longer than usual, and when breathing patterns start to change.

The episode of epilepsy lasts longer than five minutes.  
Since epilepsy is a life-threatening condition, this intervention saves a life.  

Epilepsy Nursing Care Plan 4

Situational Low Self-Esteem

Nursing Diagnosis: Situational Low Self-Esteem related to stigma correlated with the condition, perception of being uncontrollable, modifications in social roles, abandonment feeling, and unpredictable behavior secondary to epilepsy as evidenced by fear of refusal, a shift in the usual patterns of obligation, non-participation in the treatment regimen, and verbalizations of feelings of helplessness.

Desired Outcomes:

  • The patient will recognize thoughts, emotions, and coping strategies for negative self-perception.
  • Concerning the diagnosis, the patient will express an enhanced sense of self-esteem.
  • The patient will articulate a realistic perception and acknowledgment of himself in a new role or way of life.
  • The patient will have a favorable opinion of himself.
  • The patient will exhibit behaviors that will help him or her regain positive self-esteem.
  • The patient will participate in the treatment protocol or activities to address the condition’s influences.
Epilepsy Nursing InterventionsRationale
Determine the individual’s current situation of epilepsy concerning low self-esteem.    This intervention will help the patient to recognize his concerns regarding his health condition.
Examine the public’s possible or expected response to the patient’s condition. Motivate the patient not to hide the difficulties.  This intervention allows solving the problem and gives some control over the situation. Concealment is harmful to one’s self-esteem; it amplifies denial, stifles improvements in dealing with the issue, and may cause serious injuries or an adverse reaction when epilepsy occurs.  
Avoid overprotecting the patient; instead, encourage activities while providing direction and management as necessary.    Participating in as many life experiences as possible can help alleviate depression caused by constraints. Athletics activity, climbing, and water sports may improve patients’ situational self-esteem brought about by epilepsy.
Understand significant others’ attitudes and skills. Help the patient comprehend that his or her feelings are reasonable; however, remorse and blame are not beneficial.  Contrary or undesirable expectations from significant others may affect a patient’s feeling of competency and self-esteem and interfere with support, limiting the potential for best possible management and personal development.
Explain the positive impact of healthcare providers and significant others keeping calm during epileptic episodes.  Pressure and anxiousness among healthcare providers are contagious and can be passed on to the patient, amplifying or exacerbating the patient’s negative perceptions of the circumstance or oneself.  
Refer the patient and significant others to a support network that assists epileptic patients.  Allows the patient to get relevant data, assistance, and concepts for dealing with epilepsy from others who have had similar experiences. Important note: Some service dogs can detect or predict epileptic episodes, allowing patients to implement safety measures while increasing independence and personal sense of control.  
Discuss and explain the recommendation for psychotherapy to the patient and significant others.  Epilepsy has a significant impact on personal self-esteem, and the patient or significant other may experience guilt due to persistent limitations and perceived stigma. Psychotherapy can assist in overcoming feelings of inadequacy and self-consciousness.  
Spend time with the patient. Provide enough time to talk to him about his concerns and frustrations about his epilepsy condition.  Providing sufficient time for the patient demonstrates the nurse’s interest in and acknowledgment of the patient’s feelings. A trustworthy relationship is essential for self-esteem development.  
Provide patient privacy.  Private discussions should take place in an environment where the patient can express his or her feelings without being overheard. This intervention will put the patient at ease while sharing his epilepsy experiences.    
Active listening and open-ended questions should be used.    These methods of communication allow the patient to express his or her preferences, worries, anxieties, and opinions about epilepsy without interruption.  
Educate the patient about the dangers of negative self-talk.  Recognizing unwanted thoughts can help the patient establish new coping strategies. The patient must replace negative beliefs and opinions about his condition with positive ones. This intervention will assist the patient in easing his concerns about his epilepsy tendencies.  

Epilepsy Nursing Care Plan 5

Noncompliance

Nursing Diagnosis: Noncompliance related to financial constraint, denial of the illness, and the therapeutic regimen’s perceived negative consequences secondary to epilepsy as evidenced by behavior indicating a failure to follow therapeutic suggestions, proof of the emergence of complications and exacerbation of symptoms, non-appearance to checkups and consultations, and failure of achieving therapeutic effects of antiepileptic medications.

Desired Outcomes:

  • The patient will verbalize his or her understanding of the illness and treatment plan.
  • The patient will acknowledge the negative consequences of continuing non-adherent behaviors.
  • The patient will describe the event that led to the change in prescribed behavior.
  • The patient will describe appropriate side effect treatment or alternatives.
  • Following an agreed-upon care plan, the patient will exhibit health care measures that reflect this knowledge.
Epilepsy Nursing InterventionsRationale
Examine the patient’s understanding of epilepsy, treatment approaches, and medical interventions.  This intervention enables nurses to clarify or explain information as necessary, and it enables the development of a personalized treatment plan that promotes compliance.    
Analyze the causes of noncompliance, such as a history of failure to comply, socioeconomic factors, memory lapses, drug-drug interactions, uncertainty about medication guidelines, or trouble making substantial lifestyle changes.  Identifying these causes allows the nurse to concentrate on the patient’s care plan and take necessary measures.  
Allow the patient to express apathy, powerlessness, feelings of helplessness, and sadness.    Examine the patient’s perception of the efficacy or inefficacy of the treatment regimen. This intervention allows the nurses to shed light on the patient’s perception of weakness to the disease process and indications of illness denial.  
Examine the patient’s support network.  This approach aids in determining whether a problem in the family pattern influences the patient’s noncompliance with epilepsy management.  
Explain how to cope with everyday nonadherence factors such as financial restrictions and workplace harassment.  To remove and conquer these impediments is critical for patient compliance to antiepileptic treatment.  
Explain and debunk myths and stereotypes. Provide a plausible risk assessment and correct any misunderstandings.  This intervention will aid in the identification of variables that influence compliance, such as cultural context, spirituality, or personal value.  
Please provide information on the following:

A consistent blood level and a drug’s half-life.

Instructions for missing doses

How to refill a prescription if the medication has been misplaced or depleted.

Timetable for laboratory follow-up.

The significance of informing the health care provider if the prescribed medicine is abruptly discontinued.  
Interrupted medication use may be an attempt to regain control. Understanding the implications of noncompliance raises awareness that discontinuing antiepileptic medications can result in severe and fatal reactions.
Assist in locating available support networks, such as neighborhood epilepsy centers and epilepsy-specific institutions.  Patients may be capable of understanding and feel supported by the life experience of others who have epilepsy.  
Explain to the patient possibility of amending the treatment regimen with the healthcare professional once the factors of noncompliance have been ascertained. Provide guidelines on how to manage the adverse effects of antiepileptic medications Avoiding alcoholic beverages to avoid additional sedative effectsTo reduce gastrointestinal upset, take the medication after meals.    Compliance is encouraged by these interventions. Knowing the adverse effects of antiepileptic medications will enhance the patient’s adherence to the treatment regimen.
Create a therapeutic alliance with and between the patient and significant others.  This approach allows the patient to obtain the nurse’s trust and boosts confidence in finalizing epilepsy treatment.  
If suggested, recommend counseling sessions or psychosocial interventions.This approach enhances the quality of life and psychological well-being of patients who have epilepsy, which may cause noncompliance.
Let the patient be involved in determining the best epilepsy treatment for him.    Patients involved in the process have a greater interest in the result of the treatment.
Provide antiepileptic treatment that is brief and straightforward. Remove all unnecessary medications.  The patient’s compliance rises if therapy is brief and straightforward to understand. That is why it is necessary to discuss the treatment plan in layman’s terms so the patient can understand it well.    
Educate the patient and family members on the medication regime that will be followed.  This intervention raises awareness regarding the significance of following through on the recommended medication. It increases adherence to antiepileptic treatment.  
Give specific instructions as directed.  Sufficient information enables the patient to comply with the treatment recommendations.
Examine the patient’s point of view and interest in adhering to the therapeutic regimen.  As per the Health Belief Model, a patient has perceived susceptibility to, severity, and possible danger of disease, and possible benefits from following a treatment regimen influence compliance. Some patients may be unaware of the intensity of their illness or their ability to handle the complications of epilepsy.
Examine the patient’s understanding of the treatment plan for epilepsy.  Understanding and taking each patient’s concerns and misapprehensions about the treatment plan aids intervention programs.  
Examine the patient’s religious beliefs and practices about health and disease management.  People from different cultures may have distinctive perspectives and approaches to certain illnesses. Many people believe that a disease can be cured spiritually or through supernatural inspiration.    

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. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Nursing Stat Facts x
Nursing Stat Facts

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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