SEIZURES
Mr. H. is a 44-year-old white male who arrives in the ED afterexperiencing a generalized tonoclonic seizure at home, witnessed byhis fiancée. The seizure occurred approximately 1 hr prior toarrival. Mr. H admits to a long history of alcohol (ethanol) abuseand has experienced previous withdrawal seizures, although hedenies any history of delirium tremens or blackouts. He waspreviously on phenytoin, but has not been on it “for a long time. “Mr. H. states he drank 4 quarts of beer the previous evening. He isanxious and tremulous, and ambulates with a cane. Vital signs attriage are BP 170/100, pulse 112, respirations 28, and temperature37.6°C (99.6°F). Mr. H. is oriented to person, place, and time. butdoes not recall the President of the United States or othersignificant current events. Strength, sensation. and cranial nervesare intact, and reflexes are normal. However. Mr. H. has severegait ataxia and minimal end-gaze nystagmus. Finger-to-nosecoordination is slightly dysmetric. Sclera arc injected, and thereare significant dental caries. The neck is supple and lungs aredear: heart sounds reveal an S4 gallop. The abdomen is soft andnon-tender, with no masses or organomegaly. .Mr. H. denies anyillicit drug use, but smokes two packs of cigarettes a day.
Triage Assessment, Acuity Level III: Recent seizure activityand recent ethanol ingestion with history of alcohol withdrawalseizures: tremors; ataxia.
When Mr. H. is brought to the treatment area, a 1000 mlsolution of 5% dextrose and 0.45% normal saline is started at 125ml/hr with additives of 1000 mg thiamine, 0.2 mg folic acid, and 2g magnesium sulfate. Labwork is drawn simultaneously for a completeblood count (CBC), differential, electrolytes, calcium, magnesium,amylase, bilirubin, prothrombin time (PT), partial thromboplastintime (PTT), and ethanol level. Mr. H. is placed on a stretcher withside rails up in a well-lighted, high-observation area of the ED. Avest restraint is applied.
QUESTIONS AND ANSWERS
1. What nursing diagnoses are applicable to thispatient?
2. What is the basis for Mr. H.’s seizure and otherneurological symptoms?
3. How can it be determined that Mr. H.’s seizure isethanol-related? Isn’t it possible that idiopathic
epilepsy, head trauma, or other drug toxicities could be thecause of the seizures?
4. What nursing interventions would be appropriate to initiatein this situation?
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