PTSD Contributing factors involved in this hospitalization such as lifestyle Hypertensio

Seizures started in Jan 2016, fell and hit head month ago followed by headaches, PTSD from
Navy bombing and rape), HTN, Thyroidectomy, Hashimoto's thyroiditis, High cholesterol,
manic depression.
Medications
amitriptyline (Elavil) tablet 100mg
PTSD may have caused
Treats depression. This medicine is a
unexplained occurrences
TCA.
of seizure like activity.
sertraline (zoloft) 20mg/ml
concentrated solution 50 mg - Treats
depression, obsessive-compulsive
disorder (OCD), posttraumatic stress
disorder (PTSD), premenstrual
dysphoric disorder (PMDD), social
anxiety disorder, and panic disorder.
This medicine is an SSRI.
Pertinent Physical Examination findings:
Complained of headache. Patient reports seizure
like activity consisting of muscle stiffening,
twitching, loss of consciences, and incontinent.
Trigger unknown.
Priority Nursing Diagnosis (3 parts)
At risk for injury related to seizure like activity as
evidenced by loss of consciences, muscle stiffening, and
convulsions.
Measurable outcome w/ timeframe: Remain free of injury
during seizure activity till end of shift.
Nursing interventions you used with rationales:
1) Implement seizure precautions: side rails up and padded,
bed in low position, head protection if needed. Patient
safety is priority and these measures reduce risk for injury
during seizure activity.
2) If a seizure occurs, remain with patient, do not attempt to
put anything in their mouth, and maintain the airway.
Inserting objects will often cause more harm, such as
broken teeth, soft tissue injury, and airway obstruction.
3) Observe for seizure activity. Record and report
observation. Any cerebral irritation puts the patient at risk
for seizure activity.
Evaluation:
Goal Meet. Patient remained injury free during shift.
n
Medications
Atenolol (Tenormin) tablet 100 mg -
Treats high blood pressure and chest
pain. Also reduces the risk of death
after a heart attack. This medicine is a
(T.R. 53 years old)
beta-blocker.
Seizure like
activity Medications
Lorazepam (ativan) 2mg IV - Treats seizures.
Also used to relieve anxiety.
Tramadol (ultram) tablet 50 mg - Treats moderate
Pathograph of this condition to severe pain. This medicine is a narcotic pain
(Lewis, 1419) reliever.
Seizures are caused by paroxysmal discharges Oxcarbazepine (Trileptal) tablet 300mg Treats
from groups of neurons, which arise as a result seizures.
of excessive excitation or loss of inhibition.
The key unit of neurotransmission is the Psychosocial / Spiritual issues and discharge needs:
synapse, and the fundamental components of Patient sees a psychiatrist and has an engaged and
synapses are ion channels.
devoted husband and family to support healing
They may accompany a variety of disorders,
process.
or they may occur spontaneously without any
apparent cause.
It is not consider epilepsy if is seizures cease
Recent laboratory/diagnostic tests results with
when the underlying problem is solved. significance (i.e. why are they high/low?)
Epilepsy is a condition in which the person EMU Abnormal Study. Abnormalities found in
has spontaneous recurring seizures caused by Left Temporal Lobe, focal slowing, along with a
a chronic underlying condition.
rare epileptiform discharge in the area. Maybe do
to tumor, bleeding, or injury such as bruising that
resulted from a previous fall. MRI needed to
confirm reason.
MRI (no contrast Unremarkable except for
scattered white matter abnormalities, more
predominantly in the right frontal
cortical/subcortical region.
Anticipated patient teaching required - compliance with medication, keeping track of
appointments, finding support (can cause emotional stress). Have a plan for when you
have seizures and make sure your family knows what to do. If you have a seizure that lasts
longer than 5 minutes or if you do not wake up after a seizure, your family members
should call 911. Your family members should not try to put anything in your mouth while
you are having a seizure. But they should make sure you do not bang against any hard 1
surfaces. May need to make accommodation for transportation instead of driving.
 Guide for Reflection
Guide for Reflection Using Tanners (2006) Clinical Judgment Model

Program Thread: Professionalism and Commitment to Lifelong Learning

I have learned so much having clinical at St Marys NSTU and enjoyed the patient population

and cases. One week I was able to look at the MRI and CT scans of my patient who suffered from

multifocal strokes caused by vasculitis. This week I had a patient that was on EMU observation and

had the chance to learn about seizures. Each case was intriguing and inspired me to learn more

about those topics. In all these experiences on NSTU, professionals, not just nurses, took the time

to teach and explain results, procedures, and pathology of neurological diseases. That in its self,

healthcare providers taking the time to teach students, is a great example of professional because

when we take time to help others grow, our organization, and our profession also grows. These

professionals lead by example and hopeful I will do the same for future nursing students when I

become a nurse. Experiences like these are so important in developing into a nurse. Once I become

a nurse, education will never stop at the end of my degree. Nurse should always be striving to

increase their knowledge and skills and be open to new experiences. If you continue to grow, not

only do you benefit personally, but also you have the opportunity to increase patient outcomes and

grow the nursing profession.

Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment
Model. Journal of Nursing Education, 46(11), p. 513-516.

List two goals for the next practicum experience:

1. Give meds through a peg tube or NG tube
2. Develop new skills on the ICU unit not yet learned on other units