Page 257 - Critical Care Nursing Demystified

242 CRITICAL CARE NURSING DeMYSTIFIED

If the SE shows no signs of diminishing, propofol (Diprivan), a general anes-
thetic, can also be administered to provide continuous sedation.

Prognosis
Recurrent seizures can be prevented and controlled with medication therapy.
Occasionally, surgery is done to remove an epileptic focus in the brain if the
problem is difficult to manage medically. The impact of epilepsy is reduced by
75% postoperatively.

Interpreting Test Results

Electroencephalograms (EEGs) can tell if seizure activity is present. These
can be done continuously at the bedside.

ECG – to monitor for dysrhythmias and cardiac failure.

Hallmark Signs and Symptoms
Generalized seizures can be grand mal (tonic-clonic) with loss of consciousness
and rhythmic twitching and jerking.
Partial seizures may involve simple (no loss of consciousness) or complex
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1 Nursing Diagnoses Expected Outcomes
Ineffective airway clearance The patient will have clear breath sounds
Tissue perfusion, alteration in Vital signs will be within normal limits
The patient will have absent seizure activity

Nursing Interventions

Maintain a patent airway to promote adequate air exchange and ventilation
to control SE.
Monitor vital signs for abnormal changes that might need to be treated to
control seizure activity.
Provide continuous EEG monitoring. More than 50% of seizures go unde-
tected due to unwitnessed motor activity. More accurate assessment of pa-
tient’s response to treatment is indicated.

Administer first-line drugs like a benzodiazepine such as Ativan (lorazepam),
as well as Valium (diazepam) to decrease brain activity to external stimuli.
Sedative hypnotic qualities of Ativan and Valium work by depressing the
subcortical areas of the CNS.