- Caregiver Role Strain related to Chronic seizures Unpredictability of seizures as evidenced by Increased stress and Inability to drive resulting in unreliable transportation
- Deficient Knowledge related to lack of understanding of seizure causes and Poor understanding of seizure triggers as evidenced by Poor adherence to medications and Injury from seizure activity
- Ineffective Airway Clearance related to retained secretions and respiratory depression as evidenced by Absence of/ineffective cough and altered respiratory rhythm
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: Verbalizes and expressed fear about Seizure episodes Objective Data: Increased stress Anxiety, depression Disturbed sleep Inability to drive resulting in unreliable transportation Inability to maintain employment Inability to safely care for young children Isolation from family and friends | Caregiver Role Strain related to Chronic seizures Unpredictability of seizures as evidenced by Increased stress and Inability to drive resulting in unreliable transportation | Caregiver will identify resources to improve family processes Patient will report an improvement in caregiver role as evidenced by control of seizures Patient will voice realistic expectations of themselves as a caregiver | 1. Recommend an epilepsy center. All patients with epilepsy should have a neurologist they see regularly. More complex seizure disorders may require assessment at an epilepsy center that provides comprehensive testing and treatment. 2. Encourage delegation and coordination. The caregiver with epilepsy or parent of a child with epilepsy must learn their strengths and weaknesses in their role. Coordinating and delegating tasks will allow the epileptic patient to feel useful and the caregiver will feel less burdened. 3. Offer resources. Local epilepsy support groups assist with navigating the role of caregiving and being a caregiver with epilepsy. Grants and funds can assist with financial costs, housing, and transportation. 4. Refer to case management. Nurse case managers can assist with supporting the patient with epilepsy or the parents of a child with epilepsy. They can provide education on surgical options, dietary recommendations, stress management, and coordinate care with epilepsy providers or other specialists. | Caregiver identified resources to improve family processes Patient reported an improvement in caregiver role as evidenced by control of seizures Patient raised voice realistic expectations of themselves as a caregiver |
| Subjective data: Verbalizes poor understanding Seeks additional information Denial of a need to learn Objective data: Inaccurate demonstration or teach-back of instructions Inability to recall instructions Exhibiting aggression or irritability regarding teaching follow-up Poor adherence to recommended treatment or worsening medical condition Avoiding eye contact or remaining silent during teaching | Deficient Knowledge related to lack of understanding of seizure causes and Poor understanding of seizure triggers as evidenced by Poor adherence to medications and Injury from seizure activity | Patient will verbalize an understanding of their type of seizure and related symptoms Patient will report recognizing their individual seizure triggers Patient will report adherence to their medication regimen with no missed doses for 30 days | 1. Instruct on keeping a seizure diary. The patient should be instructed to keep a log of their seizures including the date, time, duration, aura symptoms, and potential triggers. They may notice a pattern and be able to recognize triggers giving them more empowerment over their seizures. 2. Review potential triggers. There are many potential triggers of a seizure and the patient should be educated on recognizing theirs. Common triggers include stress, flashing lights, menstruation or hormonal changes, medications, lack of sleep, illness, heavy alcohol use or withdrawal. 3. Help the patient to recognize warning signs. Seizures can be unpredictable but there are often signs that a seizure is going to occur. An “aura” will be different for each patient but can include unusual feelings, smells, or sensations. The patient may describe an “out-of-body” experience or deja vu. The patient should learn to recognize these symptoms and prepare for an impending seizure. 4. Provide an action plan. A diagnosis of epilepsy is life-long. An action plan includes information such as the patient’s medication list, healthcare contacts (neurologist, preferred hospital, pharmacy), medical history, and specific seizure details. The patient should have this available at all times and provide copies to their family members for continuity of care. | Patient verbalized an understanding of their type of seizure and related symptoms Patient reported recognizing their individual seizure triggers Patient reported adherence to their medication regimen with no missed doses for 30 days |
| Subjective data: Dyspnea Objective data: Adventitious breath sounds Abnormal respiratory rate, rhythm, and depth Declining oxygen saturation Ineffective or absent cough reflex Copious mucus production Hypoxemia Restlessness Change in level of consciousness Orthopnea Cyanosis | Ineffective Airway Clearance related to retained secretions and respiratory depression as evidenced by Absence of/ineffective cough and altered respiratory rhythm | Patient will maintain a patent airway. Patient will demonstrate effective airway clearance and equal and clear breath sounds bilaterally. | 1. Administer supplemental oxygen as indicated. During a seizure, ABCs (airway, breathing, circulation) must be prioritized. Administering supplemental oxygen via a non-rebreather mask is often indicated to prevent prolonged oxygen desaturation. 2. Position the patient in the recovery position during and after a seizure. While in the recovery position, the body should be turned on one side, with the mouth facing toward the ground. This position assists with breathing, helps maintain patent airways by promoting drainage of secretions, and prevents the tongue from obstructing the airway. The head should also be supported or cushioned. 3. Loosen the patient’s clothing. Loosening restrictive clothing, especially around the neck, chest, and abdomen, can help ensure a patent airway and the most effective breathing pattern. 4. Suction the patient as appropriate. During a seizure episode, never attempt to insert a suction catheter into the patient’s mouth. Apply suction only to the outside of the mouth to remove secretions during a seizure and only inside the mouth when the seizure activity has stopped. | Patient maintained patent airway. Patient demonstrated effective airway clearance and equal and clear breath sounds bilaterally. |