Checking a Neurologists After Refferal

RN HEALTH ASSESSMENT

Katherine Trembly is a 67-year-old woman who presents to the neurologist’s office after referral from her PCP (primary care provider) for a seizure.

Subjective Data

PMH: Seizure, hypertension, anxiety

Retired book keeper

C/o being tired

Periods of unresponsiveness to verbal stimuli

Objective Data

Vital signs: T 37 degrees Centigrade, P 80, R 18, BP 174/84

Lungs: clear

O₂ Sat = 98%

Heart rate regular, + peripheral pulses

Other questions to be asked by the nurse

Apart from the above listed data, the nurse could also consider asking questions related to the patient history, physical examination, special concerns and differential diagnosis (Jarvis, 2015).

Patient history

In regards to the patient history, the nurse could ask:

Whether the patient always gets unconscious

The family and friends to the patient

Prehospital personnel

Recent noncompliance with medications

History of the central nervous system (CNS) pathology

History of infections, metabolic disorders, and toxic ingestions

Recent trauma or fall

Alcohol abuse

Physical examination

The nurse in this case should ask and observe the motor activity like eye deviation and posturing (decerebrate/decorticate).

Special concerns

In regards to special concerns the nurse should enquire the presence or absence of:

Eclampsia

Trauma

Intracranial hemorrhage (ICH)

Alcohol or medication withdrawal

Differential Diagnosis

The questions related to differential diagnosis will inform the nurse about the nurse’s condition in regards to:

Delirium Tremens

Eclampsia

Febrile Seizures

Heatstroke

Meningitis

Techniques are helpful to incorporate in assessing a patient

Some of the techniques that are helpful to incorporate in assessing a patient in this age group include:

Neuroimaging of abnormalities that correspond majorly to complication. Some changes in that occur during imaging persist for weeks and normal affect the white matter as well as the cortex and always include:

T2 hyperintensity on MRI

Hypodensity on CT

Blurring of gray-white junction (Jarvis, 2015)

Electroencephalogram (EEG) is considered to be the fundamental investigation for seizure patients in the age of older adults. Focal slowing is always the major EEG manifestation following a stroke. Seizure focus development could sometimes come along with the appearance of epileptiform discharges which include spikes, sharp waves or even periodic lateralized epileptiform discharges (PLEDs) (Jarvis, 2015).

Laboratory tests include evaluations that are done purposely to rule out the metabolic factors that are known to predispose to seizures. These test measure serum chemistries, and most specifically sodium, magnesium, calcium renal indices and glucose (Magee, 2014). The measurement of the levels of the potentially offending drugs like theophylline, or at times the normeperidine metabolite of meperidine can be done and these have also been useful in the assessment of seizure. Urine and blood toxic screens have also been useful in the assessment of the possibility of use of an illicit drug that may have contributed to seizure (Magee, 2014).

The most common causes of seizure activity in older adults

Below are some of the more common conditions that may cause seizure activity in this age group:

Cerebrovascular disease, such as stroke and aneurysms.

Trauma that leads to brain hemorrhage or head injuries.

Alzheimer or dementia.

Alcoholism

Brain tumors

Brain infection which include meningitis and encephalitis among others.

The diagnostic tools to diagnose Seizure

The physician may use the following diagnostic tools to diagnose this condition:

Electroencephalogram (EEG)

Magnetic resonance imaging (MRI)

Single-photon emission computerized tomography (SPECT)

Computerized tomography (CT) scan

Neuropsychological tests

Functional MRI (fMRI)

Positron emission tomography (PET) (Baron, Binder & Wasner, 2010).

Components of the Plan of Care

The plan of care should include nursing priorities and discharge goals (Jarvis, 2015):

Nursing Priorities

The nursing priorities that should be included in the plan of care for this patient include:

Control or prevent the seizure activity.

Encourage a positive self-confidence.

Patient history.Nursing Priorities