About
Acute emergency whereby client has a continuous seizure state causing hypoxemia to the brain.
Assess
Time, length, duration, quality of seizure state; airway, neurological status, post-ictal state, precipitating factors, vital signs, pulse-oximetry
Complications
Brain anoxia, death
Diagnosis
- Impaired gas exchange related to altered oxygenation.
- Risk for injury related to constant seizure state.
Goals
- The client will be free from seizures.
- The client will be free from injury.
- The client will have a pulse-oximetry > 94%.
Interventions
- Establish and maintain patent airway.
- Administer oxygen.
- Administer benzodiazepines ( ativan, valium) to immediately interrupt seizure state.
- Follow up with long acting seizure medications to prevent return of seizure state ( dilantin, phenobarbitol).
- Maintain a patent IV.
- Pad side-rails.
- Assess neurological status and vital signs frequently.
- Monitor for return of seizure state or symptoms.
- Treat underlying cause of seizure ( fever, ETOH withdrawal, Acid-base or electrolyte disturbances, etc) or initiate treatment plan for epilepsy.
- Teach client about the medications he/ she is receiving and potential side-effects.
- Prepare for diagnostic tests as indicated.
- Monitor for signs/ symptoms of complications.
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