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Seizure Pathophysiology and Types of Seizures
Seizure Pathophysiology and Types of Seizures ( 3 Questions)
A nurse is caring for a client who has a history of simple focal seizures. Which of the following interventions should the nurse implement during a seizure episode?
Choice A is wrong because administering oxygen via nasal cannula is not necessary for a client who has a simple focal seizure. A simple focal seizure is a type of seizure that affects only one part of the brain and does not impair awareness or consciousness³. The client may experience sensory, motor, autonomic, or psychic symptoms, but they do not have generalized convulsions or respiratory compromise³. Oxygen therapy is indicated for clients who have generalized tonic-clonic seizures or status epilepticus, which can cause hypoxia or apnea¹².
This is because documenting the seizure activity is important for assessing the type, frequency, and severity of seizures, as well as the response to treatment¹. The nurse should note the time of onset and termination of the seizure, the body parts involved, the level of consciousness, the presence of aura or prodrome, the type and pattern of movements, the eye deviation or blinking, the vocalization or breathing changes, the incontinence or salivation, and any postictal symptoms¹².
Choice C is wrong because inserting an oral airway to prevent tongue biting is not appropriate for a client who has a simple focal seizure. An oral airway is a device that is inserted into the mouth to keep the tongue from blocking the airway and to facilitate ventilation⁴. An oral airway should not be used for clients who are conscious or have a gag reflex, as it can cause injury, vomiting, or aspiration⁴. A client who has a simple focal seizure is fully alert and conscious and does not need an oral airway³. Tongue biting is rare in simple focal seizures and more common in generalized tonic-clonic seizures.
Choice D is wrong because restraining the client's limbs to prevent injury is not appropriate for a client who has a simple focal seizure. Restraining a client during a seizure can cause more harm than good, as it can increase agitation, prolong the seizure, or cause fractures or dislocations¹². A client who has a simple focal seizure may have involuntary movements of one part of the body, such as twitching or jerking of an arm or leg³. The nurse should not restrain these movements but rather protect the client from hitting any hard or sharp objects¹².
This is because documenting the seizure activity is important for assessing the type, frequency, and severity of seizures, as well as the response to treatment¹. The nurse should note the time of onset and termination of the seizure, the body parts involved, the level of consciousness, the presence of aura or prodrome, the type and pattern of movements, the eye deviation or blinking, the vocalization or breathing changes, the incontinence or salivation, and any postictal symptoms¹².
Choice A is wrong because administering oxygen via nasal cannula is not necessary for a client who has a simple focal seizure. A simple focal seizure is a type of seizure that affects only one part of the brain and does not impair awareness or consciousness³. The client may experience sensory, motor, autonomic, or psychic symptoms, but they do not have generalized convulsions or respiratory compromise³. Oxygen therapy is indicated for clients who have generalized tonic-clonic seizures or status epilepticus, which can cause hypoxia or apnea¹².
Choice C is wrong because inserting an oral airway to prevent tongue biting is not appropriate for a client who has a simple focal seizure. An oral airway is a device that is inserted into the mouth to keep the tongue from blocking the airway and to facilitate ventilation⁴. An oral airway should not be used for clients who are conscious or have a gag reflex, as it can cause injury, vomiting, or aspiration⁴. A client who has a simple focal seizure is fully alert and conscious and does not need an oral airway³. Tongue biting is rare in simple focal seizures and more common in generalized tonic-clonic seizures.
Choice D is wrong because restraining the client's limbs to prevent injury is not appropriate for a client who has a simple focal seizure. Restraining a client during a seizure can cause more harm than good, as it can increase agitation, prolong the seizure, or cause fractures or dislocations¹². A client who has a simple focal seizure may have involuntary movements of one part of the body, such as twitching or jerking of an arm or leg³. The nurse should not restrain these movements but rather protect the client from hitting any hard or sharp objects¹².