RN HEALTH ASSESSMENT
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.
PMH: Seizure, hypertension, anxiety
Retired book keeper
C/o being tired
Periods of unresponsiveness to verbal stimuli
Vital signs: T 37 degrees Centigrade, P 80, R 18, BP 174/84
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).
In regards to the patient history, the nurse could ask:
Whether the patient always gets unconscious
The family and friends to the patient
Recent noncompliance with medications
History of the central nervous system (CNS) pathology
History of infections, metabolic disorders, and toxic ingestions
Recent trauma or fall
The nurse in this case should ask and observe the motor activity like eye deviation and posturing (decerebrate/decorticate).
In regards to special concerns the nurse should enquire the presence or absence of:
Intracranial hemorrhage (ICH)
Alcohol or medication withdrawal
The questions related to differential diagnosis will inform the nurse about the nurse’s condition in regards to:
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.
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:
Magnetic resonance imaging (MRI)
Single-photon emission computerized tomography (SPECT)
Computerized tomography (CT) scan
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):
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.
Maintain the airway or the respiratory function.
Protect patient from suffering an injury.
Offer information regarding the disease process, prognosis, and the treatment needs.
Seizures activity controlled.
Competent or capable self-esteem displayed.
Injury or complications prevented.
Disease prognosis, therapeutic regimen, and the limitations understood.
Proper plan underway to meet the needs after the discharge.
Baron, R., Binder, A., & Wasner, G. (2010). Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. The Lancet Neurology, 9(8), 807-819.
Jarvis, C. (2015). Physical Examination and Health Assessment–. New York, NY: Elsevier Health Sciences.
Magee, D. J. (2014). Orthopedic physical assessment. New York, NY: Elsevier Health Sciences.