Quote from kelnich
How can you tell if a patient is faking? Is it pretty obvious?
I am a student nurse and I work on a med/surg floor as a nurse extern and I had a patient seize on me. This was my first experience with seizures.
The patient had tonic, clonic movements then stopped and went into decerebrate posturing <?> then back to tonic-clonic.
I read through her chart and it said she had a history of seizure vs. pseudoseizure. The RN I was precepting under said that most likely she is faking it because she wasn't foaming at the mouth and she didn't have urine loss. Do you have urine loss with all seizures? Not only that, like 10 mins after the seizure the pt wants to eat and she said if the pt is hungry it is most likely not a real seizure.
Just curious, because this patient does an awesome job of faking it if she was.
Although I do want to add, that even *I* know not to let the patient ambulate. She wanted to go to the bathroom and I was like "nope, bedpan" so she's like can you bring me one of those things I can sit on by the bed and I was still like "nope." This unfortunate lady was 350+ pounds. If she were to seize on the comode or toilet, there is not a soul who could pick her up.
Sorry to jump on this thread but it seems to relate.
An EEG during the seizure activity is fairly diagnostic, but seizures are funny critters. In our Epilepsy Monitoring Unit, we use continuous EEG and videotape so the neurologists can study seizures and patterns of seizures. Patients are generally off antiepileptics for a week or more during stay, and we sometimes use sleep deprivation to try to provoke seizures. The goal is not only to rule out pseudoseizures (which may seem real enough to the person experiencing them) but in some cases to surgically treat localized lesions that can lead to seizures (difficult tongs birth is a classic example.)
There are also blood tests and sometimes radio-isotope tests we do, and I pretty well know my way to the CT and MRI labs.
Our EMU patients are usually ad-lib to ambulate on the unit, except immediately post-ictal. In a bit over a year, I don't know of anyone seizing in the hall. Brains are apparently a bit like cars--they do all sorts of strange things, but when you take them to the "mechanic" they start running perfectly. It's surprisingly hard to get someone to seize when you want them to. But as far as falls, these folks are at risk for falls on the street all the time, so falling in the hospital isn't really worse.
We don't generally try to lift a tonic/clonic patient back into bed, unless they are pretty small and we have plenty of horse. Again, waking up on the floor isn't a new experience for most of them. Turn them to their side, if you can, but you usually can't.
Despite what I was told in nsg school, we never, ever put anything in an epileptic's mouth during a seizure. I have yet to see a tongue bite, though I've heard it does happen.
Sometimes a nurse may carefully do suction to protect the airway, but you really don't want to provoke the gag reflex.
I have yet to see "foaming at the mouth"--sometimes there's a bit of spittle.
We get a lot of absence seizures, too, which are really hard to diagnose at a glance--is he seizing, or watching t.v.? And a few localized seizures, where maybe just the arm is seizing. I don't know how many of those are pseudoseizures--some, but not all.
The most amazing part of the EMU is how little drama there actually is.