"New" seizure precautions???

nursegirl75 · Jan 8, 2012

hey if you wanna pass NCLEX, don't question the 'perfect world' of nursing. Just accept the crazy 'perfect world' and you will be rewarded with a nursing license. haha

AJPV · Jan 8, 2012

I guess this is how I'll approach it on the actual test... If "place mattresses on the floor next to the bed" is an answer choice, I'm going to figure that the chances are extremely small that NCLEX used that as an incorrect answer just randomly thrown in. If you see that phrase, just remember that the phrase is so specific that it must have come from the same source Kaplan has in mind.

Kaplan did NOT specify anything about the HEIGHT of the bed when the mattress procedure is performed (they didn't say "lower the bed," nor did they reference the bed's height relative to the floor). I don't see any way to lower our hospital beds to the floor (well, apart from a Craftsman ratchet set!) I guess we could just put the patient on a mattress directly on the floor? But then we would have a big infection control condunrum since the floor is considered "grossly contaminated."

Kaplan also did not specify what to do as to the current position that the side rails are in when the decision is made to implement seizure precautions. In other words, since we're not allowed to PAD the side rails, do we then LOWER the 2 side rails that are up (the ones at the top half of the bed that are normally kept up) upon deciding to use seizure precautions?

Nickeli · Jan 8, 2012

Hi-

At the LTC that I have worked at ( more than one in 18 years) we have beds that are specially made. The bed frame sits on the floor. No side rails and no heights, head or feet adjustments allowed. They have the yoga type mat that sits beside it. Then we fold it or move it or step on it as need be. Hope this helps.

Nicky

AJPV · Jan 8, 2012

Nicky - that makes sense. On a number of the other Kaplan questions, our instructor sometimes mentioned we have to remember LTC. Some of the answers sound pretty impractical unless you think LTC. Thanks!

CapeCodMermaid, RN · Jan 8, 2012

This may be a bit off topic. but side rails are not always considered a restraint. If you document that the person uses them as an assistive device to reposition, they're not a restraint.That being said, I agree with the other posters....seizures can happen anywhere and most of the time, the person is not in their bed. Low bed and floor mats can work, but if the person is independent with ambulation or has a roommate who is, the floor mats can pose a trip/fall hazard. A question about the NYCLEX exam: I've seen many references on here to getting the "good pop up". Since I sat for my exam back in the day of number 2 pencils, can someone explain what the good pop up is?

NurseLoveJoy88, ASN, RN · Jan 8, 2012

Nclex test plan changes every three years therefore I would go with what you were taught in school. It is best to be safe then sorry. NCLEX may not have included these new precautions yet in the test plan.

Esme12, ASN, BSN, RN · Jan 8, 2012

thus, when seizure precautions are warranted by any of the above risk factors the care plan must include the following:

1. make certain that the patient has the following equipment: a. nasal cannula and tubing; b. oxygen flow meter; c. suction gauge; d. suction canister; e. suction tubing to connect to canister;

2. assign patient to room in close proximity to the nurses station;

3. maintain continuous observation via video monitor;

4. maintain assembled suction equipment in room;5. maintain assembled oxygen equipment at bedside;

6. pad side rails of bed;

7. keep bed in low position with all side rails up at all times;

8. keep unnecessary equipment out of patients room;

9. instruct patient not to get out of bed without assistance;

10. assure that call bell is always within patients reach. make sure that the family knows where it is and how to use it;

11. avoid use of restraints;

12. obtain one-to-one sitter if patient is unable to follow instructions to maintain safety;

13. check vital signs every fifteen minutes and maintain airway patency during the post ictal phase (period of time immediately following the seizure, during which the patient remains comatose or stuporous).

seizure precautions | thomas a. sharon, r.n., m.p.h.

the joint commission does not restrict the use of padded side rails. if they are implemented for the protection of the patient from direct injury for the rail itself the rails are not considered a form of restraint. many jump on the jacho, or the jc as they prefer to be called now, bandwagon and if they don't really know the answer they just claim the jc doesn't allow it.

http://www.ahrq.gov/qual/nurseshdbk/nurseshdbk.pdf

when i checked with the ahrq, the agency for healthcare research and quality, their recommendations for practice pearls in a emu (epilepsy monitoring unit) are as follows.....

practice pearls

concerning consent forms, have your facility consult with your legal staff to make sure that health insurance portability and accountability act (hipaa) regulations are met.
have the referring physician address aed reduction prior to the emu admission.
make sure that emu rooms include at least suction, oxygen with nonbreather masks, seizure pads for the upper side rails, a softer special type of flooring, seizure and call buttons in the room and bathroom, and a fold-away bed for the adult family member staying with the patient.
ask an adult family member to stay with the patient to assist in identifying ictal activity.
have patients bring shirts and night clothes that do not need to be placed over the head. encourage patients to bring games, books, and other things that will occupy them without interfering with the eeg.
encourage patients to ambulate in the room. (if the surgical patient is dizzy then the patient should ask for assistance to the bathroom.) ambulation is encouraged to decrease postoperative complications such as pneumonia and deep vein thrombosis.
implement the falls precaution policy of your facility. if the patient has a helmet, he or she should bring this to the emu.
watch emu monitors around the clock.

national guideline clearinghouse | care of the patient with seizures. 2nd edition.

found in nclex 101 ways to score higher on your nclex: what you need to know about the following precautions should be taken

1) pad the "client" siderails

2) keep the bed in the lowest position

3) have o2 availavble

4) have suction equiptment available and functional.

101 ways to score higher on your nclex: what you need to know about the ... - j. lucy boyd - google books

i hope this helps.

ro2878, ADN, BSN · Jan 8, 2012

To CapeCodMermaid: The "good pop up" refers to what is aka "the Pearson Vue Trick." After you take your NCLEX, you go home and try to re-register with Pearson Vue website. If you passed NCLEX the site will not allow you to re-register ("the good pop up" screen.) If the site allows you to register, you failed NCLEX.

ro2878, ADN, BSN · Jan 8, 2012

Nclex test plan changes every three years therefore I would go with what you were taught in school. It is best to be safe then sorry. NCLEX may not have included these new precautions yet in the test plan.

I agree with you but someone in our Kaplan class brought this up. Our Kaplan instructor still told us to go with the mattress since Barbara Irwin (the director of Kaplan) "spends all day long doing NCLEX studies" and apparently knows everything! The Kaplan book also says not to turn the Pt's head to the side until after the seizure and we were always taught to turn Pt's head right away.

Just like nursing school - one instructor/book tells you one thing and the other tells you something different!

Ginger's Mom, MSN, RN · Jan 8, 2012

I, too, just completed Kaplan and found this "mattress thing" crazy! I know that in NCLEX world everything is perfect and we were told by our Kaplan instructor that this is a new JCAHO standard. Don't you think our instructors would have heard about this change and informed us?
I tried to search this on the JCAHO site and could not find anything. I would like to submit an inquiry to JCAHO but the site said it takes up to 8-10 days for a response.
Are you going to go with Kaplan or still use padded rails

There is no more JCAHO any more they are called Joint Commission, that being said, if they don't understand the difference of JCAHO and Joint Commission, which changed awhile ago I would be concerned how they interpret their guidelines.

AJPV · Jan 8, 2012

I'm just going to go with pure mathematical probability on the NCLEX. I'll assume that the chances of the NCLEX writers randomly generating the phrase, "place mattresses on the floor next to the bed," as an incorrect answer choice is quite low - especially if the all-knowing NCLEX writers know that there are sources out there teaching this. I'll assume if I see that phrase that it is intended as the correct answer. Otherwise, if "pad the side rails" is a choice and none of the other answers mention mattresses, then I'll choose side rails. I hope that is a safe calculation.

NurseLoveJoy88, ASN, RN · Jan 10, 2012

I'm just going to go with pure mathematical probability on the NCLEX. I'll assume that the chances of the NCLEX writers randomly generating the phrase, "place mattresses on the floor next to the bed," as an incorrect answer choice is quite low - especially if the all-knowing NCLEX writers know that there are sources out there teaching this. I'll assume if I see that phrase that it is intended as the correct answer. Otherwise, if "pad the side rails" is a choice and none of the other answers mention mattresses, then I'll choose side rails. I hope that is a safe calculation.

My thoughts exactly! They wouldn't have both as answers.