Seizures real vs fake - page 4

Ok so there was a patient/IM that had a seizure (perhaps, unsure) and the staff that went were stating that it was fake because she was alert and oriented. I was wondering, how do you handle the... Read More

  1. by   momamma
    Well, in my earlier post I was referring to people in the prison system that fake seizures and how to recognize them. It was never an attempt to be personal and state that what I have experienced is the only truth about a seizure disorder. I was speaking specifically about people that purposely fake a serious illness just because they can. So, if you would like to refer to someone as being ignorant, refer to them for thinking they can get away with it. Its a discussion. Not an attack. Remember, I don't know you. Regardless of the fact I would never refer to you as anything other than your name.
  2. by   MaudKennedy
    Quote from momamma
    Also hold their hand over the head and drop it. If they avoid the face when it falls they are aware of what they are doing.
    And if they don't,they get slapped on the face?? That's for all people who fake it?
  3. by   cmprie
    I too am a correctional nurse and have been for only 5 years. I have seen a multitude of questionable, manipulative behaviors played out as a "Seizure" usually for secondary gain such as to get into the infirmary, protective custody, an outside trip to the ER, drug seeking. While no two person's symptoms will be identical, there are definite signs of a true seizure. That aside, I feel it is inconsequential if they are faking the seizure at the moment that it is occurring. Our job is to assess and treat per protocol.
    I look at it this way, If the patient has a history of documented seizure disorder, whether they are faking at this moment for secondary gain or not, we can assume it may be a real seizure and as everyone knows seizures are not medical emergencies for those with seizure disorder but rather a manifestation of their condition. Keep the patient safe and then when it is over ensure he returns to his cell and lies down. No need for the infirmary, however, schedule for a sick call follow up and a provider chart review to ensure the patient is on the correct dosage for his current status. The provider may ask that you draw prolactin levels when these situations occur to rule out manipulation and identify true medical concerns as well as they often want serum medication levels.
    If the patient is unknown to you or has never had a seizure before you want to take this a bit more seriously. Move the patient to your clinic if their situation allows, follow seizure protocols and draw blood for prolactin levels and drug screen as well as a CMP/ CBC to be able to determine if this patient had a seizure as well as to rule out medical or drug-induced reasons for the issue. Remember that many other very serious medical conditions can present symptoms that resemble seizures and you wouldn't want to miss this because you thought they were faking.
    Ultimately as a correctional nurse you will always be monitoring for manipulative behaviors but your job is to provide state and federally mandated medical care to the inmate population so you have to assume that there may be a real situation going on and be prudent not to dismiss symptoms as poor behavior when it comes to medical complaints. "how do you handle the fakers/manipulators/attention seekers?" Do not let yourself get wrapped up in the negativity that surround the population you care for. Set clear boundaries. Take their medical care seriously. Stay calm, focused and matter of a fact when the inmate presents with full "seizure-like activity" so that there is little to no secondary gain from the interaction. Advise them of the negative effects of misrepresenting their symptoms and that as medical professional we can determine if these symptoms are real or not, based on science. (They often believe they can pull one over on us) I use pulled video footage a lot to determine if the statements from the inmates are congruent with what I see on the video.
    On a side note, I always document "patient presents with seizure-like activity" This is important because you as a nurse do not know if it was a true seizure or not and when reviewed in court a statement that the patient had a "seizure" will be a statement of fact or a diagnosis (not yours to make) or a statement to the contrary that reads a patient "faked a seizure" is a judgement of the patients character. Both are hard to defend or retract in court.

    Good luck and stay safe!
    Last edit by cmprie on Dec 6, '15 : Reason: forgot something

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