Nursing Interventions

Sure! I think that what this question is asking you is "what do you, as a nurse, for a patient who is having a grand mal seizure?" I don't think they want you to go for the drug right off the bat. They want nursing interventions.

I worked on a neuro unit where we had patients who had seizures all the time. There are very specific nursing interventions that you perform before you grab the Valium. Look in the index of a nursing textbook under "seizure" or do a search on the internet. Then, before giving any patient intravenous Valium there are a few things about it that you need to know and you can find this in a drug reference or online. If you still have trouble finding info on IV Valium, ask me. I have IV drug references.

Diazepam (generic name), is well-known to us old-timers by its brand name, Valium, or as I lovingly called it, Valley-ally-um.

Did you find the answer to this question? I wanted to hold off posting this to give you time to research this yourself. Some of it I knew you wouldn't find.

Institute seizure precautions to

• protect the patient from injury
  
• protect the patient from complications as a result of the seizure
  
• observe the characteristics the patient exhibits during the seizure

Nursing interventions prior to the administration of IV Valium:

• gather and have ready at the bedside
  • an oral airway - tape to the wall above the bed or have at the bedside
    
  • a padded tongue blade - tape to wall above the bed
    
  • oral suction equipment
    
  • oxygen
    
  • cover side rails, headboard and footboard with specially designed pads or several thicknesses of blankets and keep the side rails up
    
  • keep the bed in a low position

  [*]when the patient begins to seize, stay with the patient and do not leave. Then,

  • if the patient is in the bed, get the bed flat
    
  • insert the airway or tongue blade in the patients mouth before the seizure starts and the patient clamps down on their jaw and bites their tongue - do not put your fingers inside the patient's mouth! - if the jaw has already become rigid you'll just have to wait until the seizure is ended to insert the airway, but do not try to force it into the mouth
    
  • make sure the side rails are up and the padding is covering the rails.
    
  • protect head and keep it from hitting any surfaces; do the same for the limbs
    
  • do not attempt to restrain or restrict the patient's movements in any way during the seizure

  [*]When the seizure ends

  • anticipate a postictal period of confusion/unconsciousness for 30 minutes or so after the seizure activity ends and just allow the patient to lie quietly during this time if there are no other complications to attend to
    
  • turn the patient to his side to facilitate drainage of secretions
    
  • suction if needed
    
  • assess for injury, particularly of the tongue
    
  • take vital signs
    
  • when the patient becomes conscious ask about any aura they might have experienced just before the onset of the seizure to include in your later documentation
    
  • things you should be noting for later documentation:
    • time of onset and how long it lasted
      
    • any head or eye deviations at onset
      
    • how the seizure activity progressed, the form it takes (tonic-clonic, jacksonian, petit mal, myoclonic, status epilepticus)
      
    • any incontinence, vomiting or salivation that occurred during the seizure
      
    • any medication given during the seizure
      
    • whether or not an IV access was established

Giving IV Valium

• establish a patent IV access - a little difficult to do if the patient is seizing
  
• IV Valium is irritating to the veins when pushed directly into a vein, so avoid small veins to avoid phlebitis or extravasation
  
• Can be injected over one minute in adults; 3 minutes in children
  
• start with smallest possible dose and increase it based on the patient's response
  
• side effects of IV injection: bradycardia, hypotension, cardiac arrest
  
• you MUST have emergency oxygen, respiratory assistance and flumazenil (Romazicon) available when you give this drug IV and resuscitate as necessary
  
• anticipate that the patient will need to be on bed rest for several hours after an IV injection of Valium
  
• Valium is incompatible with pretty much most other drugs and will cause precipitates in the IV tubing when mixed with them; best action is to remove all other IV fluids and get a mainline of normal saline established, but direct IV push through the most distal port of the existing IV tubing or through a saline lock is considered most ideal
  
• increases serum concentration of digoxin, phenytoin and benzodiazepines
  
• should not be used in patients who have glaucoma or hypersensitivity to soy protein
  
• onset of action in treating seizure activity is immediate (which is why it is the drug of choice)
  
• if the patient's seizures are due to brain lesions, the Valium is not as effective as other medications
  
• not normally used for petit mal seizures
  
• if the patient has a pre-existing chronic lung disease or unstable heart condition they will need to be monitored very closely after getting IV Valium
  
• If large or extended doses are given over time (and I've seen this done in cases of status epilepticus that just won't stop) the patient will need to be monitored for withdrawal symptoms

per 2007 intravenous medications, 23rd edition, by betty l. gahart and adrienne r. nazareno, pages 406-410:

resuscitation equipment needs to be available and ready (airway, artificial ventilation, oxygen). romazicon is given to reverse the sedative effects of diazepam.

read the list of interventions i posted.