I am a new nurse still orienting to the ICU, so yes, I am very green. I had my first experience with what was originally thought to be grand mal seizures but was soon suspected to be pseudo-seizures. The whole experience was mind boggling to me. The seizures were whole body spasmodic lasting for less than 30 seconds, no loss of bowel functions, no post-ictal (sp?), completely coherent within minutes, some expiratory wheezing afterwards, eyes responded to stimulus, and always occurred soon after the patient was emotionally upset. She had a seizure while she sitting in an upright chair and amazingly did not even end up on the floor or get hurt. I might also add that the seizures NEVER occurred as long as someone was in the room with her and giving them her full attention.
The pt. was completely noncompliant with the nursing staff, refusing to stay in bed (even though we explained REPEATEDLY the danger of being up with the frequency of the seizures), tearing leads off, even attempting to walk off the floor half naked to drive herself home. She went ballistic when she overhead the possibility of restraints. She swung from being completely happy, to being anxious, to crying, to apologizing, to screaming, etc.
As the shift went on more and more information came out - she was a frequent flyer and many of the staff remembered her from years prior at different hospitals. It was very difficult to decipher what of her history was true or not as she has changed doctors quite often.
She was currently on Dilantin, and surprisingly enough, NO psych meds. We ended up having someone come from another floor to act as a sitter and she seemed as happy as a pig in mud then. I was not her primary nurse and an still wondering why a psych consult was not ordered for her.
I have no psych experience and am completely naive in that way but I just couldn't believe someone would put themselves through the physical and emotional hell she was going through just for attention. I guess my question is has any had any experience with this? What would you have done in this situation?
The problem is, is that there are patients who do fake seizures and they are time consuming and energy draining if you don't be firm and straightforward with them and let them know that you will not put up with their manipulative behavior.
We have a frequent flyer on our unit, always coming in with CVA/TIA sx. Also has psuedoseizures (she also calls them this). Obviously has psych issues but her anxiety is way not under control. Last time I had her as a pt, they had just started her on Valium PO. It didnt sedate her, but her severe anxiety issues (girlfriend about had a panic attack when I told her she has a simple UTI ) were under control.
She was apparently back in the hospital 2 weeks later b/c they took her off the Valium after she was discharged the time before
One time we had a pt with a current DX of pseudo-seizures. I think this may have been the only one I've seen so far.
One morning one of the physicians came around and the pt started having a pseudo-seizure when she heard his voice out in the hallway talking to me.
He asked me for a saline flush, injected it, and she stopped. I didn't say anything, and the physician didn't say anything about it either, but the physician looked at me and his eyes told me everything I needed to know...
She'd also do stuff like knock her phone on the floor/leave it off the hook, hit her call light, turn her tv up all the way, or make a big ruckus somehow so you'd go in there to find her "seizing." We'd just calmly stand there, time it, and when she was finished we'd chart the episode.
We've got one of those, has had so many MRI/MRA/CT/PETs (that were all clear) that the only thing I'd worry about was radiation poisoning. Last time she came in, I think the doc had about had it with her. She came in with "unresponsive, flaccid L side, R/O TIA/CVA." Was staring into space, drooling, doing the pseudoseizure every time the doc came around. So, he called for a LP. He told the nurse anesthetist who was to do the LP (and who he'd clued in), "Now, if this doesn't bring her around, we'll just have to keep inserting needles beside each vertebra until we hit the one causing the problem." She got one needle, and *surprise* she suddenly became A/O, could move her left side, etc.
And we wonder why our insurance is sky freakin' high.
These patients are very time consuming. I worked on a stepdown unit and would have three other patients plus this one manipulative patient and it was frustrating to not be able to provide the kind of care I would like to because I was in the room with this one patient who was demanding my attention every 10 minutes. After a couple of those patients you learn very fast how to deal with them.
These patients are very time consuming. I worked on a stepdown unit and would have three other patients plus this one manipulative patient and it was frustrating to not be able to provide the kind of care I would like to because I was in the room with this one patient who was demanding my attention every 10 minutes. After a couple of those patients you learn very fast how to deal with them.
I was fooled yesterday by a patient, trying to get a "get out of jail free card" by faking a seizure and urinating on herself......she disappeared as soon as a friend arrived to pick her up....and people wonder why ER nurses have a reputation of appearing to not care!
These patients are very time consuming. I worked on a stepdown unit and would have three other patients plus this one manipulative patient and it was frustrating to not be able to provide the kind of care I would like to because I was in the room with this one patient who was demanding my attention every 10 minutes. After a couple of those patients you learn very fast how to deal with them.
"At 1200, I need my dilaudid. At 1210 I will require my phenergan IV push. At 1220 I need my valium. At 1230 I will require zofran. At 1240 I'd like my oxy pill. At 1250 I'll state my pain at a five, walk around my room and straighten things up, and ask for a sandwich. At 0100 I'll need dilaudid again....."
I took care of a middle aged lady who was actually diagnosed epileptic because of an inoperable brain tumor. However, she also had "fake" seizures. When things didn't go her way, she would moan and shake and all we had to do was stand in front of her and she would stop and talk to us. We all knew the difference between her real seizures and her fake seizures. During her real seizures, she would snort and drool and her nostrils would flare and she would not respond until the seizure was over. Whenever we oriented new nurses and aides we had to make sure they knew the difference. Her real seizures would award her neuro checks and vitals for 72 hours. Her fake ones were documented as an adverse behavior and she was monitored for 24 hours, with all behaviors in between documented as well.
be VERY careful about labeling a pt. I understand where yall are coming from. I have seen many fake seizures.....but....
I have epilepsy. I was having very frequent seizures for unknown reasons. had a doc who foolishly, along with several nurses & staff members, claimed and documented "psuedoseizures". was actually discharged like this and my family took me straight to another hosp where I was seen by a neurologists. had a stat EEG and was having cont seizure activity.
not only did the doc and nurses that labeled me as faking look completely foolish but could have set themselves up for some serious liability. yes.....it is very annoying to have a pt fake a seizure for attention......but not everyone seizing has the same symptoms. their main reason with me was because of no loss of bowel control. A neuro has sinced diagnosed and treated my epilepsy (catamenial) and I haven't had a seizure in 3 years! while that doc and those nurses are very intelligent they are now looked upon as completely foolish. remember we are dealing with a persons life.......not how annoyed we are!
Be very careful trying to play God and decide if a pt is faking!
You two hit the nail on the head!! They will wear you out if you don't, and it is really sad to see a young person's life turned around when they actually DO have a seizure disorder. They miss out on many of the things that teenagers and young adults enjoy due to the dx, stress, tx, ect.
And, I'm not saying that pseudo seizures don't deserve care, but I CAN NOT fathom taking it to the extreme that I was intubated!
) were under control.
RN1982
3,362 Posts
The problem is, is that there are patients who do fake seizures and they are time consuming and energy draining if you don't be firm and straightforward with them and let them know that you will not put up with their manipulative behavior.