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Seizures real vs fake

Correctional   (149,939 Views 41 Comments)
by princess pickles princess pickles (Member)

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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 fakers/manipulators/attention seekers? And how do you know the difference? Just curious because I know there are different kinds of seizures. I am new to the jail population of patients and am trying to be safe with the real seizures vs the manipulators.

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Rob72 is a ASN, RN and specializes in Infectious Disease, Neuro, Research.

685 Posts; 9,388 Profile Views

Oh, Lord, sis, you are innocent!

Probably the easiest "tell" for seizure activity, whether absence or GTC, is the pain response. Use a Bic pen (tail or cap), and press it forcefully into the cuticle area of a fingernail. If they withdraw, they're faking. If they are playing GTC (generalized tonic clonic) with flopping, shaking and foaming at the mouth, they may continue with this, but the limb receiving pain will be rigid, attempting to minimize manipulation which would cause more pain.

For an absence seizure (staring spell) you can flick at their eyes, and they won't blink. Again, risky in that they may alleged that you hurt them, they may injure you, using sx activity as an excuse, etc..

I say this with the obvious caveat that you may have someone take a swing at you, and say they were, "out of it". Either get a CO to do it for you, do it only under very controlled circumstances, or just let them flop(probably safest).

For your experience level, and being female, I would probably simply say that if they display a post-ictal state, they had the real thing(confusion, discoordination, lethargy). Anything else is faker-faker.

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MichaelaM,RN is a BSN, RN and specializes in Dispensary.

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When I have an inmate say they had a seizure, it is usually after the fact. I rarely have the CO call and tell me that an inmate is CURRENTLY having a seizure. A quick review of their history (once they are stable) can help. Do they have an ETOH or seizure history??

The safest thing is usually to get them stabilized as you would any seizure (turn them, do a neuro assessment, get them oriented) and then let them spend the night in the infirmary with qh or q 15m observation, depending on their LOC. If they're faking it, then they get 24h in observation, which is basically like isolation, no TV. If they're not faking, then you did the right thing by taking them to the clinic.

Just my opinion.

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Multicollinearity has 4 years experience as a BSN, RN and specializes in Acute Care Psych, DNP Student.

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Fakers:

Tend to pinch their eyes shut

Lack excessive secretions

Maintain normal or almost normal blood oxygenation

Do not have bite marks on their tongues

Do not have post-ictal confusion

Tend to sometimes "wake up" afterwards like waking up from sleep

Will allow you to drop their hand into their face - they've all seen or heard of that episode of ER

Strong sternal rub can bring them out

Real:

Excessive secretions

Lose bladder/bowel control

Pale, diaphoretic

High HR & high BP

Low blood oxygenation at times

Post-ictal confusion

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txredheadnurse has 39 years experience as a BSN, RN and specializes in Correctional, QA, Geriatrics.

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One of my favored methods for sorting out the real from the fake was an ammonia inhalant. Broken and waved under the nose of someone faking a seizure (usually with their tightly clamped eyes and mouths ensuring all the fumes went right up the nares) it never failed to elicit a marked response from the fakers.

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Multicollinearity has 4 years experience as a BSN, RN and specializes in Acute Care Psych, DNP Student.

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txredheadnurse,

I know the ammonia inhalant is supposed to work, but I've had two fakers recently who managed to not respond to it. One even admitted later that he was faking and trying to get a fix of diazepam - he showed no response.

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txredheadnurse has 39 years experience as a BSN, RN and specializes in Correctional, QA, Geriatrics.

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If that is the case then combine wafting the inhalant with a good sternal rub. Or just bypass the inhalant and use the rub. That is a tender area and rotating the knuckles briskly is virtually impossible to ignore if conscious.

For myself I never had a failure with the inhalant because I broke it right under the nose and left it there for several seconds before I moved it. The concentrated fumes are very difficult to ignore with either a flinch, grimace or copious tearing.

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In correctional nursing you rely on more of the objective data than subjective data. To differentiate real from fake always assess efficiently. General apperance, vital signs, incontinence, pupils, foaming, sounds, movement, sensation, orientation, etc. At first it'll be hard but it get's easier to spot the real and fake ones. Never get in the mentality that everyone is faking or don't let custody or even other health care influence your assessment if they say he/she is just faking.

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I walked back into the jail once to see an inmate that was having a "seizure" after "falling" off his bunk onto the floor. I radioed to the deputy room and had one of the guys come back with his K9. As soon as Stinger entered the pod on lead the "seizing" inmate jumped to his feet and quickly scrambled back to the top bunk. It was a miracle.

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One trick a coworker shared is rubbing a handful of ice on the person's belly. If they're faking they recover instantly, and most of the time they start to "come out of it" when you loudly ask the nearest officer for a handful of ice. I've never actually tried it, but there were no fake seizures on that nurse's shift!

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the first thing I check is pupillary response.....pupils will generally be dilated and/or sluggish to respond to light. There is almost always nystagmus with the dilated pupils. As soon as they stop jerking, I generally start asking questions as if they are awake when I suspect faux seizures.....like do you take seizure meds, what med, when was the last dose, how long have you had seizures, when was your last drug level, was it low, etc. The fakers generally end up answering all the questions accurately, albeit with some drama. After 32 years of ER nursing I can say I've never seen anyone wake up from a seizure and be able to answer those type of questions.

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