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Psychiatric   (4,503 Views 3 Comments)
by diawc diawc (New Member) New Member

diawc has 15 years experience and works as a Supervisor.

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I work in a free standing psych facility and we are looking to strenghten some of our policies. One I am working on is around seizures - what do you do for nursing interventions, what meds are you using, and when do you send out to an ED? Thanks for your help with this!

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sameasalways has 8 years experience and works as a RN.

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Hi, I don't work at a psych facility so I know some of what I say probably is going to sound silly. I work on a surgical floor and we get the post/op patients and some medical patients. When we have someone on "seizure precautions", the things that are supposed to be automatically put into place are 1. HOB elevated, 2. Low lighting, 3. Suction at bedside, 4. Side rails padded. Usually the patient with a seizure history has PRN seizure meds they get. I think what might be helpful would be a standing order/protocol for seizures..barring any cardiac history/respiratory disorder because I am not sure what impact some of those PRN seizure medications might have in that situation. I know if a seizure happens on the floor we are just supposed to observe it and write down what we saw but frankly most of the time, when a seizure has happenned, there was a sitter in the room from the original facility that the patient came from (they are usually long term care patients that get sent to us) and usually the seizure is so brief that we only have a description of what the sitter saw, who is usually well versed in what that specific patients seizure looks like and would probably more readily identify it than me. A friend worked at a neuro center for spinal cord issues, ect and she said they had to do rectal checks on those type of patients because a significant cause of seizure in them was constipation or being impacted. Due to their spinal cord issues their bowels didn't behave normally and were usually dependant on enemas to maintain effective evacuation of stool. If this didn't occur it would cause seizure activity. I recently had a patient at the hospital in this situation and he was there due to problems with not having a bowel movement over the course of a week. I gave him his enema CORRECTLY and he had a large bowel movement. There was no stool in his rectum as I checked for impaction. In fact the whole inside of his rectum was ballooned out, for whatever cause of that I am not sure as I had never heard of that. The dr had me give him a gallon of go-lightly as well. They were hoping to rid the patient of this problem for good. But he had a few seizures until he had his enema and his seizure medication which I believe was gabetrol (I can't remember). His seizures are so brief I never saw them (2 of them) but they consisted of his body rapidly cramping up, then releasing (just one time). Sorry I haven't been more helpful I am not sure what kind of seizures occur in a psych setting but I am interested in learning. I could see however how a PRN standing order sheet signed by the physician would be helpful...they do this in the hospital for diabetics, ect and specific orthopeadic surgeries.

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Davey Do has 35 years experience and works as a Behavioral Health RN.

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sameasalways gave a lot of good basic interventions. I can only augment her reply:

We make sure it's noted on the chart and the patient list that the patient has a seizure d/o. Upon admission, labs are drawn and the particular anticonvulsant levels are either found to be therapeutic or are dealt with accordingly. The history, type of seizures, and last episode is noted on the nursing assessment.

One facility I worked at had a prn order for a specificr benzodiazepine (valium or ativan) to be given IM in the event of a seizure. It was a good standby.


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