Per provider orders, you administer 2mg Ativan IV Push twice in 10 minutes. Ms. Cerulean continues to seize without ceasing. The provider determines that she needs to be intubated for airway protection. Per orders, you administer a loading dose of levetiracetam and fosphenytoin and the EEG technician is on the way to place the EEG electrodes.
Critical Thinking Check
Bloom's Taxonomy: Comprehension
What is the name of the condition Ms. Cerulean is in now?
To measure brain activity to determine the severity of the seizure. It can also sometimes pinpoint where the seizure is originating
It can also indicate whether or not seizures are still occurring, even after phenobarbital or a paralytic medication is administered.
They should have a seizure action plan and know how to keep her safe in the event of a seizure. This includes knowing how to administer medications and when to call 911: seizure lasting longer than 5 minutes, cyanosis or apnea, or back-to-back seizures.
Ms. Cerulean is placed on a phenobarbital IV drip and additional doses of levetiracetam and fosphenytoin are administered q6h per provider orders. After 20 hours, the EEG finally begins to show decreased seizure activity.
Prolonged seizures can cause damage to neurons in the brain, leaving long term neurological deficits.
Because of possible airway compromise, prolonged seizures can also lead to hypoxia, which also can cause brain damage and leave neurological deficits
Three days later, Ms. Cerulean is awake and able to be extubated. She doesn’t appear to have any neurological deficits at this time and is able to ambulate safely in the halls. She will likely be discharged home in the morning.
[faq lesson=”true” blooms=”Application” question=”What education topics should be included in discharge teaching for Ms. Cerulean and her family?”
Importance of compliance with antiepileptic drugs to prevent breakthrough seizures.
Cornell Note-Taking System Instructions:
Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the "real-world" disease process. To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the "critical thinking checks" as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about - growing in your clinical judgement.