本文发表在 rolia.net 枫下论坛Definition: Status Epilepticus is defined as 30 minutes or so of continuous seizure activity or a series of seizures without return to full consciousness between seizures.
Medical Maangement:
Confirm that the client has a tonic-clonic Status Epilepticus that is prolonged or repetitive seizures have occurred.
IV medications per D/O: Benzodiazepines, Diazepam (Valium) Lorazepam (Ativan), Midazolam (Versed), Phenpbarbital, Phenytoin (Dilantin).
Assess client's airway & oxygenation - check blood gas level.
Carry out Neurologic screen/exam for focal intracranial lesion.
Laboratory test: serum electrolyte, BUN, sucrose, antiepileptic drug levels, toxic drug screen, CBC
MRI & CT Scan
Lumbar puncture to r/o infectious etiologies
EEG (electroencephalography) - to establish diagnosis of the condition
Nursing measures:
At 0 minute:
initiate systemic support of the airway
check B/P
begin nasal oxygen
monitor ECG & respiration
check temperature frequently
perform neurologic exam
send serum sample to the lab
start IV line with isotonic saline at low infusion rate (per D/O)
call Lab to start EEG (per D/O)
admin Ativan 0.1 to 0.15mg /kg (per D/O)
At 20-30 minutes, if seizures persist:
check temp
as per D/O: intubate, insert bladder catheter, start EEG, admin Phenobarb loading dose of 20mg/kg IV (100mg/min)
At 40-60 minutes, if seizures still persist:
Per D/O- Phenobarb @ 5mg/kg IV initial then IV push until seizure stopped
monitor EEG
continue to monitor and document V/S
document I & O
Patient Goal:
Maintain optimal physiological functioning and preventing psychological stress.
Keep client free of systemic complications eg. cardiac, respiration or renal failure, fluid & electrolyte imbalance, hyperpyrexia.
Outcome:
Client was managed medically and was free from any complications. Optimum nursing care was carried out and client will resume to his/her ADLs with assistance and monitoring at first until confident to do so.
Reference: HealHealthCareNow.org/StatusEpilepticus更多精彩文章及讨论，请光临枫下论坛 rolia.net