By: Michelle Heim

EPILEPSY

• Describe Epilepsy • Summarize individual

research study and implications• Nursing theory• TRUEPIC care plan• Collaboration• Nurse as advocate

• Of presentation:

-Awareness

-Utilize evidence-based research

-Provide higher quality nursing care

• Of research:

-examine goal setting as intervention

Overview of Presentation

Purpose

What is Epilepsy?• Unprovoked, recurring seizures

• Classified by: age at onset, family history, and seizure type

• Most forms occur in childhood

• Can be primary or secondary, simple or complex, partial or generalized

• Possible triggers: emotional, environmental, menstruation (female), or fever

Exploring the Research• “Content and characteristics of goals created during a self-

management intervention for people with epilepsy”

• Identifies self-management through goal creating as an intervention for people with epilepsy

• Other Theories within the research: -Goal-Setting Theory (Locke & Latham, 2002)

-Transtheoretical Model (Prochaska & DiClemente, 1983)

• Nursing Theory: Imogene Kings’ Goal Attainment Theory (1971)

-Patient is a personal system within a social system

-Nurse and patient work together for best outcomes

Article Summary

Methods

• Recruited from two hospital-based clinics

• Criteria for eligability

• WebEase-Medication-Stress-Sleep

• SMART Goals-Specificity-Proximity-Difficulty

Results

• At the end of 2 weeks:

-88.9% in action or maintenance stage for medication management *taking meds consistently

-54.5% in action or maintenance stage for stress-related behaviors *stress reduction techniques

-61.9% in action or maintenance stage for sleep habit behaviors *modify bedtime behavior

Article Critique

Limitations

• Generalizability

• Goals for medication adherance

• Participants were volunteers

• Study conducted in a controlled environment

Credibility

• Quasi-experimental with pretest-posttest design (Level III) –further research

• Credible Authors

• Journal of Neuroscience Nursing

• 32 references

• Ethical indications

Collaboration• Patients/Families

• Doctors

• Other nurses

• Pharmacy

• Lab

• Nursing Assistants/Technical Assistants

• PT/OT

• Respiratory

• Dietary

TRUEPIC ScenarioSituation: Jenny is a 40 year old woman who was diagnosed with epilepsy when she was six. She has a positive family history of epilepsy. She was prescribed phenytoin (Dilantin) to help control her seizures. Over the past two weeks, Jenny has been experiencing an increase in the number and intensity of her seizures. The results for Jenny’s phenytoin levels came back from the lab and were below the therapeutic level (10-20 mcg/ml) at 2 mcg/ml. When asked if she has been compliant with taking her medication, Jenny states, “I have stopped taking it since my gums have become bigger. I will start taking my dose as prescribed once they look normal again”.1. Identify:

• 4o yr. old female• Dx. of epilepsy since age

6• Positive family hx• Frequent and worsened

seizures over past 2 weeks

• Dilantin below therapeutic level at 2 mcg/ml

• Admits to being noncompliant with taking her medication

• Gingival hyperplasia is the reason for noncompliance

2. Relate:

Primary Proposition: “Pt. is experiencing seizures that are more frequent and more intense due to abruptly stopping her medication”Possible Assumptions: “Pt. Is aware of the consequences of abruptly stopping her medication”Possible Confounding Variables: “Self-image issues are the root cause of her noncompliance with medication therapy”

TRUEPIC Cont’3. Understand:Proposition: “If patient does not become compliant with medication regimen and does not attain/maintain a therapeutic level, increased frequency and intensity of seizures will continue”Significance of Assumptions: “If the pt. is unaware of the consequences of abruptly stopping medication she may be unintentionally contributing to the worsening of her condition”Possible Confounding Variables: “If pt. is dissatisfied with the drug side effect of gingival hyperplasia then she may be reluctant to start taking her medication again”

4. ExplainProposition: “In a way meaningful to the pt., explain that abruptly stopping her medication is causing her to have a worsening in her condition and that therapeutic levels need to be managed”Significance of Assumptions: “Explain the benefits of maintaining a therapeutic drug level to the patient and its relationship to the management of her epilepsy”Confounding Variables: “Explain the side effects and proper management with the pt.”

TRUEPIC Cont’5. Predict:Proposition: “If the pt. does not become compliant with medication regiment and attain/maintain therapeutic drug levels, the pt. is at increased risk for decreased safety and functionality”Assumption: “If the pt. will become compliant with drug therapy, then therapeutic drugs levels will be achieved and seizures will occur less frequently and with less intensity”Confounding Variables: “If pt. is educated on how to deal with drug side effects, then pt. will not have body-image issues and will be compliant with drug therapy”

6. Influence:Proposition: “Make sure pt. understands benefits of drug compliance and attaining/maintaining therapeutic drug levels”Assumptions: “Make sure pt. understands the consequences to stopping her drug regimen abruptly”Confounding Variables: “Influence the pt. to become compliant with drug regimen by teaching her to practice thorough hygiene after meals, massage her gums, floss daily, and receive regular dental care in order to control gingival hyperplasia”

7. Control:

Pt. is scheduled for a lab draw in the office to assess drug compliance

Nursing Diagnoses

-Deficient Knowledge r/t epilepsy and its control AEB noncompliance with medication regimen

-Body-image issues r/t side effect of drug AEB noncompliance until gingival hyperplasia diminished

-Risk for injury r/t seizure activity AEB increase in frequency and intensity of seizures

Advocacy: Role and SignificanceAdvocate• Empathic care

-embarrassment-fear

Research Implications• Avoiding/managing triggers

- meds at same time daily/ not skipping doses

- techniques: relaxation and meditation- no TV before bed, reduce caffeine , not

worrying• Create goals with patients, not for patients

References• Brunner, L. S., Smeltzer, S. C., Hinkle, J. L., & Cheever, K. H. (2010). Brunner & Suddarth's textbook of medical-surgical nursing (12th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.• Taylor, C., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: the art and science of nursing care (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.•Walker, E. R., Wexler, B., Dilorio, C., Escoffrey, F., & Yeager, K. (2009). Content and characteristics of goals created during a self-management intervention for people with epilepsy. Journal of Neuroscience Nursing, 14(6), 312-321. Retrieved from General OneFile database.