Initial Home Visit Assessments

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Seizures

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Module 09 Content

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An older client was recently discharged from the hospital for evaluation of seizure activity. His history reveals that he has late-stage Alzheimer’s disease, Parkinson’s disease, hypertension, and type II diabetes mellitus, which is controlled by diet. He lives at home, where his wife and daughter take care of him. His discharge medications include phenytoin (Dilantin), 100 mg BID; hydrochlorothiazide (HydroDIURIL), 50 mg QD; levodopa (Sinemet), 25/100 TID; and haloperidol (Haldol), 1 mg before bed. The client has been referred for home care nursing follow-up.

Questions:

    1. On the initial home visit by the nurse what assessments should be made?
    2. The wife and daughter need teaching about his antiepileptic medication. What teaching should be included?
    3. During the initial home visit the client experiences a generalized seizure. What action should the nurse take?

Alterations in Metabolism

  Obesity Hyperthyroid Hypothyroid
Pathophysiology  

 

 

 

    
Risk Factors  

 

 

 

    
Assessment Findings (including Labs)  

 

 

 

 

 

    
Possible Nursing Diagnosis  

 

 

 

    
Interventions (including Medications)  

 

 

 

 

 

 

 

    

initial home visit assessments

Initial Home Visit Assessments

When the nurse visits the client at home for the first time, several key assessments should be made:

  1. Vital Signs: Measure blood pressure, heart rate, respiratory rate, and temperature to monitor hypertension and overall health.
  2. Neurological Assessment: Evaluate the client’s level of consciousness, cognitive function, motor skills, and any focal neurological deficits to monitor the effects of Alzheimer’s, Parkinson’s disease, and seizure activity.
  3. Seizure History: Obtain detailed information on recent seizure activity, including frequency, duration, and characteristics of seizures.
  4. Medication Adherence: Assess the client’s and caregivers’ understanding and adherence to the prescribed medication regimen.
  5. Safety Evaluation: Inspect the home environment for potential seizure hazards and ensure that safety measures are in place.
  6. Dietary Assessment: Review the client’s diet to ensure it is appropriate for managing type II diabetes.
  7. Functional Status: Assess the client’s ability to perform daily activities and the level of assistance required.

Teaching for Antiepileptic Medication (Phenytoin)

When educating the wife and daughter about the client’s antiepileptic medication, the following points should be included:

  1. Medication Purpose: Explain that phenytoin is used to control seizures.
  2. Dosage and Timing: Emphasize the importance of taking the medication exactly as prescribed (100 mg BID).
  3. Potential Side Effects: Inform them about common side effects such as dizziness, drowsiness, unsteady movements, and potential gum overgrowth.
  4. Monitoring Levels: Highlight the need for regular blood tests to monitor phenytoin levels and adjust dosage if necessary.
  5. Drug Interactions: Advise them to inform healthcare providers about all other medications being taken to avoid interactions.
  6. Dietary Considerations: Mention that phenytoin can interact with certain foods and that maintaining a consistent diet can help manage its effects.
  7. Safety Precautions: Provide tips on how to manage and prevent seizures, including what to do during a seizure.
  8. Missed Dose: Instruct them on what to do if a dose is missed (do not double up; take the missed dose as soon as remembered unless it’s close to the next dose).

Action During a Generalized Seizure

If the client experiences a generalized seizure during the visit, the nurse should:

  1. Ensure Safety: Move any dangerous objects away from the client to prevent injury.
  2. Positioning: If possible, turn the client on their side to help maintain an open airway and prevent aspiration.
  3. Timing the Seizure: Note the start and duration of the seizure.
  4. Do Not Restrain: Avoid restraining the client or placing anything in their mouth.
  5. Monitor Breathing: Observe the client’s breathing and be prepared to provide basic life support if needed.
  6. Post-Seizure Care: After the seizure stops, check the client’s airway, breathing, and circulation, and provide comfort and reassurance.
  7. Documentation: Document the seizure characteristics and report them to the healthcare provider.
  8. Emergency Assistance: Call for emergency medical help if the seizure lasts longer than 5 minutes, there is a series of seizures without regaining consciousness, or if there are any concerns about the client’s condition.

Alterations in Metabolism: Obesity, Hyperthyroid, Hypothyroid

Obesity

Pathophysiology:

  • Excessive accumulation of body fat leading to adverse health effects.

Risk Factors:

  • Genetic predisposition, sedentary lifestyle, unhealthy diet, metabolic disorders.

Assessment Findings (including Labs):

  • BMI > 30, elevated fasting glucose, abnormal lipid profile, increased waist circumference.

Possible Nursing Diagnosis:

  • Imbalanced nutrition: more than body requirements
  • Risk for impaired skin integrity

Interventions (including Medications):

  • Diet and exercise plan, behavioral counseling, possible pharmacotherapy (e.g., orlistat), monitoring for comorbidities.

Hyperthyroid

Pathophysiology:

  • Excess production of thyroid hormones, leading to accelerated metabolism.

Risk Factors:

  • Autoimmune conditions (Graves’ disease), thyroid nodules, excessive iodine intake.

Assessment Findings (including Labs):

  • Weight loss, tachycardia, heat intolerance, TSH low, free T4 high.

Possible Nursing Diagnosis:

  • Imbalanced nutrition: less than body requirements
  • Activity intolerance

Interventions (including Medications):

  • Antithyroid medications (e.g., methimazole), beta-blockers for symptom control, radioactive iodine therapy.

Hypothyroid

Pathophysiology:

  • Insufficient production of thyroid hormones, leading to a slowed metabolism.

Risk Factors:

  • Autoimmune conditions (Hashimoto’s thyroiditis), iodine deficiency, thyroid surgery.

Assessment Findings (including Labs):

  • Weight gain, fatigue, cold intolerance, TSH high, free T4 low.

Possible Nursing Diagnosis:

  • Imbalanced nutrition: more than body requirements
  • Fatigue

Interventions (including Medications):

  • Thyroid hormone replacement (e.g., levothyroxine), regular monitoring of thyroid function tests, patient education on medication adherence and symptoms of over/under-treatment.
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