Generalized Tonic-Clonic Seizure - A Case Study

Running head: GENERALIZED TONIC-CLONIC SEIZURE - A CASE STUDY
GENERALIZED TONIC-CLONIC SEIZURE – A CASE STUDY
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GENERALIZED TONIC- CLONIC SEIZURE – A CASE STUDY1
Jenny Peterson is a 23 year old patient diagnosed with tonic clonic seizure
after a car accident. She is a receptionist and a single mother to daughter
Samara who is just two years old. Her financial status has weakened, given the
continuous leaves due to her physical condition. With no support from her
husband by any means, her emotional status is highly compromised in addition
to neurological problem. Due to recurrence of her symptoms, she is now visiting
outpatient’s neurology clinic. Initially during her diagnosis, she received sodium
valproate during hospitalization and now, she receives the same at 200mg daily
and lamotrigine at 200 mg daily. Community care is critical in every health
system because it can prevent re-admission to hospital again and reduce
hospital expenses. The first motive of a community health nurse is to focus on
increasing patient knowledge about her disease and what are the trigger points
she needs to avoid during self-care. Promoting patient participation, patient
centeredness and patient knowledge is vital to Jenny’s management (Castro et
al., 2016). The aim of this case study is to formulate systematic nursing and
medical interventions based on the priorities.
Cuing the information, two care priorities can be formulated from Jenny’s
present condition. She is a single mother, her parents stays some suburbs away
and she lives with her baby daughter. Handling social isolation of the patient
along with related fears, anxieties and depression is the first priority. Sustaining
drug adherence in the patient is the second priority because she clearly desired
to “go off” the medications.
On processing Jenny’s present condition, lack of emotional and financial
support from Jenny’s husband in association with the neurological condition has
led to Jenny’s social isolation. Absenteeism from job, economic problems and the
fear that she may not be able to care for her daughter properly has led to
worsening of her depression which should be addressed with priority care. As
because Jenny has already expressed her wish in non-adherence to
anticonvulsant medications to check if she does fine otherwise. It becomes
important in identifying this ‘wish’ of hers as a potential problem and it should be
addressed as a high priority to keep her on the medications.
There are potential problems entangled with her neurological and social
situation. Depression along with chronic diseases can lead to suicidal attempts.
The chief cause of suicide is depression (Shahtahmasebi, 2013). With no other
adult to oversee Jenny at home, an occupational therapist can assess the risks

GENERALIZED TONIC- CLONIC SEIZURE – A CASE STUDY2
prevalent at her home. Jenny showed symptoms of tonic clonic-seizure three
months after a car accident which is indicative of a traumatic brain injury with
histological changes. Behavioral and emotional dyscontrol is a very common
symptom occurring as a neuropsychiatric sequel after an event of traumatic
brain injury (Arciniegas & Wortzel, 2014). Non adherence to medications can
lead to death in seizure patients and her adherence should be managed highly.
Research shows that generalized tonic-clonic seizure is the most
common seizure which has found to be associated with sudden unexpected
death in epilepsy (SUDEP) with ten times more occurrence in adults as compared
to children (Freitas et al., 2013).
The first goal is to develop self- understanding in Jenny, remove life-risk
factors and promote her Activities of Daily Living (ADL) skills. Every skill and self-
knowledge adds to improvement of quality of life (Mahrer-Imhof et al., 2013). A
client- centered intervention should help Jenny achieve a balance between
social, personal and professional life in about two and half months. The second
goal is to sustain Jenny’s medication adherence. With proper intervention, the
goal can be achieved in the first week itself.
To achieve the first goal - motivational counselling, self-esteem
development with improvement in activities of daily life is a vital plan of action in
nursing cycle. In conjunction, an occupational therapist must eliminate any
threat at Jenny’s home. Skills training, physical activities, cognitive behavioral
training and goal directed therapy is useful in psychosocial impairments
(Wheeler, Acord-Vira & Davis, 2016). Cognitive behavioral therapy is very
efficient treatment for handling depression associated with epilepsy (Gandy,
Sharpe & Perry, 2013). Presence of her parents would also help her come out of
social isolation. Jenny should continue having optimistic communication with the
community nurse and her peers where she should be encouraged to be discuss
her inner thoughts. Through this process, she would learn about her ‘cognitive
biases’ and also learn how to eliminate them for maintenance of mental and
physical health. That way, she can also focus on her infant daughter in a better
way. The management of seizure relies strongly on self-management and
intrapersonal ability of the patient. The next plan of action is to achieve the
second goal which is drug adherence through ‘patient knowledge’. Jenny should
be educated by the nurse with sufficient knowledge by explaining the
pathophysiology of seizure. Unemployment, seizure, frequency, health