Reference no: EM133658879

Case Study

Robert is a generally happy and engaging 13 year old. He is the eldest of three children and is very close with his two brothers and his parents who take him home overnight, every 2nd weekend and for holidays as much as possible.

Robert has Cerebral Palsy with spastic diplegia because of having had a brain injury at the age of 5 months. He has a severe developmental disability in the moderate range. Robert is living in a 24 hour supported, group living residence with four other children who also have developmental disabilities.

Robert can stand to transfer from his manual wheelchair to bed, etc., but is not able to walk. Robert eats foods that are minced or soft, because he is not able to chew his food sufficiently before he swallows. Robert has grown ¾" and has gained 5 pounds in the last 2 months.

Robert has been having absence and tonic-clonic seizures since birth. During the absence seizures, Robert appears to be looking at you, but does not respond to your questions; these episodes last 30 seconds in length. According to the seizure data sheets, Robert used to have four of these episodes each month, but

during the last two months, he is now having eight each month and they usually occur at breakfast. Robert has not had any tonic clonic seizures, in two years. The seizures often last 3-5 minutes which is very typical of tonic

clonic seizures and Robert often produce copious amounts of oral secretions during the seizure and is incontinent.

Robert has a prn order of Ativan to be given when a seizure lasts 3 minutes and can be repeated after another three minutes. Then if the seizure persists after another three minutes, staff will call 911 and accompany

Robert to the hospital. A pediatric neurologist follows Robert and you will be accompanying him to his 4- month follow-up appointment next week.

Medications that Robert takes include:

· Carbamazepine chewable 200mg/tab- take 1 tab bid, po at 0800 and 2000 hrs

· Lorazepam SL 1 mg tab - give SL at 3 minutes into a seizure. May repeat once if still seizing at 6 minutes. If seizure persists after another 3 minutes, call 911 and accompany Robert to the hospital.

· Multivitamin, children's chewable 1 tab, po with breakfast at 0800 hrs

· Acetaminophen 500 mg/tab - take 1 tab, po, q4h prn for pain or fever >38°C.

Questions:

1. Identify the anticonvulsants that Robert is taking. For each anticonvulsant complete a medication information form, and then prepare medication administration record for him (to begin at the start of the month.) Instead of using, the abbreviations on the MAR's (i.e. po, q4h, tid, etc.) write/type them out in full.

2. Your team is supporting Robert. You have been asked to develop a draft seizure protocol specifically

for Robert using information above and from the Epilepsy Canada or Toronto web site and other reliable resources.

The purpose of the protocol is to ensure that everyone is clear on the nature of Robert's seizures and the action to take when a seizure occurs. In the Protocol you will include the following:

- Identify and describe the two types of seizures that Robert experiences.

- Identify first aid required (include both do's and don'ts)

- Identify who should be notified, and when.

3. You will be taking Robert to his neurology follow-up appointment next week. Identify what you are going to do to ensure that Robert is well supported at this appointment to achieve the best possible outcome. Identify your actions before, during and after the appointment.