An Older Client Was Recently Discharged From The Hosp 784318

An Older Client Was Recently Discharged From The Hospital For Evaluation

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.

Paper For Above instruction

When conducting the initial home visit for this elderly client post-hospitalization, a comprehensive assessment is essential to ensure safety, medication management, and effective care planning. The nurse should begin by evaluating the client’s current neurological status, especially focusing on seizure activity, cognitive function, and mobility. Observing the client’s mental status, responsiveness, and the presence of any neurological deficits is critical, particularly given the history of seizure activity and neurodegenerative diseases like Alzheimer's and Parkinson's. Vital signs, including blood pressure and heart rate, should be documented to monitor for potential side effects or complications related to the prescribed medications.

Assessments should also include a thorough review of medication adherence, possible medication interactions, and side effects, especially considering the potential for phenytoin to cause neurological and psychiatric side effects. The nurse should evaluate the client’s skin integrity, hydration status, and nutritional intake, as these factors influence seizure control and overall health. Functional assessments should include evaluating the client’s ability to perform activities of daily living (ADLs), mobility status, and balance, which are particularly relevant given Parkinson’s disease and the risk of falls.

Environmental safety assessments are equally important. The nurse should check for hazards such as loose rugs, clutter, poor lighting, or other factors that could increase fall risk—especially since Parkinson’s disease can impair gait and balance. The home environment should be optimized to minimize risks, and recommendations for modifications (such as grab bars, non-slip mats, and accessible pathways) should be discussed with the family. Family caregivers’ knowledge about seizure management, medication administration, and emergency response is vital to ensure continuous safety at home.

Additionally, the nurse should educate family members about monitoring for signs of seizure recurrence, medication side effects, and behavioral changes associated with Alzheimer's and Parkinson’s diseases. Emphasis should be placed on the importance of regular medication administration, recognizing early warning signs of adverse effects, and understanding when to seek emergency help.

During this visit, if the client experiences a seizure, the nurse’s response must be prompt and appropriate. The first step is to ensure the client’s safety by preventing injury—carefully turning the client onto their side (recovery position) to maintain airway patency and prevent aspiration. The nurse should avoid restraining the client or placing objects in the mouth. It is essential to time the seizure duration and observe its characteristics, such as tonic-clonic movements, tongue biting, or incontinence, to relay accurate information to emergency services if needed.

If the seizure lasts longer than five minutes, the client has multiple seizures without regaining consciousness, or if there are signs of respiratory distress or injury, emergency medical services should be activated immediately. Post-seizure, the nurse should remain with the client to monitor consciousness, airway, and breathing status. Once stabilized, the nurse must document the event in detail and notify the healthcare provider for further evaluation and adjustment of the seizure management plan if necessary.

Education for the wife and daughter should emphasize the importance of adhering to the medication regimen, recognizing early signs of seizure activity, and understanding the potential side effects of medications like phenytoin (e.g., gum hypertrophy, neurological symptoms). They should be instructed on how to maintain a seizure diary, including recording seizure episodes, duration, and any precipitating factors, which can inform future treatment adjustments.

Additionally, family members should be trained in basic first aid for seizures, including maintaining a safe environment during an episode, protecting the head, and not restraining movements. They should also know when to seek emergency help—specifically, if a seizure lasts longer than five minutes, if multiple seizures occur, or if breathing or consciousness does not resume normally afterward. Counseling on medication compliance, routine medical follow-ups, and the importance of maintaining a safe environment is fundamental to reducing risks and promoting the client’s safety and well-being.

References

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