School-Age Students with Seizures and School Nursing - Dissertation Example

? Seizures and School Nurse Number s and Number Number of Words: 2,499 Introduction Epilepsy is a medical condition that is characterized by recurrent seizures that are caused by abnormal electrical activity in the brain that leads to involuntary movements in the body function, physical awareness or behavior (CDC, 2011). As of 2011, there are as much as 2.0 million cases of epilepsy throughout the United States and that 10% of these people are expected to go through the symptoms of seizure from time-to-time (ibid). Although there are as much as 30 different types of seizures, this particular disease is often categorized as generalized or partial (National Dissemination Center for Children with Disabilities, 2010). In line with this, the Epilepsy Foundation (2011) has recently reported that there are as much as 120,000 individuals below the age of 18 years old are going through seizure and that between 75,000 to 100,000 of these young people are experiencing seizure attacks are under the age of 5 years old. On top of this figures, approximately 326,000 school-age children are suffering from epilepsy at the age of 15 years old (ibid). Considering the number of school-age students who may anytime go through seizure attack, this report will focus on describing how the school nurse should function as the coordinator of epileptic students in school and within the community circle. To allow the readers gain better understanding about this subject matter, the etiology of epilepsy, its presenting signs and symptoms, and the appropriate medical treatment, medication and its side-effects. Eventually, a literature review will be conducted to determine the best educational accommodations available to the students including the organizations or special support that should be made available to epileptic students and parents based on the students concerns as they progresses through elementary, middle, and high school years of education will be explored in details. Literature Review Etiology of the Disease Etiology of epilepsy is multi-factoral by nature. Even though one can be more predominant than the other, there are some studies suggesting that the main causes of epilepsy are mostly combined genetic factors, developmental factors (i.e. birth asphyxia, malformation of the cortical or vascular development), or diseases that are often associated with epilepsy (i.e. neurodegenerative disorder, CNS infection, tumor, autoimmune disorders, hippocampal sclerosis, idiopathic generalized epilepsy, cerebrovascular diseases, cryptogenic) (Shorvon, Andermann, & Guerrini, 2011, p. 113; Silva, 2009; Wyllie, Gupta, & Lachhwani, 2005, p. 348, 351; Maudgil, 2003, p. 3). Aside from inheritable health conditions like tuberous sclerosis, metabolic syndrome or chromosomal aberration; patients with history of alcoholism, head injury or head trauma, stroke, or the presence of vascular diseases could also trigger epilepsy (Shorvon, Andermann, & Guerrini, 2011, pp. 114 – 115; Wyllie, Gupta, & Lachhwani, 2005, p. 351). Presenting Signs and Symptoms In general, the presenting signs and symptoms of epilepsy includes: loss of consciousness or confused memory, fainting followed by excessive fatigue, excessive involuntary body movements of the arms and legs, the loss of muscle tone or movement, disturbances in the patient’s mood, behavior, sensation and perception (Silva, 2009). In case the student is going through a simple partial seizure, Silva (2009, p. 33) revealed that the school nurse should be able to observe “visual, auditory, olfactory, gustatory, or vertiginous misperception or hallucinations”. In line with this, the student may show signs of finger or hand shaking or the uncontrollable jerking of the mouth (Wagner et al., 2009). In some cases, the student may end up talking without any sense or complain about dizziness, unpleasant sights, odors, sounds, or taste in case the patient is still conscious. In case the student is going through complex partial seizure, the school nurse can observe the student having impaired or altered levels of consciousness aside from being motionless or show some uncoordinated movements. Aside from being unable to recall the past seizure attacks, the student who is suffering from a complex partial seizure may show signs of excessive emotions related to anger, fear, elation, or irritation which makes the student shout or scream or end-up chewing his/her tongue, smacking their lips, spitting, swallowing, or complex automatism like running in circles or undressing since the patient at this point is confused (Silva, 2009, p. 35). It is common for convulsive movements to occur within a time frame of 1 to 2 minutes per seizure attack. In the case of generalized seizures (grand mal seizures), the student may show signs of intense rigidity within the entire body followed by a jerky alterations of the muscle contraction (tonic) and muscle relaxation (atonic) (Silva, 2009). This is possible since a generalized seizure involves the patient’s brain hemispheres (ibid). It is also possible on the part of the school nurse to see simultaneous contractions in the patient’s diaphragm or chest area which eventually produces epileptic cry. The only difference between a simple partial seizure and complex partial seizure is that the student is expected to experience impaired consciousness in complex partial seizure but not in simple partial seizure (Schwartz, 2003, p. 470). After incidence of simple partial seizures or complex partial seizures, the student will end-up feeling relaxed and often times breathing noisily in a deep coma. After sleeping for long period of hours, the student can end up complaining about feeling confused or having sore muscles and headache. Medical Treatment, Medications and Side Effects that Impact the Student during the School Day In order to prevent the patient from possible brain damage, the medical intervention for epilepsy is often based on the immediate needs of the patients. To immediately stop the seizure, the provision of cerebral oxygenation is necessary to make the patient able to reach a seizure-free health condition (Smeltzer et al., 2009, p. 1888). In line with this, intubating the patient with sufficient oxygen should be established. To prevent cases of hypoglycemia, the school nurse should administer IV infused dextrose to the student right after the seizure attack (Smeltzer et al., 2009, p. 1888). Basically, it is not proper nor is it advisable on the part of the school nurse to insert the IV line or administer IV medication to the patient during the seizure attack since there is a greater risk that the school nurse may end-up causing more harm to the patient. In case the student would experience recurrent seizure attack, it is advisable on the part of the school nurse to closely monitor the patient’s IV line to ensure that it will not be dislodged during the next seizure attack (Smeltzer et al., 2009, p. 1889). With regards to pharmacologic intervention, the administration of intravenous diazepam (i.e. Valium) or lorazepam (i.e. Ativan) can be slowly given to the patient in order to stop the seizure (Smeltzer et al., 2009, p. 1888; Johnson, 2004, p. 327). Likewise, it is possible to give the patient with general anesthesia with short-acting barbiturate in case the initial pharmacologic intervention is ineffective in terms of halting the seizure (Smeltzer et al., 2009, p. 1888). Preferably administered at night, diazepam like Valium is a benzodiazephine which could trigger side-effects like yellowing of eyes and skin, dizziness, sleepiness, muscle weaknesses, somnolence and paradoxical side-effects like insomnia, increased levels of anxiety, hostility, hallucination and difficulty in walking, talking or breathing (Wolny, 2008, p. 28). Similar to the use of Valium, administration of lorazepam in managing the patient’s anxiety could also trigger side-effects like sedation, dizziness, weaknesses, unsteadiness, and disorientation on patients who are receiving this type of medication (Aronson, 2009, p. 415). As part of maintaining the patient’s seizure-free condition, the use of other anti-convulsant medication such as the carbamazepine, primidone, phenytoin, Phenobarbital, ethosuximide, and valproate should be prescribed to the patient after the patient’s initial seizure has been successfully treated (Majkowski, 2005, pp. 212 – 213; Johnson, 2004, p. 327). Although the use of anti-convulsant medications can cause mild sedation effects which could last for a few weeks, the school nurse should take note that the use of this particular medication can trigger drug dose-related reactions (i.e. sedation that progresses to coma or the production of ataxia effects when overdosed with anti-convulsant drugs) and idiosyncratic reactions that are unrelated to drug level (i.e. allergic reactions like skin rashes) when administering anti-convulsant medications to the students that has recently gone through seizure attack (Neinstein, 2008, p. 336). The Best Educational Accommodations Available to the Student Epileptic students are prone to untimely seizure attacks. Therefore, educators should provide them with sufficient space in case they fall down or become unbalanced. Aside from the need to assign epileptic students to seat in a spacious corner, the best educational accommodation for this group of students should include a classroom that has chairs and tables supported with padding on the side corners of the hard surface to protect the head of the students from further head injury (Epilepsy Action, 2011). Since there are some epileptic students are suffering from decreased cognitive development, educators should develop course materials that are simple and less disturbing on students with epilepsy. To avoid stressing out epileptic students, educators should provide this group of students with advance assignments to give them sufficient time to complete their work (Price et al., 2011). Since there are cases wherein epileptic students who are sensitive to light could trigger seizures, educators should avoid the use of anything that flashes or blink light when teaching inside the classroom (Davis, 2009, p. 77). In case a student is sensitive to light, educator should make use of other teaching tools like listening devices more than the use of computer technology (Price et al., 2011). Concerns for the Students as They Progresses through Elementary, Middle, and High School Years of Education Often associated with head injury, it is common for epileptic individuals with seizures to experience psychiatric symptoms and cognitive decline (Engel & Pedley, 2008, pp. 2095 – 2096; Kanner, Soto, & Gross-Kanner, 2004). As compared to students without epilepsy, several studies revealed that epileptic school-age students are most likely to encounter decreasing IQ levels and less capability in terms of improving their academic knowledge and skills (Berg et al., 2004; Kanner, Soto, & Gross-Kanner, 2004). Therefore, epileptic individuals may end up suffering from intellectual disability which significantly affects the students’ ability to have a normal social life as they progress through elementary, middle, and high school years of education. In general, students with epilepsy needs special support coming from educational institutions as they progress through elementary, middle, and high school years of education. According to Berg et al. (2004), epileptic individuals are unable to control their seizure attacks. With regards to the psychological impact of having epileptic seizures, most of the school-age students with epilepsy encounter behavioral disturbances and psychiatric disorders. Since epileptic students could suffer from severe depression, the feeling of hopelessness, and high levels of anxiety, several authors revealed that there are some cases wherein this group of students may end-up displaying unexplainable and uncontrollable aggressive behavior or inflicting self-injury for no reasons at all (Reisinger & Dilorio, 2009; Wagner et al., 2009; Engel & Pedley, 2008, p. 2096; Berg et al., 2004). Because of their inability to control stress, Reisinger & Dilorio (2009) explained that severe depression could make epileptic individuals choose to isolate themselves from the crowd. Organizations or Support Systems Available to Children and Parents for School-Age Child There are quite a lot of support systems that can be made available to students with epilepsy and their parents. Based on the research findings of Yen et al. (2009), depressed epileptic individuals are most likely to suffer from poor quality of life particularly when it comes to their physical appearance or perception, psychological development, and social relationship with other people as compared to students who do not have signs of depressive symptoms. Depression could negatively affect the students’ quality of life especially when it comes to the child’s ability to become self-efficient. For this reason, the support systems that should be provided to school-age students with epilepsy and their parents should focus on how to enable them to effectively manage depressive symptoms that are significantly associated with epileptic seizures (Wagner et al., 2009). Upon examining the relationship between depressive symptoms, stigma, social support, and regimen-specific support over the quality of life of adult individuals with epilepsy, the research findings of Whatley, Dilorio, & Yeager (2010) revealed that there is a positive correlation between the use of social support group and improvements in the quality of life of the patients but not with the use of other support interventions like depressive symptoms, stigma, social support, and regimen-specific support. Majority of the epileptic students are taking medications that could trigger a long-list of side effects, the particular social group that will be made available to epileptic students and their parents should also discuss how they can effectively monitor the side-effects of these medications. Likewise, the school personnel should also work closely with the school psychologists and the students’ parents concerning the best way to deal with and improve the students’ psychological and social development. Description on How the School Nurse Function as the Coordinator for the Students both in School and in the Community As a coordinator, the school nurse should work closely with the school teachers and students’ parents in order to protect the child’s physical and cognitive development as the child progresses through elementary, middle, and high school years of education. This can be done by encouraging the school teachers and the students’ parents to support the social group project that will be designed to cater the special needs of the epileptic students. As compared to the school teachers and the child’s parents, the school nurses are more aware of the etiology, signs and symptoms, medical intervention including the side-effects of the prescribed drugs given to epileptic students. Therefore, the school nurse should disseminate this knowledge in the form of health teachings. By coordinating with the school teachers and the epileptic students’ parents, the school nurse will be able to accomplish his/her goal in terms of providing the epileptic students with holistic caring. Conclusion Epileptic students who are going through seizure attacks are prone to alteration of their cognitive and physical developments. Since a lot of epileptic students who failed to receive proper care, support and understanding from the people around them could make them suffer from psychological and behavioral disturbances, it is crucial on the part of the school nurse to perform their role and responsibility as a coordinator between the school teachers and the students’ parents. It is the duty of the school nurse to provide holistic care to the students. As compared to other support intervention, implementing a support group that closely considers the major concerns of epileptic students can be helpful in terms of enabling this group of students to improve their learning development and they increase their academic achievements. Knowing that the kinds of prescribed medications for seizure control could make the students feel dizzy, sleepy, experience muscle weakness, increased levels of anxiety, hallucination, and difficulty in their overall mobility, the school nurse should remind the school teachers the importance of making the classroom more accommodating to the specific needs of the epileptic students. *** End *** References Aronson, J. (2009). Meyler's Side Effects of Psychiatric Drugs. CA: Elsevier. Berg, A., Smith, S., Frobish, D., Beckerman, B., Levy, S., Testa, F., et al. (2004). Longitudinal Assessment of Adaptive Behavior in Infants and Young Children With Newly Diagnosed Epilepsy: Influences of Etiology, Syndrome, and Seizure Control. Journal of American Academic Pediatrics , 114 (3): 645-650. CDC. (2011). Retrieved April 19, 2011, from Epilepsy: http://www.cdc.gov/Epilepsy/ Davis, B. (2009). Tools for teaching. 2nd Edition. CA: Jossey-Bass Higher and Adult Education Series. 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