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From the information given, it can be stated that in order to solve her problem, Jessica needs to consult a GP. Consultation with a doctor regarding stopping to take the drugs for any reason is extremely important. If not guided by a professional, a change in the treatment course can pose a risk to both the patient and her child, as evident from the episodes of uncontrolled epilepsy and mania. The doctor can also advise on the lifestyle that Jessica should adapt to ensure that the pregnancy is not affected by her epileptic condition. The doctor would also advice accordingly regarding the risks for breastfeeding a child while taking anticonvulsants. In any case, the specificity of the patient’s situation requires a guidance of healthcare professionals.
Jessica has experienced the full tonic-clonic seizure three months after she self-weaned from the Epilim. Epilim is seen to have an effect on a developing baby, especially if administered in the first pregnancy trimester. The exposure of foetus to Epilim causes an increased risk of malformations and an increased risk of impaired cognitive development (Batchelder, 2012). Besides, Epilim’s effect consists in controlling the seizures rather than curing the condition.
Unlike Epilim, Metformin has no records of interfering with pregnancy, which is why Jessica did not wean herself off this medication. Most drugs that are used by epileptics such as Epilim pass into breast milk, which could harm the new-born. Jessica’s current situation could have pushed her to take alcohol and dance as a way of reducing stress. The effects of coupling alcohol with Epilim include feeling dizzy, light-headed and sleepy, which caused the seizures that Jessica experienced.
Seizures are commonly experienced by people with diabetes of type 1, as they are triggered by low blood sugar levels (hypoglycaemia). Therefore, it was very inadequate of Jessica not to monitor her blood sugar levels carefully, as she would mostly forget and check them when she felt ill-defined. Given the state at hand, Jessica is probably too busy to have sessions with her GP for consultations on her health. This could be the reason why she can’t be able to monitor her sugar levels, which can cause the seizures when the levels are small. Jessica’s long hours of work could have been caused by the fact that she is the only child and she used to be given more attention from the parents, so now she avoids staying alone as there is no more attention.
Having lived for six years with her husband, Jessica could feel an urgent need of having a child, which led to self-weaning off the drugs to get pregnant. Jessica should learn to the significance of her visits to GP and also adhere to the advices the doctor gives. It is important to monitor her sugar levels and avoid alcohol as long as she is on Epilim (Cartwright, & Wallace, 2013). Jessica’s seizure could have been a result of tiredness, flickering lights, stress, heavy drinking or low blood sugar levels, which is caused by irregular meals and fatigue. Therefore, Jessica should avoid any of the factors that could trigger a seizure, especially weaning off Epilim.
After Jessica was hospitalized, her health state has stabilised and she had to strictly follow up her visits with the GP, which took her back to the anticonvulsants, and this means that the chances of her getting seizures are minimized. She also had to begin monitoring her blood sugar levels, as she was now aware of the adverse effects they had on her health. Cooperation with the GP is plays a key role, since the patient is advised accordingly on when and how to handle pregnancy taking into consideration her epileptic condition. This would ensure the safety of her and her unborn child’s health.
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The two healthcare priorities are the efficient management of the full tonic-clonic seizures and creating awareness of the importance of following up with the GP and checking the blood sugar levels frequently enough. Jessica should not wean herself off Epilim, the anticonvulsant, without consulting with the GP. The knowledge that she is equipped properly for handling epilepsy will allow her to manage her work and spend her leisure time safely.
The initial nursing home visit for epilepsy would require a preparation for the visit, such as calling the patient to create a rapport that will facilitate the interaction between the nursing care professional and the patient (Wong, Hockenberry, & Wilson, 2011). At this initial visit, the professional gets all the information that he or she needs, including the medical history of the patient and the description of events that may have led to the patient’s referral. The rapport gives the nursing care practitioners an ample time to carry out the epilepsy management efficaciously.
The initial home visit helps to establish trustworthy relationships between the patient and the professional, which facilitates the patient’s healing process, since trusting what the nurse instructs them to follow is for their benefit and will eventually improve their health (Fisher, Dezort, Nordli, & Berg, 2012). During the visit, the patient is informed on the essence of wearing a medical alert tag, which could be carrying a card or a bracelet that identifies the epileptic condition. This assists in case the patient experiences a seizure in an unknown environment and allows them to be managed with a knowledge of their condition.
Consequently, the patient will learn about the importance of the close follow-up and taking drugs as prescribed and, in case of any abnormality, they consult before making any decision. At times, it is also important for the healthcare personnel to visit places of work or education if there is a recommendation to such measures. In this visit, the health care practitioner gets information that allows to understand the patient’s case better and hence handle it accordingly (Mazze et al., 2011a). When there are drugs that need to be substituted, or a situation at hand such as pregnancy, with a close monitoring by the professional, the patient is able to manage the situation safely.
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To save time and depending on the patient’s preferences and needs, some patients prefer consultations via the telephone, since they will not have to take time off work. This emphasizes the need to value one’s appointments with the GP. Patients who do not turn up for the clinic visits are sent more appointments that act as reminders. When they do not come for the appointments, then they are termed as defaulters.
In the subsequent visit, the priorities would be to enquire the patient’s response to drugs and check the seizures chart. This helps the healthcare practitioner in assessing the effectiveness of the drugs. The seizures charts aids in identifying if the seizures have stabilised and thus make the necessary recommendations. In case the patient has not been driving due to the frequent occurrence of seizures and the chart during the visit shows that the patient has not had seizures in the last three months, then the patient can be allowed to drive.
To diagnose Jessica’s situation, several blood tests can be carried out in addition to the brain scan and electroencephalography, where the brain activity is recorded. Besides, Jessica can undergo complementary therapies, surgery and also counselling (Mazze et al., 2011b). To regulate the blood sugar levels, she should ensure that her meals are regular to avoid a hypoglycaemic state that could lead to a seizure.
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An important part of managing a seizure includes self-management. Self-management can only be effective if the patient understands the condition at hand. Therefore, the nursing care professional needs to offer good and accurate information on which to base their actions, the information can be tailor-made or general. It is within the nurse’s jurisdiction to evaluate on what information applies to the particular case, since the epileptic conditions vary from person to person. The nurse should also be aware that different patients have different abilities. Thus, not all epilepsy patients are willing to self-manage.
The information given could include an explanation on the seizures and the diabetic condition and their implication to patients in secondary care. The information would also include the side effects of the anticonvulsants on pregnancy, advices on safety and titration if needed (Swearingen, 2016). Booklets that discuss the introduction of epilepsy and diabetic condition and how diabetes type 1 may trigger a seizure are given out for more information. They also explain how one can manage this with the diet. The patient should have regular meals to avoid low blood sugar levels (hypoglycaemia) that trigger seizures.
Jessica is among the patients that are envisioning a change of lifestyle because of pregnancy. Information giving is crucial to a patient who intends to change their way of life. Therefore, there needs to be a very clear communication between her and the GP. Jessica should closely follow up and should not default any appointment given to manage her condition effectively. Information on how to live life socially is pertinent. Jessica should be advised to avoid alcohol, since it triggers seizures. In addition, the long working hours should be avoided to give her body enough rest, thus reducing fatigue that could also trigger seizures. Patients value information as much as they rate an opportunity to discuss the issue.