epilepsy
Jessica Williamson is a 28 year old women with a past history of epilepsy. Two weeks ago
Jessica was out socially, drinking alcohol at a dance club. Jessica experienced a seizure whilst
on the dance floor. Upon arrival at the local Emergency Department, paramedic staff reported that she had experienced a full tonic-clonic seizure that lasted for three
minutes, during which she lost consciousness. Jessica was assessed and admitted. During her hospitalization Jessica was
stabilized and discharged from hospital 1 week after the episode. Her discharge medications included an anticonvulsant.
On discharge Jessica was asked her GP for follow-up.
Medical History
Jessica was diagnosed with epilepsy in late adolescence. Initially the seizures were very difficult to control using anticonvulsants but her condition stabilised 5
years ago. Three months ago
she weaned herself off her anticonvulsants as she wanted to fall pregnant. During her hospitalization she was recommenced on her anticonvulsant.
Four years ago Jessica was diagnosed with Type 2 Diabetes Mellitus. Jessica was taught to
control her blood glucose levels using diet and oral hypoglycaemics, this is now decreasingly effective. Her most recent observations include:
•BP: 150/90
•P: 115 regular
•Height: 158 cms
•Weight: 122 kgs
•BGL 12.9
Her current medications are:
•Epilim1 gm BD
•Metformin 850mg BD
Social History
Jessica lives in a two-storey house with her current partner of six years, Martin. Jessica’s parents live overseas where her mother has been posted for work. Jessica
is an only child. She works as a
real estate agent selling homes and covers a large geographic area involving long and irregular work hours. This can involve her driving long distances and for long
periods of time. Jessica enjoys her work and the challenges of being independent at work and at home.
Despite being advised by her GP that she must not drive after suffering this recent seizure, Jessica continues to do so.
Current Issue
Following the follow-up appointment with the GP, the GP was concerned about Jessica’s
seemingly poor acceptance of her medical diagnoses and her compliance with the treatment regime for both her diabetes and epilepsy. Jessica indicated she did not need
any more prescriptions for her anticonvulsants at the moment.
Jessica is not particularly careful about monitoring her blood sugar levels.She says she often forgets, and tends to check when she “feels fuzzy”.
As this is your first visit to Jessica in her home, justify and discuss the immediate plan of care for her.
Assessment Focus
You are the Registered Nurse from the Community Nursing Service.
You will be undertaking an initial visit to Jessica’s home.
Prioritise and provide a rationale for the activities you will undertake as part of this initial visit
and identify two (2) priorities for your follow-up visit.
The purpose of this essay is for students to present a comprehensive discussion linking the health issues identified through a client assessment to the impact they
have on the client
and their level of function in the community setting. It requires the student to prioritise the health issues and to show analysis of the complexity of care provision
demonstrating critical reflection on practice