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Transcript
THE QUEEN'S MEDICAL CENTER
Honolulu, Hawaii
Competency Validation
Review/Revised
February 2003
March 2007
Jan2010
Employee Name:
Employee Number:
Unit:
Date Completed:
Epilepsy Monitoring Unit, Care of the Patient
Critical Elements
Registered Nurse
1.
Locate and summarize the major contents of the Department Order Set
(DOS) and EMU protocol for the Epilepsy Monitoring Unit (EMU)
Epilepsy Monitoring Unit Manual – Protocol Medical Orders
Section: Part 1 and 2
2.
Identify three (3) common epilepsy medications, major side effects and
precautions
Epilepsy Monitoring Unit Manual – Medication Summary Section
(a) Tegretol, Depakote, Dilantin
(b) All Anti Epileptic Drug’s can cause ataxia, rash, confusion
(c) Evaluate patients for balance, rash, cognitive baseline
3. Identify the 4 major patient/family education topics regarding
activities in the EMU:
Epilepsy Monitoring Unit Manual – Patient Information
(a) Locked waist restraint while in bed. Patient will have key within
reach or on wrist.
Utility strap must be applied if patient up in chair.
(b) Patient must call for assistance to go to BR. T5 staff must
accompany patient to BR and remain in room, door must
remain slightly open.
(c) Bed rails X 4 with padded side rails in place are to remain while
patient in bed.
(d) Out of bed to chair with exercise bike BID to prevent DVT
Phase II Monitoring: Additional teaching
(a) Patients must use commode (NO BRP)
(b) Ensure hands are washed after every BRP
(c) Wipe bedside table down with Sani-Cloth daily
(d) Restraints may be used for safety during post-ictal period
Met
Not Met *
Employee Name:
Employee Number:
Unit:
Date Completed:
Epilepsy Monitoring Unit, Care of the Patient
Critical Elements
Registered Nurse
4. Identify the signs for the following epileptic seizures:
REMINDER: What a seizure looks like is dependent on where the focus is located
within the brain (i.e. dominant versus non-dominant hemisphere, speech center,
visual center, motor strip, frontal lobe) and type of seizure.
Partial versus generalized seizures:
a)
Partial seizures arise from one location (focal or localized) within the brain
b)
Generalized seizures begin over all areas of the brain at once (may be
confused for seizures which start focally and spread extremely rapidly)
Seizure classifications:
c)
Simple Partial Seizures (SPS): Patient remains alert without LOC change
d)
Complex Partial Seizures (CPS): Patient with alteration of LOC
e)
Secondarily Generalized Seizures: Seizure starts as a simple partial or
complex partial seizure and spreads to become a generalized seizure
f)
Generalized Tonic Clonic Seizure: Convulsion; alternating clonic, tonic
movements.
5.
Identify the specific steps of neurological testing during and after a seizure
Epilepsy Monitoring Unit Manual- Seizure Observation, Testing and Documentation:
(a) Assess responsiveness
(b) Observe what patient is doing
(c) Ask patient to follow commands
(d) Ask patient to respond verbally to questions
(e) Assess length of seizure
(f) Assess length of time for patient to return to baseline
Met
Not Met *
Employee Name:
Employee Number:
Unit:
Date Completed:
Epilepsy Monitoring Unit, Care of the Patient
Critical Elements
Registered Nurse
6. Identify specific EMU protocol and indications for activation
Ativan Administration
a)
Ativan: 1-2 mg Ativan IV or PO when 3 CPS occur in 8 hrs. or 4 CPS
in 24 hrs. or 2 GTC seizures in 24 hrs
b) Ativan is administered to prevent Status Epilepticus or interrupt
successive seizure activity
c) If patient continues to have prolonged or subsequent seizures, give
another dose of ativan and page physician (See MD notification
protocol)
Physician Notification
Call for:
a)
Tonic clonic seizure lasting 10 minutes
b)
c)
2 consecutive seizures without regaining consciousness between seizures
Four (4) or more complex partial seizures in 24 hours.
d)
Any change in Neuro status including change in motor response, level of
consciousness, or confusion (other than post-ictal confusion lasting < 30
minutes).
e)
Any Falls.
f)
Pain not responsive to Acetaminophen
No Need to call for:
a)
Post-ictal confusion lasting less than 30 minutes or post-ictal sleepiness
Phase II – Restraints
a)
b)
c)
Restraints (used d/t risk of electrodes being pulled during/after seizure
activity
Soft restraints: pre-secured to bed and/or chair to be in place for rapid
use in case of post-ictal agitation
Leather restraints: available on floor (not to be hooked up unless patient
becomes violently agitated)
7. Verbalizes the basic use of the following equipment:
Epilepsy Monitoring Unit Manual – Equipment / Data Security
(a) Video camera and camera controls: Review the Camera System Reference
Guide
(b) Seizure alarm (initiating and turning off)
PHASE II Monitoring
8. State two (2) reasons for placement of depth electrodes
Epilepsy Monitoring Unit Manual – Phase II Monitoring
(a) Used to localize seizure focus
(b) Can identify multifocal seizure onset
Met
Not Met *
Employee Name:
Employee Number:
Unit:
Date Completed:
Epilepsy Monitoring Unit, Care of the Patient
Critical Elements
Met
Registered Nurse
9. State two (2) reasons for placement of subdural grids
Epilepsy Monitoring Unit Manual - Phase II Monitoring
(a) To stimulate and map areas of speech
(b) To localize larger areas of seizure focus
10. State three (3) safety needs for patients with intracranial monitoring
Epilepsy Monitoring Unit Manual – Phase II Monitoring
a) CSF leak
b) Infection
c) Fall Prevention
d) Pain Management and Nausea Control
11. State the procedure for dressing changes for intracranial monitoring
Epilepsy Monitoring Unit Manual – Phase II Monitoring
(a) Masks and gloves
(b) Dressing is changed ONLY by the Epileptologist or Surgeon,
RN to reinforce as needed.
Notify surgeon and Epileptologist of CSF leaks or increased bleeding
12. State signs and symptoms of CSF leaks
Epilepsy Monitoring Unit Manual – Phase II monitoring
(a) Assess head dressings for clear wet fluid
(b) Assess pillow for clear fluid, or linen near dressing
(c) Assess for fluid or dampness leaking from incision sites
13. Able to perform room set-up per checklist
Epilepsy Monitoring Unit Manual – Room Preparation Check List
a)
Review checklist when setting up room day of admission
* If critical elements not met, must identify learning needs and date when those needs will be accomplished.
Employee Signature/Date
Reference: Tower 5 Epilepsy Monitoring Unit Manual
Evaluator Signature/Date
Not Met *
Employee Name:
Employee Number:
Unit:
Date Completed:
Epilepsy Monitoring Unit, Care of the Patient
Critical Elements
Met
Registered Nurse
* If critical elements not met, must identify learning needs and date when those needs will be accomplished.
Employee Signature/Date
Reference: Tower 5 Epilepsy Monitoring Unit Manual
Evaluator Signature/Date
Not Met *
Employee Name:
Employee Number:
Unit:
Date Completed:
Epilepsy Monitoring Unit, Care of the Patient
Critical Elements
Registered Nurse
Met
Not Met *