Implement seizure precautions

Oct 13, 2025 by wbrum.org 111 views

Emergency Department Prioritization: A Case of Altered Mental Status

Introduction

In the fast-paced environment of an emergency department, prioritizing patient care is crucial to ensure timely and effective treatment. When an 89-year-old patient presents with a change in mentation and level of consciousness, the nurse must quickly assess the situation and determine the most critical action to take. This article will explore the priority actions a nurse should undertake in such a scenario.

Assessing the Patient's Condition

Upon arrival, the nurse should conduct a thorough assessment of the patient's condition, including vital signs, mental status, and any relevant medical history. This information will help the nurse identify potential causes of the patient's altered mental status, such as infection, medication side effects, or underlying medical conditions.

Priority Action: Stabilizing the Patient's Airway, Breathing, and Circulation (ABCs)

The first priority in caring for an 89-year-old patient with altered mental status is to ensure the patient's airway, breathing, and circulation (ABCs) are stable. This involves:

Securing the airway: The nurse should assess the patient's airway for any obstructions or difficulties with breathing. If necessary, the nurse may need to insert an oropharyngeal airway or endotracheal tube to maintain a patent airway.
Establishing breathing: The nurse should ensure the patient is receiving adequate oxygenation, either through a mask or endotracheal tube. This may involve administering oxygen therapy or using a bag-valve-mask (BVM) device.
Maintaining circulation: The nurse should assess the patient's circulation, including blood pressure and cardiac output. If necessary, the nurse may need to administer fluids or vasopressors to maintain adequate blood pressure.

Implementing Seizure Precautions

While stabilizing the patient's ABCs is the primary concern, the nurse should also be aware of the possibility of seizures. Seizures can be a complication of altered mental status, particularly in elderly patients. To prevent injury and ensure patient safety, the nurse should:

Implement seizure precautions: The nurse should ensure the patient's environment is safe, with any potential hazards removed or secured. This may involve padding the bedrails, securing any loose objects, and ensuring the patient is in a safe position.
Administer seizure medications: If the patient is at risk of seizures, the nurse may need to administer anticonvulsant medications, such as lorazepam or diazepam.

Requesting IV Fluid Rate Increase

While increasing the IV fluid rate may be necessary in some cases, it is not the primary action the nurse should undertake in this scenario. The nurse should focus on stabilizing the patient's ABCs and implementing seizure precautions before considering fluid administration.

Conclusion

In the event of an 89-year-old patient presenting with altered mental status, the nurse's priority action should be to stabilize the patient's ABCs and implement seizure precautions. This involves securing the airway, establishing breathing, and maintaining circulation, as well as ensuring the patient's environment is safe and administering seizure medications if necessary. By prioritizing patient care and taking prompt action, the nurse can help ensure the best possible outcome for the patient.

Recommendations for Future Practice

Prioritize patient care: In emergency situations, prioritize patient care based on the severity of the condition and the potential for harm.
Assess the patient's condition: Conduct a thorough assessment of the patient's condition, including vital signs, mental status, and any relevant medical history.
Implement seizure precautions: Ensure the patient's environment is safe and administer seizure medications if necessary.
Stabilize the patient's ABCs: Secure the airway, establish breathing, and maintain circulation to ensure the patient's safety and well-being.

References

American Heart Association. (2020). Advanced Cardiovascular Life Support (ACLS) Provider Manual.
American Academy of Emergency Medicine. (2020). Emergency Medicine: A Comprehensive Review.
National Institute on Aging. (2020). Alzheimer's Disease and Related Dementias.
Emergency Department Prioritization: A Case of Altered Mental Status - Q&A

Introduction

In the previous article, we discussed the priority actions a nurse should undertake when an 89-year-old patient presents with altered mental status. In this Q&A article, we will address some common questions and concerns related to this scenario.

Q: What are the most common causes of altered mental status in elderly patients?

A: The most common causes of altered mental status in elderly patients include:

Infections: Urinary tract infections, pneumonia, and sepsis can all cause altered mental status in elderly patients.
Medication side effects: Certain medications, such as sedatives and antidepressants, can cause altered mental status in elderly patients.
Underlying medical conditions: Conditions such as dementia, stroke, and hypothyroidism can cause altered mental status in elderly patients.
Dehydration: Dehydration can cause altered mental status in elderly patients, particularly if they have underlying medical conditions.

Q: What are the signs and symptoms of altered mental status in elderly patients?

A: The signs and symptoms of altered mental status in elderly patients can include:

Confusion: The patient may be disoriented, confused, or have difficulty understanding their surroundings.
Disorientation: The patient may be unable to identify the time, date, or location.
Agitation: The patient may become agitated, restless, or aggressive.
Hallucinations: The patient may experience hallucinations, such as seeing or hearing things that are not there.
Changes in behavior: The patient may exhibit changes in behavior, such as becoming more withdrawn or aggressive.

Q: What is the role of the nurse in assessing and managing altered mental status in elderly patients?

A: The nurse plays a critical role in assessing and managing altered mental status in elderly patients. The nurse should:

Conduct a thorough assessment: The nurse should conduct a thorough assessment of the patient's condition, including vital signs, mental status, and any relevant medical history.
Develop a care plan: The nurse should develop a care plan that addresses the patient's specific needs and goals.
Implement seizure precautions: The nurse should ensure the patient's environment is safe and administer seizure medications if necessary.
Stabilize the patient's ABCs: The nurse should secure the airway, establish breathing, and maintain circulation to ensure the patient's safety and well-being.

Q: What are the potential complications of altered mental status in elderly patients?

A: The potential complications of altered mental status in elderly patients can include:

Seizures: Altered mental status can increase the risk of seizures in elderly patients.
Injury: Altered mental status can increase the risk of injury to the patient or others, particularly if the patient becomes agitated or aggressive.
Dehydration: Altered mental status can increase the risk of dehydration in elderly patients, particularly if they have underlying medical conditions.
Infection: Altered mental status can increase the risk of infection in elderly patients, particularly if they have underlying medical conditions.

Q: What are the best practices for preventing and managing altered mental status in elderly patients?

A: The best practices for preventing and managing altered mental status in elderly patients include:

Conducting regular assessments: Regular assessments can help identify potential causes of altered mental status and prevent complications.
Developing a care plan: A care plan can help address the patient's specific needs and goals and prevent complications.
Implementing seizure precautions: Ensuring the patient's environment is safe and administering seizure medications if necessary can help prevent seizures and injury.
Stabilizing the patient's ABCs: Securing the airway, establishing breathing, and maintaining circulation can help ensure the patient's safety and well-being.

Conclusion

Altered mental status in elderly patients is a complex and potentially life-threatening condition that requires prompt and effective management. By understanding the causes, signs and symptoms, and potential complications of altered mental status, nurses can provide high-quality care and improve patient outcomes. By following best practices for preventing and managing altered mental status, nurses can help prevent complications and ensure the best possible outcome for their patients.

Recommendations for Future Practice

Conduct regular assessments: Regular assessments can help identify potential causes of altered mental status and prevent complications.
Develop a care plan: A care plan can help address the patient's specific needs and goals and prevent complications.
Implement seizure precautions: Ensuring the patient's environment is safe and administering seizure medications if necessary can help prevent seizures and injury.
Stabilize the patient's ABCs: Securing the airway, establishing breathing, and maintaining circulation can help ensure the patient's safety and well-being.

References

American Heart Association. (2020). Advanced Cardiovascular Life Support (ACLS) Provider Manual.
American Academy of Emergency Medicine. (2020). Emergency Medicine: A Comprehensive Review.
National Institute on Aging. (2020). Alzheimer's Disease and Related Dementias.