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Other Drugs: Neuromuscular blocking agents; antipyretics; analgesics; anticoagulants; sedatives, antianxiety agents, and muscle relaxants such as diazepam are administered to decrease muscle spasms. Neuromuscular blocking agents may be required to paralyze the patient if other agents cannot control the spasms or seizures. Antidysrhythmic drugs are given if cardiac rhythm disturbances arise, antipyretics are administered for fever, and analgesics are provided for relief of pain. Prophylactic anticoagulation therapy may be instituted to prevent thrombus formation.

Independent

Nursing care focuses on maintaining a patent airway, regular breathing, and adequate circulation and on providing comfort management, protection from injury, and psychosocial support of the patient and family. If muscle spasms or seizure activity places the patient at risk for airway compromise, use the chin lift or jaw thrust to maintain an open airway if possible. Insert an oral or nasal airway before seizures, but if the patient has lockjaw do not attempt to force an airway in place because you may injure the patient and worsen the airway patency. Have intubation and suction equipment immediately available at the bedside should the patient require it. Anchor the endotracheal tube firmly, and document the lip level of the endotracheal tube in the progress notes for continuity.

Institute seizure precautions as soon as the patient is admitted to the unit. Pad the side rails of the bed, and provide immediate access to oxygen, suction, intubation equipment, artificial airways, and a resuscitation bag. Place the patient in a quiet, dark room to reduce environmental stimuli. Position the patient who is unconscious or paralyzed from pharmacologic agents in a side-lying position and turn the patient every 2 hours.

Provide clarification of information about the patient's diagnosis, prognosis, and treatment to the patient and family. Make sure that the family has adequate time for expression of their feelings each day. Support effective coping mechanisms and provide appropriate referrals to the chaplain, clinical nurse specialist, or counselor if the patient or family demonstrates ineffective coping behaviors.

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