Epilepsy - How It Can Be Diagnosed and Managed

There are different ways of diagnosing epilepsy; some of which when added together give a better and clearer picture of the existence of the disease condition. It is usually advisable to carry out a comprehensive investigation before trying to make a diagnosis because of the social importance of the condition.

Diagnosis
i. The presenting signs and symptoms can give a clue to diagnosis.
ii. Electro-encephalogram (EEG): This will help detect the electrical discharges of the brain.
iii. Blood test: To determine the glucose and calcium levels of the blood.
iv. Lumbar puncture: To detect if there is any infection that may have likely spread to the brain.
v. X-ray of the skull: This will help in detecting any tumour of the brain.
vi. Physical and neurological examination.

First Aid management of Epilepsy
a. Give a helping hand to the patient quickly to prevent him from injury during a fall.
b. Loosen tight clothing from around the neck, chest and abdomen.
c. Place a spatula in-between the teeth to prevent him biting his tongue or lips.
d. Remove dangerous instruments around the patient
e. Allow enough air to reach patient by controlling the crowd around him
f. Do not restrict patient during fit/jerking to prevent injury/fracture
g. Reassure on-lookers
h. Observe vital signs
i. Note whether patient sustained injury or had incontinence. Also note the time the fit stopped and how long it lasted.
j. Remove his clothes if they are soiled and give him a bath

Medical management
1. Anti-convulsants: e.g. Phenobarbitone, Epanutin (Phenytoin Sodium), Mysoline, Tegretol, etc. may be given as recommended by the doctor.
2. Tranquilizers: e.g. Chlorpromazine (Largactil), Diazepam (Valium).
3. Electroconvulsive therapy (ECT)

Nursing management
i. Admit patient into epileptic ward
ii. Nurse in a low bed with adequate ventilation and good lighting
iii. Observe vital signs and maintain a proper record
iv. Provide comfort measures
v. Give easily digestible, semi-solid diets to prevent choking
vi. Patient should be encouraged to have enough rest and sleep. Soft pillows should be removed from him to prevent suffocating himself with the pillows during fits
vii. Personal hygiene should be encouraged
viii. Give psychological support.

Advice to patients
1. Patients should not swim, climb or operate machinery
2. Patients should have an identity card to show they are epileptic
3. Patient must guide against open fire
4. Take prescribed drugs regularly
5. Remove dentures before sleeping
6. Avoid sleeping with soft pillows
7. Do not bath alone especially if you have to use the bath tub
8. Do not go to River, stream, pond or well to fetch water alone. You must be accompanied by somebody
9. Avoid sharp instruments or corrosive liquids if fit is frequent
10. Don't drive if fit is frequent.

Epistaxis - What Does It Mean, and How Can It Be Managed?

Oftentimes you see people bleed from the nose either in the middle of a fight or as a result of an accident or a fall. When you see such you simply say that Epistaxis has occurred.

Epistaxis is simply bleeding from the nose following a rupture of a blood vessel or blood vessels in the nostrils, or due to other factors. It can either be mild or severe depending on its cause and the extent of the injury, etc.

Causes:
It is usually due to rupture of tiny blood vessels in the mucous membrane of the septum. Nosebleed can therefore be caused by the following:

1. Direct blow to the nose
2. Picking of the nose.
3. Perforated septum
4. Acute sinusitis (inflammation of the lining of the sinus of bone of the face)
5. Hypertension
6. Cancer
7. Violent or vigorous blowing of the nose during a cold
8. Irritation from foreign bodies
9. Rheumatic fever in children
10. Polyps in the nose
11. Leukemia
12. Arteriosclerosis especially in the elderly
13. Allergy to certain foods
14. May be connected with menstruation
15. Excessively dry weather

First aid care of Epistaxis

1. Sit the patient up in order to prevent discomfort as a result of standing. This also lessens fatigue or the possibility of fainting.
2. Patient should tilt his head slightly forward to prevent ingesting the blood (can cause vomiting) or inhaling the blood (which can cause choking)
3. Have patient pinch the soft part of the nose firmly between the thumb and forefinger (index finger)
4. He should be instructed not to blow the nose as this may dislodge blood clot that would help arrest the bleeding.
5. he should also be instructed to breathe through the mouth
6. Apply cold compress to the bridge of the nose, lips and back of the neck
7. Reassure the patient that bleeding would soon stop
8. Protect his clothing from being soiled with blood
9. If bleeding is severe call the doctor or arrange to take patient to the hospital.

You must be aware that your first aid is needed to help the patient before the arrival of the doctor. Don't keep a severe case of epistaxis or try to manage it yourself if you are not a competent health care provider; otherwise you get things complicated and put the person at risk. You must call the doctor immediately to help you out.