# Situation: A nurse at a Rural Health Unit (RHU) trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) follows up a 24-year-old woman who has just been diagnosed with epilepsy and started on carbamazepine. She lives with her husband and works as a store clerk. Her husband asks what he should do if she has a convulsion at home. Which instruction should the nurse give?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630105  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A nurse at a Rural Health Unit (RHU) trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) follows up a 24-year-old woman who has just been diagnosed with epilepsy and started on carbamazepine. She lives with her husband and works as a store clerk.

Her husband asks what he should do if she has a convulsion at home. Which instruction should the nurse give?

## 보기

1. Turn her on her side and stay with her until she wakes up **✔ 정답**
2. Put a spoon between her teeth so she does not bite her tongue
3. Give her water and her tablet as soon as the jerking stops
4. Hold her arms and legs firmly so that the jerking stops sooner

**정답: 1**

## 해설

mhGAP-IG teaches carers to lay the person down on the side with the head turned to help breathing, to put nothing in the mouth, not to restrain the person, and to stay until the convulsion stops and the person wakes. A convulsion lasting longer than 5 minutes, trouble breathing, or not waking up needs care at a health facility.

## 심화 해설

What a carer does during a convulsion
The mhGAP-IG teaches carers of people with epilepsy a few simple, safe steps. During a convulsion, lay the person down on her side with the head turned to help breathing, put nothing in her mouth, do not restrain her, and stay with her until the convulsion stops and she wakes up. Turning her on her side lets saliva and vomit drain out of the mouth and keeps the tongue from falling back, which protects the airway. Staying until she is awake allows the carer to watch her breathing and recognize when help is needed.

Other safe actions
The carer can move hard or sharp objects away, cushion her head with something soft, loosen tight clothing around the neck, and note the time the convulsion started. After the jerking stops, the person is often drowsy and confused for a while, the postictal phase; she should be allowed to rest on her side and should not be given food, drink, or tablets until she is fully awake and able to swallow.

| Instruction | Safe? | Reason |
| --- | --- | --- |
| Turn her on her side and stay until she wakes | Yes | Protects the airway; allows monitoring |
| Put a spoon between her teeth | No | Can break teeth or block the airway |
| Give water and her tablet when jerking stops | No | Choking risk while drowsy |
| Hold her arms and legs firmly | No | Does not stop the seizure; can cause injury |

Why the other instructions are unsafe
Putting a spoon or any object between her teeth is a dangerous myth; it can break teeth, injure the mouth, or block the airway, and people cannot swallow their tongue. Giving water or tablets as soon as the jerking stops risks aspiration because she is still drowsy and may not swallow safely. Holding the arms and legs firmly does not shorten the seizure and can cause fractures, dislocations, or injury to the carer.

Watch out! Teach the warning signs that need care at a health facility: a convulsion lasting longer than 5 minutes, difficulty breathing, failure to wake up after the convulsion, repeated seizures without recovery in between, or injury during the seizure.

Exam takeaway
Key point! Seizure first aid: side-lying, nothing in the mouth, no restraint, stay until awake, and seek care if the convulsion lasts more than 5 minutes or she does not wake. These are the points mhGAP-IG asks health workers to teach families.

## 임상 시나리오

Seizure First Aid at HomeTeaching the carer under mhGAP-IG
Lay her on her side with the head turned to help breathing. Put nothing in her mouth and do not restrain her.

Move hard objects away, cushion her head, and stay with her until the convulsion stops and she wakes. Give no food, drink, or tablets until she is fully awake.

Note the time the convulsion started so its length can be judged.

CautionSeek care at a health facility if a convulsion lasts more than 5 minutes, breathing is difficult, or she does not wake up.

## 핵심 개념

- **Convulsion** — A seizure with uncontrolled jerking movements of the body.
- **Postictal phase** — The period of drowsiness and confusion after a seizure.
- **Aspiration** — Entry of food, fluid, or vomit into the airway, a risk when a drowsy person is given anything by mouth.
- **Recovery position** — Side-lying with the head turned to keep the airway open and let fluids drain.

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