2.9 Neurological and Sensory SEIZURE Flashcards
What are seizures?
Seizures occur when there is abnormal electrical discharge in the neurons in brain.
Temporary.
Disturbs skeletal muscle function, sensation, autonomic function, behavior and/or consciousness.
Epilepsy = recurring seizures, variable frequency. Prevalence & incidence increases in older adults
Occurs when there is an imbalance in excitatory (Neurotransmitter=glutamate) and inhibitory (Neurotransmitter= GABA) neurons in areas of the cerebral cortex (focal) or the entire cerebral cortex (generalized).
Many factors can alter the membrane potential & increase risk of hyperactive response of neurons.
Everyone has a seizure threshold and pathologic processes can lower it.
What are seizures? Risks/Triggers
Risks/Triggers: fatigue, fever, hypoglycemia, acid/base imbalance, IICP, tumors, ETOH, meds, constipation, hyperventilation, menses as well as individual factors like flashing lights, certain odors, music/sounds
Stages of seizures
PRODROMAL – can begin days before for some pts individual: emotional changes, fatigue, GI, urinary symptoms
AURA – immediately prior to onset of seizure for some types of seizures individual: smells, vision change, auditory hallucination
ICTUS – actual seizure event
POST-ICTUS – recovery after seizure variable length of time (can be up to days), initially unconscious, confusion, fatigue, sleepiness
Focal seizures (“partial”)
Start in, and affect, one hemisphere (sometimes just a small area of one lobe)
Manifestations are dependent on area of the brain affected:
- May remain conscious, but can be altered
- Motor: recurrent muscle contraction of the face or contralateral part of the body (often hands)
- Sensory: abnormal sensations, smells, tastes, numb/tingling, hallucinations
- Autonomic : tachycardia, flushing, hypo/hypertension, psychic sensation like Déjà vu, emotions
May be preceded by an aura (which is different than prodromal symptoms that can happen days before)
Can progress to generalized seizures
Generalized seizures
Affect both sides of the brain and deeper brain structures
Loss of consciousness
Generalized seizures ABSENCE
ABSENCE: (more common in children)
brief cessation of motor activity
blank stare, unresponsive
Automatisms & eyelid fluttering may occur
Generalized seizures
Tonic clonic
TONIC-CLONIC (grand-mal):
most common type, last 60-90 seconds
Aura is possible and pt will experience sudden loss of consciousness
Tonic phase: muscles rigid, often cry out, arms & legs extended & back is arched, jaw clenched, incontinence of bladder/bowel possible, breathing ceases, become cyanotic
Clonic phase: alternating contraction and relaxation of extremities, hyperventilation, eyes roll back, frothing at mouth, subsides gradually
Post ictal phase – unconscious and unresponsive to stimuli, event amnesia
Precautions for pts at risk for seizure
Think about who might be at risk – can happen anywhere
ETOH withdrawal, high fever, CNS infection, substance abuse, any history of epilepsy, Alzheimer’s, head trauma, CVA hx.
Make sure you have a functional IV access in acute care
Suction, oxygen available
Padded bed rails
Keep bed in low position
Ask your pt with seizure history about triggers, prodromal/aura associated
Any change to seizure med orders? NPO? Drug levels?
Assessment during seizure
What was the pts LOC? If consciousness was lost, at what point?
Indicates area of brain involved and type of seizure
What was the pt doing just before the attack?
May suggest precipitating factors
In what part of the body did the seizure start?
Can indicate site of seizure activity in the brain tissue
Was there an epileptic cry?
Usually indicates tonic stage of generalized tonic-clonic seizure
Were there any automatisms such as eyelid fluttering, chewing, lip smacking or swallowing?
Often seen in complex, partial, and absence seizures
How long did movements last? Did the location of character change(tonic/clonic?) Did movements involve both sides of the body of just one?
Indicates areas in which focal activity originated
Did the head and/or eyes turn to one side?
Helps localize focus of seizure
Were there changed in pupil reaction?
Indicates involvement of autonomic nervous system
If the pt fell, was the head hit?
May need to rule out subdural hematoma/fracture
Was there foaming/frothing from the mouth?
Was there urinary or bowel incontinence?
Usually indicates tonic-clonic seizure
Nursing Interventions during seizure
Support airway
Support airway, breathing, and circulation
have oxygen and suction available
turn patient to side to allow secretions to drain while maintaining airway
Nursing Interventions during seizure
Stay with patient
Stay with patient
observe seizure activity
note time and duration – if more than 5 min risk for status epilepticus
assess behavior at the onset of seizure: if the patient experienced an aura, a change in facial expression occurred, and progression of movements
note and document: type, characteristics, and progression of movements
administer intravenous medications as prescribed to stop the seizure
watch for incontinence
Nursing Interventions during seizure
Keep patient safe from injury
Keep patient safe from injury
keep bed locked and in low position with padded side rails
if patient is standing or sitting place on bed and protect head and body
loosen clothing from around neck
do not hold patient down
Nursing Interventions during seizure
POST SEIZURE
POST SEIZURE
monitor behavior, VS
level of consciousness, motor ability, and speech ability
Diagnosis
Seizure
EEG
ELECTROENCEPHALOGRAM (EEG)
Helps localize any brain lesions and confirm the diagnosis, assesses brain activity
No caffeine X8 hrs, withhold seizure meds or other meds impacting CNS, clean, dry hair
May have sleep restrictions
Diagnosis
Seizure
LUMBAR PUNCTURE
LUMBAR PUNCTURE
To assess spinal fluid for CNS infections (increased WBCs)
or tumors (increased protein)
