5.6 Seizures Flashcards
Seizure
- Sign of disorganized and excessive neuronal discharges of the brain (abnormal electrical firing in the brain)
- How it manifests depends on the part of the brain effected.
- Can cause loss of consciousness, altered consciousness, involuntary movement, changes in perception, behaviors, sensation and posture.
- Most frequent neurological dysfunction
Stages of a Seizure
Aura - Sensory change that precedes seizure activity (odor, taste, smell, flashing lights, de-ja-vu, hallucinations)
Ictal State - Period during a seizure
Post Ictal - Period after the seizure (drowsy, confused, weak)
Clonus - Rhythmic alternating contraction/relaxation of muscle groups
Epilepsy
- Not every seizure is epilepsy
- 2 or more unprovoked seizures
CAUSES
- Idiopathic (genetic)
- Symptomatic (secondary to disease/injury)
- Provoked (by medication, stress, anxiety, fatigue)
- Environmental (flashing light is most common)
- Cryptogenic (no cause)
- Important to figure out the cause of their seizure for proper treatment/care
Partial Seizures (Focal)
- Localized and involve only a small part of the brain. Localized symptoms
- HAS AURA
Simple Partial Seizure
- No alteration in consciousness but various sensation such as numbness, tingling, paresthesia
Complex Partial Seizure
- Loss of Consciousness accompanied by aura
Simple/Complex Secondarily Generalized Seizure
- Begin as simple than evolve into complex seizure (tonic-clonic)
Generalized Seizures
- Typical seizure. No focal onset and involves both hemispheres
- NO AURA
Signs
- Begins with loss/impairment of consciousness WITH impairment to motor function
Types
Tonic-Clonic - Typical full blown seizure with eyes rolling up and back, loss of consciousness.
Tonic - Entire body contracts
Clonic - Intense jerking and contraction of muscles
Absent Seizure - Sudden alteration in consciousness with blank stare. All of the sudden starts staring off into space but nothing gets their attention. (Completely spaced out)
Atonic Seizure - Sudden loss of muscle tone (head drops, legs give out)
Myoclonic Seizure - Brief contraction of a muscle or group of muscles.
Status Epilepticus
- Continuous seizure that lasts more than 30 minutes or series of seizures where child does not regain consciousness.
INTERVENTIONS
- ABCs, O2, IV Access, Antiepileptic Medication (Intranasal/Buccal midazolam, IV Ativan, Rectal Diazepam at home)
- May have hyperthermia after seizure
Nursing Care During Seizure
- PROTECT PATIENT FROM INJURY
(Safe environment, ease them down to floor if standing up, seizure precautions for at risk patients (padded side-rails, no clutter on bed) - TIME THE SEIZURE (Many medications cannot be given for seizure until seizure has lasted 5+ minutes to see if it stops on its own)
- ABCs
(Side-lying position to lower risk of aspiration, monitor O2 status, have suctioning and oxygen available. Do not put anything in patients mouth but suction if seen outside. Loosen tight clothing to not restrict) - DO NOT RESTRAIN
Post-Ictal State - Extremely tired. maintain side-lying position, assess injuries, preform neuro checks, re-orient the child, OK TO SLEEP
- DOCUMENT
(How long the seizure lasted, what the cause was, what movements were observed, what interventions were needed) - NPO until fully awake
Seizure Precautions
- Oxygen and Suctioning
- Pad bed rails and lowest position
- Anti-epileptic drugs (AED’s)
(Benzodiazepines) - History of Seizures
EDUCATION
- Education on safety equipment needed at school (medication and teacher education)
- Teach parents what to do if a kid has a seizure
(Educate to protect the child, safe environment, time the seizure)
- IF SEIZURE LASTS LONGER THAN 5 MINUTES ADMINISTER RECTAL DIAZEPAM AND CALL FOR MEDICAL HELP
Febrile Seizures
- Seizure secondary to high fevers (104)
- Everyone has a convulsion threshold for fever, most kids is between 106-107
Principles to Remember
- DO NOT RESTRAIN
- DONT PUT ANYTHING IN MOUTH
- MOST ARE HARMLESS
- TIME THE SEIZURE
- FIGURE OUT THE CAUSE
