Alterations in Neuro [seizure + LOC] Flashcards
myelination proceeds in ____ direction
cephalocaudal direction
head to fingers/toes
newborn reflex is fr lack of myelination
cerebral BF is maintained thru…
autoregulation
most important indicator of neuro dysfunction
states of consciousness
5 types of aletered levels of consciousness
1 confusion 2 delirium 3 lethargy 4 stupor 5 coma
confusion
disoriented to person, place, time
-may still be able to answer simple questions
delirium
- disoriented
- fear, irritable, agitated
- mental or motor excitement
lethargy
- profound slumber
- limited speech + movement
stupor
deep sleep or unresponsiveness
-only aroused by vigorous stimuli
coma
unconscious
-cannot be aroused
altered states of consciousness often follows a predictable sequence
1 slight disorentatn 2restlss + irrtbl 3 drowsy 4 non-purposeful response to pain 5 posturing, siezures, fixd pupils ***6*** crushing triad
cushing triad of altered states of consciousness
- incr SBP w widened pulse pressure
- bradycardia
- irregular respirations
early signs of ICP
- headache
- slow reacting pupils
- slight change in LOC
- restlessness
early signs of ICP in infants are similar but with…
- bulging fontanelle
- high pitched cry
nonspecific to infants
- headache
- slow reacting pupils
- slight change in LOC
- restlessness
late signs of ICP
-significant change in LOC
-cushing triad
»incr SBP w widened pulse pressure
»bradycardia
»irreg RR
altered states of consciousness
treatment
AIRWAY> positioningm, intubation, bag-valve mask
BREATH>O2
CIRC> IV fluids, blood products
altered states of consciousness
is assessed with..
Glasgow Coma Scale
>eye opening
>verbal response
>motor response
altered states of consciousness
nursing mgmt
provide sensory stimultn
»encourage family to stroke + touch in soothing manner
repeated orientation
»bring familiar toys to bedside
Seizure Disorders
excessive neurons becoming overexcited
highest rate of onset of seizures
during first 12 months of life
possible causes of seizures
wide variety; many are unknown
- brain injury
- infection
- electrolyte disturbance
- toxins
Status Epilepticus
prolonged continuous seuzire lasting longer than 15 min
or
intermittent seizures longer than 15 min w/o full recovery bw each seizure
seizures use up a lot of ___ +___
glucose + oxygen
generalized seizures aka
tonic clonic
generalized seizures/tonic clonic
manifestations
body becomes stiff + rigid
>followed by rhythmic jerking motions
childhood absence epilepsy is caused by genetic predispotiion
touch does not interrupt seizures
infantile spasms - genetic
abrupt spasms
>involves head nods + jackknife body contractions
Phases of Seizure Disorders
Tonic
Clonic
Postictal
Tonic
- unconscious
- continuous muscular contraction
- sustained stiffness
Clonic
- alternating muscular contraction
- relaxation or rhythmic jerking
Postictal
decreased LOC
NEONATAL SEIZURES
findings
- *subtle**
- roving eye mvmt
- repetitive blinking
- sucking, lip smacking, tongue thrusting
- leg pedaling mvmt
- swimming mvmt of arms
- apnea + tachycardia
seizure disorder
maintaining safety
- nothing in mouth
- side-lying position
- ensure rails have pads
- move objects away
seizure disorder
ABC’s
airway suctioning
supplt O2
bolus
how to stop seizure
anticonvulsant + tx of cause
post-seizure care
monitor postictal period (30 min-2hr)
get glucose + abg levels
when starting new antiepileptic drugs, adolescents….
should NOT drive or do anything risky
-avoid ETOH
MEDS for seizures
benzos [diazepam, lorazepam/ativan] fosphenytoin/cerebryx levetiracetam/keppra phenobarbital valcroic acid/depakote
benzos [diazepam, lorazepam/ativan]
monitor for
>hypotension
>tachycardia
>resp dprssn
*rectal or nasal form for home admin
fosphenytoin/cerebryx
monitor for resp dprssn
levetiracetam/keppra
monitor gait/coordinatn problems
phenobarbital
monitor for excess sedation
valcroic acid/depakote
can be given in sprinkle form
Seizure Disorder
treatments
- vagal nerve stimulator
- ketogenic diet
vagal nerve stimulator
activated vagal nerve after AURA
-to reduce spread of seizure
ketogenic diets must cut out
all glucose fr all sources
a trial of antiseizure medication withdrawal
attempted after 2 years of no seizures
seizure/anti epileptic meds are at risk for..
-depression
-anxiety
-behavioral problems
ADHD
seizure education
nonadherence is common (esp w alcohol)
safety measures includes no bath, may need helmet, no playing around open flames, medical alert ID
*teach parents to focus on what they CAN do
Febrile Seizures
usually w temp >39C in first 24 hr of illness
SIMPLE Febrile Seizures duration
last less than 15 min
do no recur during the same illness
SIMPLE Febrile Seizure
manifestations
- generalized w tonic-clonic mvmt + eye rolling
- brief postictal period
- not tx w anticonvulsant
- give antipyretic + education
