Chapter 15 Seizures

Question 1

Seizure

Answer 1

-disturbance of electrical activity in the brain that may affect consciousness, motor activity, and sensation
- caused by abnormal or uncontrolled neural charges (Foci, Focus,or spread)
- symptom of underlying disorder, not diagnosis
-SINGLE OCCURENCE

Question 2

Can you have a seizure w/o convulsions?

Answer 2

Yes

Question 3

Can hypoglycemia cause seizure activity

Answer 3

Yes, brain love glucose

Question 4

Epilepsy

Answer 4

Neurological disorder
- two or more occurrence of seizures; seizures occurring chronically
-people have periods of seizure activity
-characterized by recurrent symptoms that may include blackouts, fainting spells, sensory disturbances, jerking body movements, and temporary loss of memory

Question 5

Convulsions

Answer 5

-ALWAYS mean seizure activity
- all convulsions are seizures but not all seizures are convulsions
- INVOLUNTARY, violent spasms of large skeletal muscle of the face, neck, arms, and legs
-localized twitching

Question 6

T or F: over 50% of seizures are idiopathic: no specific cause can be identified

Answer 6

True

Question 7

Known causes of seizures (6)

Answer 7

-Fever
-Infectious disease
-Metabolic disorder
-Neoplastic disease
-Trauma
- Vascular disorder

Question 8

Fever: cause of seizures

Answer 8

Rapid increase in body temperature may cause febrile seizures seen in infants and toddlers

Question 9

Metabolic disorders: cause of seizure

Answer 9

Changes in fluid and electrolyte levels
Hypoglycemia, hyponatremia, water intoxication, may cause seizures by alternating electrolyte impulse transmission at cellular level

Question 10

Infectious diseases: cause of seizure

Answer 10

Acute infections such as meningitis or encephalitis, can cause inflammation to the brain

Question 11

Neoplastic disease: cause of seizure

Answer 11

Tumor, especially rapidly growing ones, can occupy space, increase intracranial pressure and destroy brain tissue by distrusting blood flow

Question 12

Trauma: cause of seizure

Answer 12

Physical trauma such as blows to the head can increase in trace animal pressure; chemical trauma from presence of toxic substances from ingesting poison, causing brain injury

Question 13

Vascular disease: cause of seizure

Answer 13

Changes in oxygenation (respiratory hypoxia, CO poisoning)

Changes in perfusion (HYPOtension, shock, seizure, cardiac dysrhythmias)

Question 14

Why is pregnancy planning a concern for women w/ epilepsy

Answer 14

several AED decrease effectiveness of hormonal contraceptives

pregnancy category D

Question 15

General classification for seizures (3)

Answer 15

1) partial (focal)
-seizure activity starts in one part of the brain
2) generalized (spread)
- consciousness is lost at onset
-seizure activity involves the whole brain
3) special epileptic syndromes

Question 16

Two types of partial seizures

Answer 16

1) simple partial
2) complex partial (psychomotor)

Question 17

Simple partial

Answer 17

• olfactory, auditory, visual hallucination
• intense emotion
• twitching of arms, legs, face
• jerking, deja vu,
  -alert
  -nausea
  -strange taste or smell

Question 18

Complex partial (psychomotor)

Answer 18

• altered awareness and behavior
• repetitive movements, cognition
  -PRECEDING AURA
• no response to verbal
  -brief period of confusion or sleepiness after w/ no memory of seizure (postural confusion)

Question 19

List Generalized seizures

Answer 19

1) absence (petit mal)
2) atonic (drop attacks)
3) tonic-clonic (grand mal)

Question 20

Can a partial seizure be generalized

Answer 20

Yes, a complex or simple can become tonic clonic

Question 21

Absence seizures

Answer 21

Few seconds
Trance like state
Petit mal
Misdiagnosed with ADHD or daydreaming

Question 22

Atonic seizures

Answer 22

Drop attack or abrupt fall
Stiffening (tonic) or loss of muscle tone (atonic)
Few seconds
Stumbling or falling for no reason

Question 23

Tonic clonic (grand mal)

Answer 23

-preceding aura
-tonic: intense muscle contraction
-clonic: alternating contraction and relaxation of muscles
- shallow breathing with apnea (1-2 min)
-disorientation and deep sleep after seizure (postictal state)
-Incontinence
-crying at the beginning as air leaves lung
-LOSS OF CONSCIOUSNESS with convulsion, stiffening of body then jerking of limbs

Question 24

List Special epileptic syndromes

Answer 24

1) febrile seizures
2)myoclonic seizures
3)Status epilepticus

Question 25

Febrile Seizures

Answer 25

Tonic clonic activity 1-2 min Children ages 3 months to 5 years Rapid return to consciousness

Question 26

Myoclonic seizures

Answer 26

Sudden large jerking movements Falling from sitting position or dropping what is held

Question 27

Status epilepticus

Answer 27

Medical emergency Continuous seizure activity; can lead to death or coma >30 min 2 or more seizures without full recovery of consciousness give IV diazepam

Question 28

Treatment for status epilepticus

Answer 28

IV diazepam

Question 29

MOA of diazepam, class, onset, contraindications, interventions, AE

Answer 29

Potential effects GABA (increase influx of Cl-) Benzodiazepine Effects in minutes, anticonvulsant effects last 20 min Contraindications: alcohol, shock, coma, depressed vital signs, Interventions: monitor respirations every 5-15 min, have airway and resuscitate equipment available AE hypotension, tachycardia, muscular weakness, respiratory depression

Question 30

Phenytoin (Dilantin), lab monitoring, abrupt withdrawal

Answer 30

Hydantoin MOA: inhibit influx of Na Monitor blood glucose level; may increase blood glucose serum level Monitor DM patients closely Risk for hepatotoxicity Abrupt withdrawal—> status epilepticus

Question 31

Phenobarbital (Luminal)

Answer 31

Barbiturate Potentiate GABA - increase GABA in CNS—> decrease neuron firing, suppress seizure activity GABA —> primary inhibitory neurotransmitter in brain

Question 32

Goal of seizure activity

Answer 32

Suppress neuronal activity just enough to prevent abnormal focus from forming or spreading across cerebrum Directed at controlling the movement of electrolytes across neuronal membranes or affecting neurotransmitter balance

Question 33

Phenobarbital AE, how to assess

Answer 33

Barbiturate Common SE: drowsiness, vitamin deficiencies (vitamin D, folate (b9), b12), laryngospasms (makes it hard to speak or breathe) Overdose: coma, death, severe respiratory depression, CNS depression Monitor patients condition Liver and kidney function Excessive signs of bleeding Drowsiness and bone pain

Question 34

Phenytoin AE

Answer 34

Dysrhythmias (Bradycardia, ventricular fib) SEVERE HYPOTENSION Hyperglycemia Multiple blood dyscrasias (disorder): agranulocytosis (low WBC), aplastic anemia (bone marrow aphasia, bone stops producing enough new blood cells)