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Nursing 271 > Chapter 28: Seizure Disorders and Epilepsy (Children) > Flashcards

Chapter 28: Seizure Disorders and Epilepsy (Children) Flashcards

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1
Q

Seizure

A

an electrical disturbance within the brain, resulting in changes of motor function, sensation, or cognitive ability
-classified according to the area of the brain experiencing the abnormal electrical activity and the neuromuscular sensory and psychogenic alteration from the electrical conduction disturbance

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2
Q

Seizures can result from?

A

a traumatic brain injury, an infection in the central nervous system, toxic ingestion, endocrine dysfunction, atrial-venous malformation, or an anoxic episodes
-neonates may develop seizures b/c of intrapartum or postpartum anoxic episodes, maternal ingestions or exposure to teratogens, and prenatal infections; hypoglycemia and congenital malformations can also cause neonatal seizures in the first month of life

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3
Q

Febrile Seizures

A

-common form of first-time seizure in childhood
-usually seen in children younger than 3
>Simple febrile seizure: a brief (less than 15 minutes), generalized episode that occurs only once during a 24-hour period in a febrile child without any evidence of metabolic imbalance, history of prior febrile seizure, or intracranial infection
>Complex febrile seizure: lasts longer than 15 minutes and recurs within 24 hours
-antipyretics and anticonvulsant therapy may be administered

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4
Q

Diagnosis

A

-neurological testing; used to determine the etiological epileptic focal center in the brain causing the abnormal electrical activity
-in-depth testing of the neurological system helps to classify the type of seizure and determine appropriate anticonvulsant therapy
-neurological exam: consists of a cranial nerve assessment, deep tendon reflex, sensory and motor response, LOC, and hearing and pupil checks
>CT scan or MRI performed to look for CNS malformation, lesions, neoplasms, hemorrhage, trauma, foreign body, or edema
>angiography: to assess for arteriovenous malformations that may be hereditary
>Electroencephalogram (EEG) is the accepted standards for diagnosing a seizure disorder
>Positron emission tomography (PET) scans are performed if brain structures require outlining or mapping before a surgical procedure, but not indicated for seizure evaluations

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5
Q

New on-set seizures may suggest what?

A

malignant neoplasms and warrant emergent neuroimaging

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6
Q

What test is the accepted standards for diagnosing a seizure disorder?

A

Electroencephalogram (EEG)
>evaluates the electrical activity of the brain while the brain is in a sleepy or drowsy state and also when stimulated
-loud noises, bright lights, and rapid flashing images are presented during the procedure, and the resulting electrical brain wave response is graphed
>Video EEG can also be done if the EEG is inconclusive or if the child experiences sleep and walking onset seizures

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7
Q

Pseudoseizures

A

false seizures

-evaluated as neurological episodes until determined to be psychological or not pathological in nature and etiology

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8
Q

Partial (Focal) Seizure

A

localized to one area

  • one area is affected: hands, lips, wrist, arms, or face
  • impaired loss of consciousness at onset
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9
Q

Partial Complex (psychomotor) Seizure

A
  • location: temporal lobe
  • loss of consciousness and loss of awareness of surrounding
  • changes in behavior (lip smacking, picking, inappropriate mannerisms, confusion) follow the seizure
  • evolve to a generalized seizure
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10
Q

Partial Simple Seizure

A
  • lasts 5 minutes
  • child only remembers the aura (feeling before the seizure that something bad is going to happen)
  • automatisms are noted (brief unconscious behaviors)
  • no loss of consciousness or awareness
  • motor signs are isolated to one area of the body and then spread to the rest of the body
  • may experience senses such as buzzing sounds, tingling, flashing lights, anxiety, fear, or anger
  • evolve to generalized seizures
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11
Q

Generalized: Toxic-Clonic Seizure

A
  • Cause: genetic predisposition or brain injury secondary to anoxia
  • partial simple and complex seizures evolve to this
  • aura is experienced followed by loss of consciousness and tone
  • patient falls to the floor with tonic-clonic muscle contractions
  • patient is postictal and confused after the seizure is over
  • loss of urine may occur
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12
Q

Generalized: Atonic Seizures (Absence/ petit mal)

A
  • loss of muscle tone; drop attacks
  • sudden drop to the floor caused by loss of motor muscle tone
  • seen in children 2 to 4 years of age
  • no loss of consciousness; but loss of awareness
  • non-convulsive
  • periods of staring or minor movements lasting seconds
  • may occur several times a day
  • interferes with learning and schoolwork
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13
Q

Generalized: Tonic Seizures

A
  • stiffening of the body that is sustained

- involving all four extremities

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14
Q

Generalized: Myoclonic Seizures

A
  • cause: metabolic etiology

- single or multiple jerks or flexion of limbs

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15
Q

Generalized: Clonic Seizures

A

-intermittent rhythmic jerking, 1-3 per second; may start in one body location and move to another location

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16
Q

Generalized: Myoclonic and Akinetic Seizure

A

complete or total lack of movement

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17
Q

Causes of Epilepsy

A

preventable events such as traumatic and/or anoxic brain injuries, brain infections, or stroke

18
Q

Nursing Care

A
  • completes a detailed history of the seizure event
  • in depth review of child’s prenatal and postnatal history
  • review of systems
19
Q

What must be included in the seizure event history?

A
  • antecedent events that may have precipitated the seizure (e.g. dehydration, videogaming, exercise, or any ingestion of substances that may cause seizures)
  • type of activity during the seizure
  • any loss of consciousness
  • loss of urine
  • noises made
  • cyanosis
  • history of present illness
  • a family history and type of seizure activity
20
Q

Seizure Management

A
  • collaborative effort
  • determined by the type of seizure
  • if pathological (disease) in origin, managed medically until cause can be resolved
  • if cause is a brain tumor, the mass is excised
  • if caused by endocrine dysfunction, it is resolved
  • if infection, antibiotic therapy
  • if unknown and no structural abnormality, placed on anti-convulsant therapy for the type of seizure being experienced
21
Q

What is The Priority Nursing Intervention for Child Experiencing Seizure?

A

Airway Management

  • continuous monitoring of respiratory status b/c seizure medications can cause a decreased LOC, apnea, and hypotension
  • also, after the postictal phase, the child may need to be reoriented
  • maintain airway patency; ensure nothing is placed in the child’s mouth during a seizure; a loose tooth may be aspirated or knocked out; suctioning may be necessary after the seizure is over
22
Q

The Hospitalized Child

A

-receives continuous cardiac, respiratory, and oxygen monitoring

23
Q

Seizure Precautions

A
  • maintain airway patency; ensure nothing is placed in the child’s mouth during a seizure; a loose tooth may be aspirated or knocked out; suctioning may be necessary after the seizure is over
  • monitor oxygen saturation; the child’s color should remain pink; pulse oximeter should read 95% or greater and the heart rate normal or slightly raised
  • administer IV medications; give the medication slowly to reduce risk of side effects such as respiratory or circulatory failure
  • raise and pad the side rails when in bed or crib; needs to be protected from injury
  • have child war a medical alert bracelet
  • provide emotional support to child and family; allow the child and family to express their feelings, offer a support group, and remind the family to treat the child as normally as possible
24
Q

Emergency Care for the Child Having a Seizure

A
  1. In community setting, call 911
  2. In a hospital, use the designated emergency number
  3. Maintain a patent airway; if the airway is occluded, open the airway with a jaw thrust maneuver; administer oxygen if needed and available; do not put anything in the mouth; if the situation warrants emergency medical care, qualified health-care personnel can insert an appropriate-sized oral airway
  4. loosen restrictive clothing to ensure adequate circulation to essential body organs
  5. administer medications such as diazepam (Valium), lorazepam (Ativan), or fosphenytoin (Cerebyx) as ordered; not administered to a neonate b/c they are toxic as a result of immature liver function
  6. monitor respiratory status and circulatory status throughout the seizure
  7. position the child in a lateral position to prevent aspiration
  8. inform the child that he/she has just had a seizure; tell the family that the child may still be confused and disoriented for a short time
  9. stay with the child; support is essential b/c a seizure is frightening to both child and family
  10. document all important details about the seizure, the care provided, and the condition of the child after the seizure and give notification to the physician
25
Q

Medical Care

A
  • Antiepileptic drug (AED) therapy is the main treatment for seizure management in children with epilepsy
  • monotherapy (one drug) is goal of epilepsy treatment
  • polytherapy (more than one drug) may be initiated for intractable epilepsy or seizure control is improved with the synergistic effects of two antiepileptic medications
26
Q

Anticonvulsant Medications

A
  • can become toxic when taken on a daily basis
  • baseline liver function, renal function, and hematological values assessed before initiation of pharmacotherapy
  • anti-convulsant drug serum levels monitored
  • children may outgrow a certain dosage and begin having seizures because of lowered serum levels; levels assessed every 3 to 6 months
27
Q

Other Supplemental Treatments for Epilepsy besides antiepileptic Agents?

A
  • vagus nerve stimulation

- ketogenic diet (high-fat, adequate-protein, low-carbohydrate)

28
Q

Surgical Care

A

epilepsy surgery is most commonly performed when a seizure focus is located in a single area of the brain

29
Q

Education/ Discharge

A
  • medication information; type of medication, dose, route, and frequency of dosing
  • medication regimen adhered to in the day-care setting
  • child is not left alone until the seizures have been controlled and he/she is seizure free for several months
  • adolescents may drive (depending on state laws) and participate in sports as long as therapeutic serum anticonvulsant drug levels are within normal range and the adolescent is seizure free for at least 6 months
  • school nurses and teachers informed about child’s seizure condition
  • medical alert identification bracelets are worn by children
30
Q

Adolescents and Seizures

A

may drive (depending on state laws) and participate in sports as long as therapeutic serum anticonvulsant drug levels are within normal range and the adolescent is seizure free for at least 6 months

31
Q

How Often are Serum Drugs Levels Assessed?

A

every 3 to 6 months

32
Q

Drugs Administered for Partial Complex (psychomotor) Seizures?

A
  • carbamazepine (Tegretol)
  • valproic acid (Depakene)
  • phenytoin (Dilantin)
  • phenobarbital (Luminal)
  • fosphenytoin (Cerebyx)
33
Q

Drugs Administered for Generalized Tonic-Clonic Seizures

A
  • carbamazepine (Tegretol)
  • valproic acid (Depakene)
  • phenytoin (Dilantin)
  • phenobarbital (Luminal)
  • Ketogenic diet (high in fat, low in protein and carbohydrates)
34
Q

Drugs Administered for Absence (Petit Mal) Seizures

A
  • ethosuximide (Zarontin)

- valproic acid

35
Q

Drug Administered for Partial Simple Seizures

A

topiramate (Topamax)

36
Q

Carbamazepine (Tegretol)

A
  • antiepileptic drug (AED)
  • used for partial complex, and generalized tonic-clonic seizures
  • adverse reactions: drowsiness, nausea, liver changes, increased appetite (CARBamazepine)
  • nursing care: give with food but NOT with milk
37
Q

Valproic Acid (Depakene)

A

-antiepileptic drug (AED)
-used for partial complex, generalized tonic-clonic, and absence (petit mal) seizures
>Adverse Reactions: confusion, ataxia (impaired coordination), nystagmus (uncontrolled repetitive eye movements), nausea, gingival hyperplasia, bleeding disorders)
>Nursing Care:
-ALWAYS give with food
-monitor serum drug levels
-Oral Hygiene! (for gingival hyperplasia)
-wear medical alert tag
-watch for toxicity

38
Q

Phenytoin (Dilantin)

A

-antiepileptic drug (AED)
-used for partial complex and generalized tonic-clonic seizures
>Adverse Reactions: dizziness, drowsiness, physical incoordination
>Nursing Care:
-avoid abrupt discontinuation
-daily multivitamin with medication
-ALWAYS give with food
-monitor drug serum levels
-oral hygiene
-medical alert bracelet
-watch for toxicity
-GIVE with water, juice, or milk

39
Q

Phenobarbital (Luminal)

A

-antiepileptic drug (AED)
-used for Partial Complex and Generalized tonic-clonic seizures
>monitor for sleepiness, hyperactivity, drowsiness, and school performance changes

40
Q

Ethosuximide (Zarontin)

A
  • antiepileptic drug (AED)
  • used for absence (petit mal) seizures
  • AVOID antacids
41
Q

Topiramate (Topamax)

A

-antiepileptic drug (AED)
-used for partial simple seizures
>Adverse Reactions: weight loss, dizziness, diarrhea, cognitive dysfunction
>AVOID antidepressants and antacids

Nursing 271 (208 decks)

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