Cognition Flashcards
Cognition affects
- Mental Status (Orientation, memory)
- Level of consciousness (alertness, awareness, wakefulness, responsiveness)
- Intellectual Function
- Thought content (coherent, thoughts spontaneous, unusual thoughts or fixed ideas)
- Emotional status (irritable, mood)
- Language (Ability to speak)
Causes of seizure
- Cerebrovascular disease
- Diabetes
- Dehydration
- Hypoxemia
- Fever
- Head injury
- Hypertension
- CNS infections
- renal failure, electrolyte imbalances, pesticide exposure
- Brain tumor
- Drugs and alcohol withdrawal
- Allergies
Seizure disorder - epilepsy
•Group of neurologic diseases marked by reoccurring seizures.
- may fire without a clear cause.
- Firing is caused by some stimulus
- May be genetic or environmental link
How is a seizure different from epilepsy
•Seizures from systemic and metabolic problems are not considered seizure disorder if they stop when the underlying condition is corrected
Seizure age 2-20 cause
Birth injury
Infection
head trauma
Genetic
Seizure age 20-30 cause
Lesions from trauma, brain tumor or vascular disease
Seizure after 50 cause
Stroke and brain lesions
Seizure disorder risk factor
•Genetic link
Seizure is determined by
Site of electrical disturbances
Phases of seizure
•Prodromal phase:
- Sensation or behavior changes that precede a seizure by hours or days
•Aural phase:
- Sensory warning that is similar each time a seizure occurs. Is considered a part of the seizure (right before)
•Ictal phase:
- from first symptoms to the end of seizure activity
•Postictal phase:
- Recovery phase after the seizure
Aura phase
A premonitory or warning sensation, which can be visual or olfactory)
- Bright / Flashing lights
- Strange feelings
- Scotomas (blind patchy spots)
- Visual distortions
- Strange smells / taste
⚠️ warning sign seizure is coming
Seizure effects what 3 things
- Altered level of consciousness
- Loss of muscle tone or movement
- Disturbances of behavior, sensation, and perception
Clinical signs of seizure depends on
And range from
•location of the discharging neurons
Range from
- simple staring episode (absence seizure)
- prolonged convulsive movements with loss of consciousness.
Focal onset seizure
•Begin in 1 hemisphere of the brain in a specific region
- Aware: Person conscious and alert but have unusual feelings or sensations
- Impaired awareness: Loss of consciousness or change in awareness, dreamlike state. Eyes open but no interaction.
Focal AWARENESS seizures
- Sudden and unexplainable feelings of joy, anger, sadness, or nausea
- May hear, smell, taste, see, or feel things that are not real
Focal Impaired seizures
•Eyes are open but cannot interact
•May do things that can be dangerous or embarrassing
- walking into traffic/changing clothes
•After seizure, no memory of activities
•May continue the activity started before the seizure
Types of Motor activity during focal seizure
- Atonic: Loss of tone
- Tonic: sustained stiffening
- Clonic: rhythmic jerking
- Myoclonic: Irregular, brief jerking
- Epileptic spasms (flexion or extension of arms with flexion of trunk
- Strange behavior (lip smacking or other repetitive , purposeless actions called automaticisms)
Nonmotor activity during focal seizure
- Emotional manifestations (fear, joy, strange, feelings)
- Heart racing
- Goose bumps
- Waves of heat or cold
General onset seizure
- over wide area of both sides on brain
- characterized by bilateral synchronous epileptic discharges from onset
- patients awareness is impaired for a few sec to several mins 
Generalized
Tonic-clonic seizures
•loss of consciousness - Patient will fall if standing - Can result in head injury •Tonic comes before clonic phase •Cyanosis, excessive salivation •Tongue or cheek biting •Incontinence of bowel/or bladder •May cry out
Postictal phase of general seizure
•may sleep for several hours
- Difficult to arouse
•May not feel normal for hours or days
•No memory of seizure
- confusion
•Noisy breathing/ Abdominal respirations
•May report headache, sore muscles, fatigue and depression
What to do DURING a seizure
➢Maintain a patent airway
➢Protect the patient’s head with a pad
➢place the patient on one side with head flexed forward
➢Push aside any furniture
➢remove pillows & raise/ pad side rails
➢Loosen constrictive clothing
➢Ease patient to the floor (if seated)
➢Don’t try to open jaw or insert anything
•Provide privacy (patient with aura may have time to seek a safe, private place)
•Have O2 and suction at the bedside
•Remove potentially harmful objects from the bedside
•No attempt to restrain
•IV medications
Care after a seizure
“Postictal”
•Prevent complications
- hypoxia, vomiting, aspiration, injury
•Maintain seizure precautions.
•Keep suction at the bedside and oral airway (airway patent)
•Place bed in a low position with 2 to 3 side rails up and padded
•may be drowsy and may wish to sleep
- may not remember events
- Allow to rest
- Dim the lights, decrease the stimuli
•Once the patient recovers orient to person, place and time
•Perform a neuro assessment
•Keep the patient on one side
•A short apneic period may occur during or immediately after a generalized seizure
•If the patient becomes agitated after, use persuasion to assist them to stay calm
Nursing assessment postictal
What is happening after?
➢Level of consciousness ➢Vital Signs ➢Pupil size ➢Memory ➢Position loss ➢Muscle soreness ➢Speech disorders (aphasia, dysarthria) ➢Weakness or paralysis ➢Sleep period ➢Duration of each sign or Symptoms
Status epilepticus (SE)
•continuous seizure activity or seizures recur back to back WITHOUT return to consciousness between seizures
•Neurologic emergency
•Can occur with any type of seizure
• more than 5 mins
• Vigorous muscular contractions can interfere with respirations.
- Can cause respiratory arrest, brain hypoxia and fatal brain damage
Convulsive status epilepticus
- Prolonged or repeated tonic-clonic seizures
* Can lead to fatal respiratory insufficiency, hypoxemia, dysrhythmias, hyperthermia, and systemic acidosis
Status Epilepticus
Management
•Goal = stop seizures quickly to ensure cerebral oxygenation
- ET tube if unconscious or unresponsive
•IV line established dextrose for hypoglycemia, blood samples to monitor serum electrolytes & meds
•Nursing: monitor cardiac an respiratory function, Suction equipment, close monitoring, watch for complications
Long term Complications from seizure
- lifestyle is most common
- Depression
- Social stigma still exists
- Discrimination in employment and educational opportunities
- Driving sanctions
Diagnostic studies for seizure
- accurate comprehensive description of seizure and health history
- EEG
- determine type
- many don’t have abnormal findings first time
Things used to diagnosis seizure
- Developmental history (pregnancy, childbirth, head injury)
- Neurologic exam
- Biochemical, hematologic exam, serologic studies.
- MRI (detect structural lesions, CV abnormalities, cerebral degenerative changes
- EEG (evidence of epilepsy)
- SPECT: tool sometimes used. Useful in identifying the epileptic zone so that the area in the brain giving rise to seizures can be removed surgically
Epilepsy drug control
•Control rather than cure - with minimal side effects •When properly prescribed and taken, most are controlled - some don’t have improvement •Medication blood levels are monitored.
Drug therapy based on
Age
Weight
Seizure type
Pregabalin (lyrica)
Additional treatment for FOCAL AWARE or IMPAIRED AWARENESS seizure not successfully controlled with one medication
Status epileptics medication
Rapid acting IV
- lorazepam
- diazepam
Important about anti seizure meds
&
Common side effects
Should NOT be discontinued abruptly as this can cause seizures
Common side effects involve:
- diplopia
- drowsiness
- ataxia (will see when walk)
- mental slowness
Dilantin LONG TERM side effects
•drug toxicity, gingival hyperplasia (tender and swollen gums. Excessive growth of gum tissue )
- Will need periodic physical and dental exams
- Good dental hygiene (regular brushing and flossing)
•Can cause hematologic changes (agranulocytosis, aplastic anemia).
Dilantin side effects and teaching
• rash, drowsiness, N&V, dizziness,
** HYPOTENSION & TACHYCARDIA with IV
• agranulocytosis, aplastic anemia, thrombocytopenia (monitor blood levels)
- Avoid driving until cleared
- with or immediately after meals
- Avoid alcohol
- same time each day
Neurologic assessment involves testing for
- Nystagmus
- Hand and gait coordination
- Cognitive functioning
- General alertness
- toxicity
Gerontologic considerations
•must be recurring for meds
- more responsive to drugs
•Higher incidence of new-onset epilepsy
** Cerebrovascular disease is the leading cause of seizures in older adults
- head injury, dementia, infection, alcoholism, aging are a risk
• antiseizure meds may interact w/ their other meds
- Absorption, distribution, metabolism, and excretion of medication is altered due to age-related changes.
•Cost of antiseizure medications can lead to poor adherence.
Dilantin for older people with compromised liver function
•problematic because the liver metabolizes it.
•Phenobarbital, carbamazepine, and primidone may negatively affect cognitive function and can increase the risk osteomalacia, osteopenia and osteoporosis
- risk for fractures !
Surgery for uncontrollable epilepsy
is an option for many with uncontrolled epilepsy
•Anterior temporal lobe resection
Food to help seizure
•Ketogenic diet
- High-fat, low carbohydrate diet
- Ketones pass into the brain and replace glucose as an energy source
Nursing assessment of health history
- Previous seizures?
- Birth defects or injuries at birth
- Anoxic episodes 🧠 complete lose o2
- CNS trauma, tumors, infections
- Stroke, metabolic disorders
- Alcohol use disorder/withdrawal
- Drug use
- Hepatic/renal failure
Precipitating factors in seizure
- Metabolic acidosis or alkalosis
- Hyperkalemia
- Hypoglycemia
- Dehydration OR Water intoxication
General tonic clonic assessment
- Loss of consciousness, muscle tightening, then jerking
- Dilated pupils, hyperventilation then apnea
- Postictal somnolence (excessive sleepiness)
What type of things happen in each Focal seizure
•Aware
- Aura
- Focal sensory, motor, cognitive or emotional phenomena
•Impaired awareness
- Altered consciousness with inappropriate behaviors, automatism, amnesia of event
When seizure occurs
- observe and record details
- what events preceded
- when it began
- how long each phase lasted
- what happen in each phase
- note if you saw the beginning
Assessment ictal phase
➢Exact onset ➢Which body part was affected first and how ➢Course and nature (Loss of consciousness, tongue biting, automatisms, stiffening, jerking, total lack of muscle tone) ➢Body parts involved ➢Flushing ➢Dilated pupils ➢Diaphoresis ➢Excessive salivation ➢Incontinence ➢Cyanosis ➢Altered breathing
Documentation about seizure
- type of movement/part of body
- area of body
- size of pupils
- where eyes open
- eyes or head turns to one side
- involuntary motor activity
- lip smacking
- incontinence
- duration of each phase
- unconsciousness?
- inability to speak
- if sleep after
- confusion
- paralysis ? Weakness?
What should people with epilepsy wear
Medical alert bracelets
Health promotion for seizure
- Practice good general health habits (proper diet, adequate, exercise)
- Help to identify events or situations that cause seizures and ways to avoid
- Teach to AVOID excessive alcohol, fatigue, and loss of sleep
- Help to handle stress
Ambulatory Care
Provide Instructions
What to do so patient can walk safely
- Risk factors that increase risk for seizures
- Take meds as prescribed, report side effects to HCP
- Keep appointments to have blood levels of medications drawn.
- Safety measures during & after a seizure
- Include caregiver
- When to take the patient to the hospital
Epilepsy Lifestyle Changes
•Rest (⬇️sleep make worse)
•ONLY Moderate activity
•Coping strategies (constant fear)
•Not able to drive, employment & relationship issues
•Side effects of medications
- Keep meds & seizure record
- Tell Doc if can’t take bc illness
•Avoid activities that require mental alertness and coordination
•Avoid triggers (alcohol, electrical shocks, caffeine, constipation, fever, hyperventilation, and hypoglycemia)
•Take showers rather than baths
•Never swim alone
Seizure Response Dogs
- Seizure response dogs receive special training to assist those in distress
- They can find help if owner is in trouble
- They can pull away objects that pose danger
- Can carry information about their handler for emergency response teams
- Provide emotional support
