Exam 2: Seizures

Question 1

Epilepsy

Answer 1

Chronic recurring abnormal brain electrical activity resulting in two or more seizures, 24 hours apart

Seizures resulting from identifiable causes (substance withdrawal, fever) are not considered epilepsy

Question 1

Seizure

Answer 1

Abrupt, abnormal, epilepsy and uncontrolled electrical discharge of neurons within the brain

Alterations in:
LOC
Motor function
Sensory ability
Behavior

Question 2

Seizure risk factors

Answer 2

Primary (Idiopathic): Unprovoked seizures with no identifiable cause, thought to be genetic

Secondary (Provoked): May occur during almost all serious injuries or illnesses affecting the brain including metabolic derangements, infections, tumors, drug abuse, vascular lesions, brain injury

Question 3

Seizure triggers

Answer 3

Vary per person

Increased physical activity, excessive stress, hyperventilation, overwhelming fatigue, acute alcohol ingestion, excessive caffeine intake, exposure to flashing lights, substances (cocaine, aerosols, inhaled glue products)

Question 4

Electroencephalogram (EEG)

Answer 4

Non-invasive procedure that assesses the electrical activity of the brain

Used to determine abnormalities in brain wave patterns

Provides information about ability of the brain to function and highlights areas of abnormalities

Question 5

Nurse education for patient who is undergoing an EEG the next day

Answer 5

Try to stay awake the night before

Question 6

Tonic-Clonic Generalized Seizure

Answer 6

Bilateral symmetrical tonic contractions, then bilateral clonic contractions; rigidity and rhythmic jerking

Aura = warning sign of an impending seizure activity

Seizure activity: Short period of tonic episode (stiffening of muscles) and loss of consciousness, 1-2 minute clonic episode (rhythmic jerking of extremities)

5 minute seizure = status epilepticcus medical emergency

Respiratory issues
Cyanosis Biting of cheek or tongue

Postictal period: Incontinence, confusion, sleepiness

Question 7

Todd’s Paralysis

Answer 7

Weakness for up to 24-48 hours following seizure, not typical

Question 8

Tonic Seizure

Answer 8

Generalized

Sudden loss consciousness, sudden rigid, violent contraction of the muscles, fixing the limbs in a strained position

Autonomic manifestations: Arrhythmia, apnea, vomiting, incontinence, salivation

Lasts 30 seconds to a few minutes

Question 9

Clonic Seizure

Answer 9

Repetitive rhythmic muscular contractions/relaxation that are bilateral and symmetric

Hyperventilation

Lasts several minutes

Question 10

Absence Seizures

Answer 10

Generalized, non-convulsive epileptic events

Typically occur in children and cease in adulthood or evolve to generalized motor seizures

Manifestations: Blank stare, motionless, unresponsiveness. Automatisms: Lip smacking, mild clonic motion (eyelids)

Question 11

Complex partial seizures

Answer 11

Focal, with loss of consciousness

Manifestations: Automatisms or repetitive non-purposeful activities (lip smacking, grimacing, patting, rubbing clothing), hallucinations (deja vu), amnesia

Question 12

Simple partial seizure

Answer 12

Focal, without loss of consciousness, effect ONE hemisphere

Manifestations: Aura, involuntary motor movements, somatosensory disturbances (tingling/crawling sensations), increased HR, flushing, sensory disturbances (visual. auditory, olfactory phenomena)

Question 13

Nursing care of seizure patient

Answer 13

Assess onset, duration, and findings prior to, during, and following the seizure

Put PT on their side

Plan and intervene for PT safety, O2 and suction available, padded side rails, bed in lowest position, privacy provided, loosened clothing

Reassess and monitor patient afterwards

Question 14

Nursing care after seizure

Answer 14

PT in side lying (prevent aspiration and facilitates drainage of oral secretions)

Check VS and perform neuro checks

Assess for injuries

Allow PT to rest, reorient and calm PT

Question 15

Seizure precautions

Answer 15

Suction, oral airway, oxygen available

Bed in lowest position with mats underneath

2-3 side rails up and padded

Question 16

Status epilepticus

Answer 16

Repeated seizure activity within a 30 minute time frame OR a single prolonged seizure lasting more than 5 minutes

Goals:
1. Stop seizures as quickly as possible
2. Ensure adequate cerebral oxygenation
3. Prevent future seizures

Concerns: Hypoxia, respiratory arrest, cerebral anoxia and edema

MEDICAL EMERGENCY

Medications: Diazepam or lorazepam IV push, IV phenytoin, IV fluids with glucose

Question 17

True/False: Patients with epilepsy are at risk for status epilepticcus from having their medication regimen interrupted

Answer 17

TRUE

Question 18

Anti-seizure agents

Answer 18

Control of seizures (may not completely eliminate)

Choice of drug depends on seizure type, age, and health status

Monotherapy is the desired goal but combination therapy may be necessary

Most have narrow therapeutic ranges

Question 19

Phenytoin (Dilantin)

Answer 19

Treatment of tonic-clonic seizures, prevention of status epilepticcus

Action: Stabilized neuronal membranes, prevents hyperexcitability caused by excessive stimulation, limits spread of seizure activity

Adverse effects: CNS depression, nystagmus, diplopia, Gingival Hyperplasia, liver toxicity, bone marrow suppression, teratogenic

Take at same time every day, no alcohol

Question 20

Carbamazepine (Tegretol)

Answer 20

Treatment of tonic-clonic seizures and focal seizures, prophylactic drug

Monitor: Therapeutic serum levels, CBC, sodium

Adverse effects: CNS depression, bone marrow suppression, hepatitis, Stevens-Johnson syndrome, teratogenic

Interactions: Warfarin, grapefruit, Phenytoin and Phenobarb

Priority statement from PT’s parents: So many new bruises on body

Question 21

Phenobarbital

Answer 21

Treatment of tonic-clonic seizures, emergency treatment of status epilepticcus

Monitor: Therapeutic serum levels

Adverse effects: CNS depression, bradycardia, hypotension, hypoventilation, dependence and withdrawal

Toxicity: Nystagmus, ataxia, respiratory depression, coma, pinpoint pupils, hypotension, death

Interactions: Vitamins D and K, CNS depressants, Valproic acid

Question 22

What medication class is used pre-operatively for decreased risk of post-operative seizures?

Answer 22

Anti-convulsants