Exam 2: Seizures Flashcards
Epilepsy
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
Seizure
Abrupt, abnormal, epilepsy and uncontrolled electrical discharge of neurons within the brain
Alterations in:
LOC
Motor function
Sensory ability
Behavior
Seizure risk factors
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
Seizure triggers
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)
Electroencephalogram (EEG)
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
Nurse education for patient who is undergoing an EEG the next day
Try to stay awake the night before
Tonic-Clonic Generalized Seizure
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
Todd’s Paralysis
Weakness for up to 24-48 hours following seizure, not typical
Tonic Seizure
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
Clonic Seizure
Repetitive rhythmic muscular contractions/relaxation that are bilateral and symmetric
Hyperventilation
Lasts several minutes
Absence Seizures
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)
Complex partial seizures
Focal, with loss of consciousness
Manifestations: Automatisms or repetitive non-purposeful activities (lip smacking, grimacing, patting, rubbing clothing), hallucinations (deja vu), amnesia
Simple partial seizure
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)
Nursing care of seizure patient
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
Nursing care after seizure
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
Seizure precautions
Suction, oral airway, oxygen available
Bed in lowest position with mats underneath
2-3 side rails up and padded
Status epilepticus
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
True/False: Patients with epilepsy are at risk for status epilepticcus from having their medication regimen interrupted
TRUE
Anti-seizure agents
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
Phenytoin (Dilantin)
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
Carbamazepine (Tegretol)
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
Phenobarbital
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
What medication class is used pre-operatively for decreased risk of post-operative seizures?
Anti-convulsants
