Seizure Disorders Flashcards
Partial Seizures
simple (focal)
complex
complex»_space; generalized tonic-clonic
Generalized Seizures
absence
myoclonic
tonic-clonic
atonic
Seizures v Epilepsy
Partial, Generalized, Status Epilepticus
Epliepsy
-refers to chronic seizure activity that occurs w/out a reversible, metabolic cause
-“primary” epilepsy develops in childhood and research indicates there is a genetic predisposition toward this disorder
-“secondary” epilepsy occurs as a result of hypoxemia, brain injury, infection, stroke, or tumors in the CNS
Seizures
-a seizure disorder is a general term used to describe any condition in which seizures may be a symptom. Seizure disorder is a general term that is often used in place of the term “epilepsy”
-the point at which cell membranes become destabilized and uncontrolled electrical discharges begin is the seizure threshold
-seizure thresholds vary among people making some more prone to seizure activity than others
-seizures happen when increased activity in the action potential seizure threshold
Seizure Activity
-are sudden, uncontrolled discharges from brain neurons
-cerebral neurons become hyperexcitable or easily depolarized, referred to as an epileptogenic focus
-as a seizure continues, inhibitory neurons in the brain fire and cause neuronal discharges to slow, then stop
Generalized seizures (grand mal seizures)
incl tonic-clonic seizures characterized by rigid, intense contractions of the arm and leg muscles (tonic), followed by rhythmic contractions and/or relaxation of the muscles (clonic)
Partial (focal) seizures
are simple partial seizures (consciousness is not impaired) or complex partial seizures (impaired consciousness)
Jacksonian seizures
are simple partial seizures characterized focal motor symptoms beginning in one hand and then marching up the extremity
Absence seizures
are characterized by brief periods of staring and sudden cessation of activity (most often seen in children)
Seizure Conditions
-cerebral edema
-cerebral hypoxia
-cerebral trauma
-CNS infections
-Congenital or developmental brain defects
-expanding brain lesions
-hyperpyrexia
-metabolic disturbances
-use of convulsive or toxic drugs
Areas of Cortical Dysfunction
CAUSES OF SEIZURE ACTIVITY
-idiopathic
-severe hypoxemia
-hypoglycemia
-severe acidosis
-severe alkalosis
-dehydration
-high fever
-medication withdrawal
-toxins (metabolic or drugs)
-genetic predisposition
Prodrome
a feeling that may precede a seizure by hours or days
Aura
a sensory sensation that frequently and immediately precedes a seizure
Postictal
occurs following a seizure w/ manifested as stupor or coma, followed by confusion, headache, and fatigue
Medications that May Lower Seizure Thresholds
Propofol (anesthetics)
&
Primaxin/Imipenem (antibiotics)
RN Responsibilities for Seizure Activity
-Protect the airway (turn the pt on their side)
-Obtain IV access (establish in postictal stage)
-Administer anti-seizure meds: IV ATIVAN, VALIUM
or IV DILANTIN, TEGRETOL
-Administer O2: draw blood/ABGs per MD order (pt does not breathe during seizure, increased lactic acid = cause brain to stop seizing)
-Place the pt in recovery position (on the LEFT side - left side is bc when we lay pts on the left side we lay them on the aorta which has a lot of smooth muscle preventing them from collapsing)
-Documentation: length of seizure and type, duration of postictal phase (until pt can follow commands)
Recovery Position
-LEFT side
-the mouth is downward so that vomit or blood can drain from the pt
-the chin is up to keep the epiglottis opened and protect airway patency
-arms and legs are positioned to stabilize the position of the pt
Seizure Complications
-hypoxic brain damage and mental retardation may result w/ chronic seizure activity
-depression & anxiety may develop w/ possible long term social isolation
Status Epilepticus
- repeated seizure activity w/out full recovery between seizures lasting 30 min or more (although some sources say 5 min or more)
-medical emergency!
-if not treated, status epilepticus will lead to death: neurons begin to die, leading to permanent brain damage
-a compromised airway can lead to hypoxia
RN Interventions for Seizures
-ABCs
-use pads or cushions to protect the head
-move harmful objects to a safe distance
-provide privacy
-dont put anything in the pts mouth
-observe and be aware of potential for status epilepticus
-pepare for diagnostic testing
-document the event
-investigate precipitating factors
- important to document: time it started, time it ends, if you hear cry b4 the seizure
Medications for Seizures
-IV Ativan, Valium, and/or Dilantin (IVP - no more than 50 mg per minute) are used for STATUS EPILEPTICUS
-benzos - affect GABA - surpress CNS activity
- if your pts rcvd any of these drugs monitor frequently for: respiratory depression or hypotension
-meds work in 2 ways:
1. suppress the activity of damaged nerves
2. reduce responsiveness of neighboring normal neurons
-pt is started on low does to minimize adverse reactions and prevent toxicity
-dosage is increased as needed to control seizures
lorazepam (Ativan)
[classes, MOA, indications, SE, AE]
Therapeutic Class: sedative - hypnotic; anxiolytic
Pham Class: benzos
MOA: acts by potentiating the effects of GABA, an inhibitory neurotransmitter of the CNS
Indications: anxiety, seizures, anesthetic adjunct
SE: drowsiness and sedation
AE: when given in higher doses or by IV - hypotension and respiratory depression/arrest
lorazepam (Ativan)
[half life, RN Responsibility, Safety, Preg Cat, Tx OD]
Half life: 10 to 20 hrs
RN Responsibility: except during seizure activity, check BP and RR prior to admin
Safety Admin: when administering IV, monitor respirations and BP every 1-5 minutes. Have accessible airway and resuscitate equipment.
Pregnancy Cat: D + risk to fetus
Tx of OD: flumazenil (Romazicon)
Causes of Seizures Include:
-Allergies
-Brain tumor
-Cerebrovascular disease
-CNS infections
-Drug and alcohol withdrawal
-Fever (childhood)
-Head injury
-Hypertension
-Hypoxemia of any cause, including vascular insufficiency
-Metabolic and toxic conditions (e.g., kidney injury, hyponatremia, hypocalcemia, hypoglycemia, pesticide exposure)
