Seizure Disorders

Question 1

Partial Seizures

Answer 1

simple (focal)
complex
complex&raquo_space; generalized tonic-clonic

Question 2

Generalized Seizures

Answer 2

absence
myoclonic
tonic-clonic
atonic

Question 3

Seizures v Epilepsy

Answer 3

Partial, Generalized, Status Epilepticus

Question 4

Epliepsy

Answer 4

-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

Question 5

Seizures

Answer 5

-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

Question 6

Seizure Activity

Answer 6

-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

Question 7

Generalized seizures (grand mal seizures)

Answer 7

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)

Question 8

Partial (focal) seizures

Answer 8

are simple partial seizures (consciousness is not impaired) or complex partial seizures (impaired consciousness)

Question 9

Jacksonian seizures

Answer 9

are simple partial seizures characterized focal motor symptoms beginning in one hand and then marching up the extremity

Question 10

Absence seizures

Answer 10

are characterized by brief periods of staring and sudden cessation of activity (most often seen in children)

Question 11

Seizure Conditions

Answer 11

-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

Question 12

Areas of Cortical Dysfunction

Question 13

CAUSES OF SEIZURE ACTIVITY

Answer 13

-idiopathic
-severe hypoxemia
-hypoglycemia
-severe acidosis
-severe alkalosis
-dehydration
-high fever
-medication withdrawal
-toxins (metabolic or drugs)
-genetic predisposition

Question 14

Prodrome

Answer 14

a feeling that may precede a seizure by hours or days

Question 15

Aura

Answer 15

a sensory sensation that frequently and immediately precedes a seizure

Question 16

Postictal

Answer 16

occurs following a seizure w/ manifested as stupor or coma, followed by confusion, headache, and fatigue

Question 17

Medications that May Lower Seizure Thresholds

Answer 17

Propofol (anesthetics)
&
Primaxin/Imipenem (antibiotics)

Question 18

RN Responsibilities for Seizure Activity

Answer 18

-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)

Question 19

Recovery Position

Answer 19

-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

Question 20

Seizure Complications

Answer 20

-hypoxic brain damage and mental retardation may result w/ chronic seizure activity
-depression & anxiety may develop w/ possible long term social isolation

Question 21

Status Epilepticus

Answer 21

• 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

Question 22

RN Interventions for Seizures

Answer 22

-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

Question 23

Medications for Seizures

Answer 23

-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

Question 24

lorazepam (Ativan)
[classes, MOA, indications, SE, AE]

Answer 24

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

Question 25

lorazepam (Ativan)
[half life, RN Responsibility, Safety, Preg Cat, Tx OD]

Answer 25

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)

Question 26

Causes of Seizures Include:

Answer 26

-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)