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NURS 301 - Exam 4 > Seizure Disorders > Flashcards

Seizure Disorders Flashcards

1
Q

Seizures include what types of abnormal activity? (4)

A
  • Motor
  • Sensory
  • Autonomic
  • Psychic
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2
Q

Describe the physiological process that provokes seizures

A

Sudden, uncontrolled electrical discharge from cerebral neurons

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3
Q

What acute problems are associated with provoking seizures? (3)

A
  • Hypoglycemia
  • Drug / alcohol withdrawal
  • Traumatic brain injury
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4
Q

How are seizures classified?

A

According to the part of the brain involved

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5
Q

Where do focal (partial) seizures occur?

A

One hemisphere

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6
Q

Where do generalized seizures occur?

A

Both hemispheres

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7
Q

An unknown classified seizure is due to ______

A

Epilepsy spasm

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8
Q

A provoked seizure is due to ______

A

Acute reversible condition

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9
Q

What is the requirement for a seizure to be considered epileptic?

A

Must be more than one unprovoked seizure - an isolated single seizure does NOT constitute epilepsy

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10
Q

What factors are manifestations of seizures dependent on? (3)

A
  • The area of the brain affected
  • The number of neurons excited
  • The extent to which activity spreads
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11
Q

Sensory seizure symptoms arise from the ______

A

Parietal lobe

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12
Q

Motor seizure symptoms arise from the ______

A

Frontal lobe

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13
Q

Psychomotor seizure symptoms arise from the ______

A

Temporal lobe

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14
Q

Which gene is responsible for myoclonic epilepsy?

A

Chromosome 21

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15
Q

1/3 of seizures are ______

A

Secondary

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16
Q

2/3 of seizures are ______

A

Idiopathic

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17
Q

What are the causes of seizures? (8)

A
  • Allergies
  • Brain tumor
  • CNS infections
  • CVD
  • Fever (childhood)
  • Hypertension
  • Hypoxemia
  • Metabolic conditions
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18
Q

Seizures result in increased ______

A

Oxygen demand

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19
Q

What pathological factor is most likely responsible for seizures?

A

Insufficient amounts of GABA (inhibitory neurotransmitter)

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20
Q

What occurs if the body regains homeostasis after a seizure?

A

No residual damage

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21
Q

Everyone has a ______

A

Seizure threshold - when exceeded, a seizure may result

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22
Q

What is an epileptogenic focus?

A

Neurons that initiate a seizure

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23
Q

During a seizure, ______ increase dramatically

A

Metabolic needs of the brain

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24
Q

What metabolic needs of the brain increase during a seizure? (2)

A
  • Cerebral blood flow
  • Glucose and oxygen - needed for ATP
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25
Q

The period prior to a seizure that warns the patient of an impending seizure is called ______

A

Aura

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26
Q

What is an aura?

A

An intense taste / odor / sensory hallucination (ex. feeling of spiders crawling on the skin)

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27
Q

The seizure itself is called ______

A

Ictus

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28
Q

The period following a seizure is called ______

A

Postictal

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29
Q

What are the types of focal seizures? (2)

A
  • Simple partial seizures
  • Complex partial seizures
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30
Q

Partial seizures are ______, meaning they arise from a localized area of the brain

A

Jacksonian

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31
Q

Describe the characteristics of simple partial seizures (4)

A
  • Consciousness is not affected
  • No aura present
  • Jacksonian March may occur
  • Tremor-like movements start on one side of the body
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32
Q

What is Jacksonian March?

A

Muscle contraction that spreads centrally involving an entire limb

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33
Q

How long do simple partial seizures last?

A

30 - 60 seconds

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34
Q

A simple partial seizure may progress to a ______

A

Tonic-clonic seizure

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35
Q

What are the manifestations of simple partial seizures? (7)

A
  • Tachycardia / tachypnea
  • Numbness / tingling
  • Visual distortions
  • ‘Deja Vu’
  • Pallor
  • Sweating
  • Flushing
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36
Q

Where do complex partial seizures usually originate?

A

Temporal lobe

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37
Q

Describe the characteristics of complex partial seizures (5)

A
  • Consciousness affected
  • Aura present
  • Automatisms may occur
  • May remain motionless
  • Unawareness of what is happening
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38
Q

Describe some examples of automatisms (3)

A
  • Aimless walking
  • Picking at clothes
  • Lip smacking
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39
Q

Automatisms are ______

A

Involuntary

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40
Q

What are the manifestations of complex partial seizures? (3)

A
  • Epigastric pain
  • Tongue fasciculations
  • Excessive emotions - fear, anger, irritability
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41
Q

What are the types of generalized seizures? (6)

A
  • Absence (petit mal)
  • Myoclonic
  • Clonic
  • Tonic
  • Tonic-clonic (grand mal)
  • Atonic
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42
Q

Describe the characteristics of generalized seizures (3)

A
  • Causes reaction in both sides of the body
  • Consciousness always impaired
  • The patient may be hard to arouse for hours after
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43
Q

Describe the characteristics of absence seizures (4)

A
  • Sudden cessation of all motor activity
  • Blank, unresponsive stare
  • Eyelid fluttering
  • Automatisms
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44
Q

How long do absence seizures last?

A

5 - 10 seconds

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45
Q

Absence seizures primarily occur in _______

A

Children

46
Q

Describe myoclonic seizures (2)

A
  • Sudden muscle jerking
  • Confusion
47
Q

Myoclonic seizures may be triggered by ______

A

Fatigue

48
Q

In what populations are myoclonic seizures most common? (2)

A
  • Children
  • Elderly
49
Q

When do myoclonic seizures usually occur?

A

In the morning

50
Q

What is a common concern associated with myoclonic seizures?

A

Falls

51
Q

Describe tonic seizures (2)

A
  • Abrupt increase in muscle tone
  • Autonomic signs
52
Q

Describe clonic seizures

A

Rhythmic muscle contraction / relaxation

53
Q

______ seizures are most closely associated with epilepsy

A

Tonic-clonic

54
Q

_______ seizures account for only 10% of seizures

A

Tonic-clonic

55
Q

Describe the pattern of tonic-clonic seizure occurrence (5)

A
  • Aura may / may not be present
  • Loss of consciousness
  • Tonic phase - 30 - 60 seconds
  • Clonic phase - 60 - 90 seconds
  • Postictal phase - 30 minutes
56
Q

How long do tonic-clonic seizures last?

A

2 - 5 minutes

57
Q

Describe the tonic phase of a tonic-clonic seizure (6)

A
  • Loud cry / moan
  • Entire body becomes rigid
  • Pupils fixed / dilated
  • Respirations stop
  • Cyanosis
  • Incontinence
58
Q

Describe the clonic phase of a tonic-clonic seizure (4)

A
  • Rhythmic muscle contraction / relaxation
  • Hyperventilation with excessive salivation - frothing
  • Tachycardia
  • Eyes roll back
59
Q

Describe the postictal phase of a tonic-clonic seizure (5)

A
  • Unresponsiveness / sleeping for several hours
  • Fatigue
  • Headache
  • Confusion
  • Amnesia
60
Q

What injuries can be expected after the postictal phase of a tonic-clonic seizure? (2)

A
  • Muscle aches
  • Bruising from falls
61
Q

Describe atonic seizures (3)

A
  • Loss of muscle tone
  • Body becomes limp
  • Mild head nodding
62
Q

How long do atonic seizures last?

A

< 15 seconds

63
Q

Status epilepticus is often a result of …

A

Noncompliance with prescribed anticonvulsant medications

64
Q

Describe status epilepticus

A

30 minutes of continuous seizure activity without full recovery between attacks

65
Q

Describe the primary concern associated with status epilepticus / continuous clinical seizures

A

Vigorous muscle contractions produce a heavy metabolic demand - may interfere with respirations

66
Q

What are the risks associated with status epilepticus? (5)

A
  • Acidosis
  • Hypoxia
  • Hypoglycemia
  • Hyperthermia
  • Exhaustion
67
Q

Why is status epilepticus considered a life-threatening medical emergency?

A

Repeated episodes of cerebral edema / hypoxia can lead to irreversible brain death

68
Q

What are the goals in the medical management of status epilepticus? (2)

A
  • Stop seizure activity
  • Ensure cerebral oxygenation
69
Q

What nursing intervention should occur if a patient with status epilepticus remains unconscious?

A

Insert an endotracheal tube

70
Q

What medications may be administered DURING a status epilepticus episode? (3)

A
  • IV D50
  • IV diazepam (Valium)
  • IV lorazepam (Ativan)
71
Q

What medication may be administered AFTER a status epilepticus episode to maintain a seizure-free state?

A

IV phenytoin (Dilantin)

72
Q

Describe the monitoring associated with status epilepticus (3)

A
  • CBCs
  • Electrolytes
  • Serum anticonvulsant levels
73
Q

Describe the nursing interventions associated with status epilepticus (2)

A
  • Establish IV access
  • Assist patient to side lying position with suction available - prevent aspiration
74
Q

What are the goals of diagnostic testing for seizures? (3)

A
  • Determine type of seizure
  • Determine frequency / severity
  • Determine pre-existing injuries
75
Q

What diagnostic tests are used in the diagnosis of seizures? (4)

A
  • EEG
  • SPECT
  • CT / MRI
  • Lumbar puncture
76
Q

What is the function of EEG testing?

A

Determine the type of seizure

77
Q

What is the function of SPECT testing?

A

Identification of epileptogenic zone

78
Q

What is the function of CT / MRI testing?

A

Rule out tumor, lesions, infarction, and hemorrhage

79
Q

What is the function of lumbar puncture testing?

A

Determine presence of infection (meningitis)

80
Q

In head to head trials there is …

A

NO anti-seizure drug more effective than any other

81
Q

What is the safest / most effective surgery used for complex partial seizures?

A

Cortical resection of the anterior temporal lobe

82
Q

What type of alternative therapy is used for seizures?

A

Vagal nerve stimulation

83
Q

What are the indications for vagal nerve stimulation? (2)

A
  • Patients who are not surgical candidates
  • Patients who do not respond to medication
84
Q

Describe vagal nerve stimulation

A

Uses a stimulus to desynchronize uncontrolled electrical brain activity

85
Q

Describe injury prevention associated with seizures (4)

A
  • ABCs
  • Protect head
  • Clear the area
  • Loosen constrictive clothing
86
Q

Describe the nursing interventions that are contraindicated for a patient having a seizure (3)

A
  • DO NOT restrain the client
  • DO NOT force jaws open
  • DO NOT to force objects into mouth - can obstruct airway
87
Q

Describe nursing assessments after seizures (3)

A
  • Assess for confusion - indication of tonic-clonic seizure
  • Assess glucose and oxygen saturation
  • Assess for injuries
88
Q

Describe the risks associated with ineffective airway clearance from a seizure (2)

A
  • Decreased gag reflex
  • Pooling of secretions in the throat
89
Q

In most states, a patient cannot drive for ______ after a seizure episode

A

6 months - 2 years

90
Q

Describe home care associated with seizures (3)

A
  • Wear a medic-alert bracelet
  • Take showers instead of tub baths
  • Do not lock bedroom / bathroom doors
91
Q

Describe the nursing interventions associated with phenytoin (Dilantin) (3)

A
  • Give IV slowly
  • Use a filter
  • DO NOT give with D5W
92
Q

Describe the education associated with phenytoin (Dilantin)

A

Oral hygiene / dental care - avoid gingival hyperplasia

93
Q

What are the side effects of phenytoin (Dilantin)? (3)

A
  • Rash
  • Gingival hyperplasia
  • Urine discoloration
94
Q

What are the manifestations of phenytoin (Dilantin) toxicity? (4)

A
  • Ataxia
  • Nystagmus
  • Sedation
  • Diplopia
95
Q

Describe the monitoring associated with carbamazepine (Tegretol)

A

CBC - agranulocytosis / anemia

96
Q

What is the primary indication of valium (Diazepam)?

A

Status epilepticus

97
Q

What is the therapeutic dosage of valium (Diazepam)?

A

5 - 10 mg Q 10 - 15 minutes

98
Q

Administration of valium (Diazepam) can be repeated up to ______

A

30 mg

99
Q

Describe the nursing interventions associated with valium (Diazepam) (2)

A
  • Give IV slowly
  • DO NOT mix with other drugs
100
Q

What is the primary concern associated with valium (Diazepam)?

A

Can cause respiratory depression

101
Q

What alternative form is valium (Diazepam) available in?

A

Rectal gel (Diastat)

102
Q

______ is effective for all generalized seizures

A

valproic acid (Depakote)

103
Q

What is the primary side effect associated with valproic acid (Depakote)?

A

Weight gain

104
Q

What is the other indication of clonazepam (Klonopin) other than seizures?

A

Depression

105
Q

What is the primary indication of lorazepam (Ativan)?

A

Status epilepticus

106
Q

What is the other indication of gabapentin (Neurontin) other than seizures?

A

Neuropathic pain in diabetics

107
Q

Which medication is used for the treatment of broad-spectrum seizure types?

A

keppra (Levetiracetam)

108
Q

What is the primary indication of keppra (Levetiracetam)?

A

Prevention of seizures after head trauma - short-term use

109
Q

How long should a patient receive keppra (Levetiracetam)?

A

7 days - if no seizure activity presents within that time, stop the medication

110
Q

What is the other indication of topiramate (Topamax) other than seizures?

A

Prevention of migraines

111
Q

What are the side effects of topiramate (Topamax)? (2)

A
  • Cognitive impairment
  • Kidney stones
112
Q

pregabalin (Lyrica) is a relative of ______

A

gabapentin (Neurontin)

NURS 301 - Exam 4 (5 decks)

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