Seizure Module

Question 1

Complications with seizures

Answer 1

Status epilepticus is state of constant seizure or condition when seizures recur in rapid succession without return to consciousness between seizures.

Neurologic emergency

Can involve any type of seizure

Status epilepticus causes the brain to use more energy than supplied.

Neurons become exhausted and cease to function properly.

Permanent brain damage can result
WHY is this (the brain will use up all its glucose and oxygen reserves)

Question 2

Complications facts for seizures

Answer 2

Tonic-clonic status epilepticus most dangerous as it can cause ventilatory insufficiency, hypoxemia, cardiac arrhythmias, hyperthermia, and systemic acidosis.

Trauma during seizures can cause severe injury and death; involves falling with potential for head injury, fractures.

-Social stigma- (kids wearing helmets)
Interferes with values of self-control, conformity, and independence
-Discrimination in employment and education
Driving sanctions

Question 3

Diagnostic studies for seizures

Answer 3

Goal: RULE OUT UNDERLYING CAUSES
Accurate, comprehensive description of seizures with patient’s health history
EEG
Only small percentage of patients with seizure disorders have abnormal findings with first test
Continuous monitoring may be needed
Magnetoencephalography in conjunction with EEG
Greater sensitivity for detecting small magnetic fields generated by neuronal activity
CBC, serum chemistries, liver and kidney function, UA to rule out metabolic disorders
CT or MRI in new onset seizure to rule out structural lesion
Cerebral angiography, SPECT, MRS, MRA, and PET in selected situations

Question 4

Collaborative Care I

Answer 4

DRUG THERAPY aimed at prevention
Stabilize nerve cell membranes and prevent spread of epileptic discharge; MEDS HELP THIS.
70% of patients controlled with medication
Monitor drug serum levels; MEDS NEED TO BE IN THERAPEUTIC WINDOW
Serum levels of medication should be monitored

Question 5

Collaborative Care II

Answer 5

Antiseizure drugs should not be discontinued abruptly as it can precipitate seizures.

All anti-seizure medications have some side effects. 
Mild side effects 
-Fatigue
-Dizziness
-Weight gain
-Loss of bone density
-Skin rashes
-Loss of coordination
-Speech problems

More severe but rare side effects
Depression
Suicidal thoughts and behaviors
Severe rash
Inflammation of certain organs, such as your pancreas

Question 6

Nursing Implementation

Prevention

Answer 6

-Wearing helmet if risk for head injury (kids)
General health habits (diet, exercise)
-Assist to identify events or situations precipitating seizures and avoidance if possible (ID triggers)
-Instruct to avoid excessive alcohol, fatigue, and loss of sleep (potential triggers)

Question 7

Nursing Implementations

Acute Interventions

Answer 7

Observation and treatment of seizure
-Maintain patent airway, support head, turn to side (Recovery position) after the seizing stops, loosen constrictive clothing, ease to floor if possible pad the side rails. NO BITE STICKS.
-May require suctioning or oxygen after seizure so equipment needed should be available at the bedside.
-May need to help lower patient to the floor
Patient may need to rest after seizure (pt may sleep a lot after a seizure.

Question 8

Nursing Interventions for Autonomic Dysreflexia

Answer 8

First thing to do! Immediately raise HOB to 90o and lower legs.
You should ask them what usually causes AD, if they know.

Loosen or remove any tight clothing or restrictive garments or braces
Check urinary drainage system, catheterize if needed
If indwelling catheter, irrigate for clogs or change
Check bowels. Are they impacted? Use lidocaine jelly 2% to numb rectum before checking
Check for ingrown toenail, broken bone, burn, etc
Monitor BP q5min until it returns to baseline
If symptoms persist and/or BP does not decrease or goes over 150 systolic, notify MD immediately and consider medications for BP control (nifedipine 10 mg, chew & swallow most common)