Seizures Flashcards
Define Seizure
Abnormal episodes of motor, sensory, autonomic, or psychic activity (or combo) that involves abnoral electrical discharges from neurons
What are the different classifications of seizures?
Partial: Simple/Complex
Generalized
What is a partial seizure?
One hemisphere of the brain that can either be simple or complex.
What is a generalized seizure?
Involves the whole brain
What is the main characteristic of Epilepsy ?
Recurring seizures
What causes Epilepsy?
Generally unknown: idiopathic
What are secondary causes of seizures?
These are pathologies and conditions that causes seizures
- not the same as epilepsy
Causes of secondary seizures? (5)
- brain tumor
- alcohol withdrawals
- electrolytes
- metabolic dysfunction
- drugs
Epilepsy risk factors
Stimulants/Caffeine
Drug/ETOH
Hormonal changes - menstruation, pregnancy
Electrolyte Imbalance - glucose, Na, Ca, Mg
Dehydration
Environmental triggers for seizures
Loud music
Flashing lights
Specific odors
Medication changes that illicit seizures?
Changes in dosages or not taking meds.
Antipsychotic med that triggers seizures?
Antidepressant med that triggers it?
Clozapine - antipsychotic
Buproprian - antidepressant
Antibiotics that can trigger seizures?
What other med classification can trigger seizures?
Cyclosporine, Quinolone
Antidopaminergics
Patient has seizure symptoms. What will we try to rule out with diagnostics?
Cerebral Mass - MRI CT
Infection - lumbar puncture and labs
What diagnostics are used to r/o cerebral mass?
CT
MRI
What diagnostics are used to r/o infection?
Lumbar puncture
Labs
What is the main diagnostic tool for seizures?
EEG - Electroencephalogram which measures electrical activity of the brain and converts to readable patterns
For an EEG, how long do stickers take?
Take 20-30 to place them but can take longer if it is the one time
Your patient is hooked up to EEG. And we are waiting for them to have the seizure. How can we induce the seizure?
Bright flashing light
Hyperventilation - not as common
Not letting them sleep
Patient has EEG ordered. What do you know your job will be as the nurse?
Clean
Educate
Confirm
Assisst
Before the EEG stickers are placed, what do you as the nurse need to do?
Clean the hair and make sure there’s no oils.
When cleaning the hair for an EEG, what should you not use?
Oils
Sprays
Conditioner
- all of these are to oily and won’t allow the stickers to stick
What education do you need to provide for the patient and family when doing an EEG?
Educate to reduce fear and anxiety because these can affect the results due to tense muscles
When doing an EEG, what might you need to hold beforehand?
Certain medications
Diet
What medications should be withheld before an EEG for 24 hours?
Sedatives
Stimulants
Anticonvulsants
- we want to see the seizure as natural as possible
What diet will we hold for an eeg?
Caffeine or tea
- stimulants since they illicit seizures
T/F
Nurses don’t participate in the EEG Procedure
False. If anything, we can help assist with positioning and we need to be on standby for emergency meds .
Describe the Simple Partial seizure (focal aware)
Patient will remain awake and may tell you they smell or see things (auras).
Motor alterations of the finger, hand, mouth
Sensory alterations of taste, smell, sound, visual
Before patient had seizure, they reported blurry vision and floating auras. During their seizure, they remained conscious. They experienced finger, hand, mouth alterations. As well as different smells, tastes, sounds, and hallucinations.
What type of seizure is this?
Simple partial seizure
Patient begins to have a unilateral clonic jerking movement of the hand that spreads to the leg and then on.
What type of seizure is this?
Jacksonian “march” seizure which is simple partial
What classification is the Jacksonian march seizure again?
Simple partial
Your patient’s seizure was precipitated by reported auras. And they had movement of the mouth, hands, fingers. And they also had sensory issues. They went unconscious. What type of seizure is this?
Complex partial - key is they lost unconscious.
What can a complex partial seizure evolve into?
Generalized tonic-clonic seizure
Because partial seizures affect one side of the brain, do you expect bilateral or unilateral seizure movements?
Unilateral or one sided - opposite of the side of the brain affected
What is a Generalized seizure? And how many types?
Seizure of both hemispheres ; 4 types
What are the types of Generalized seizures? (4)
Absence
Tonic
Clonic
Tonic-Clonic
What behavior would you expect with an Absent seizure?
Child having a brief and sudden lapse of consciousness that looks like they spaced out
What would you expect from a patient who has Tonic seizures?
The patient’s body and limbs go stiff
What would you expect your patient to look like during a clonic seizure?
Jerking of the body and the limbs
What does a tonic - clonic seizure look like?
Alternating between stiffness and jerking
Will a tonic clonic seizure be one sided or on both sides?
It can be either
How common are tonic clonic?
Talked about a lot but not commonly seen
Is there a postical phase with tonic clonic?
Yes
What age do tonic clonic seizures occur?
Any age - but less frequently seen.
What are the four types of generalized seizures again and what does it mean?
Absent, Tonic, Clonic, Tonic-clonic
Means whole brain
If a child is clenching their hands and stiff. What type of seizure is this?
Tonic - stiff
What is a postictal phase?
Portion of the seizure that comes after. Probably be sleepy, confused, amnesia, and dysphagia/slurred speech.
- occurs after tonic clonic seizure
How long does positical phase last?
Usually lasts 30 min to 2 hours
Can last up to 24-72 hours
Patient is in the positical state and they ask for water.
What do you do?
You don’t give it to them - aspiration risk.
What do you need to assess during the Postictal state?
Respiratory rate - the longer the seizure, the more oxygen used up.
BP
LOC
Check for dysphagia
A patient is having a seizure. What times you need to document?
Onset time
Time it ends
(the length of the seizure)
What do you need to document for the seizure?
Onset Time & length
What happened before such as auras
Describe what happens during the seizure
What are some things you should document during the seizure?
Movements
Incontinence
O2 sat
Vomit - make sure they don’t aspirate
Injuries
Primary goal if seizure patient is aspiratin
Get them to their side so they don’t have aspiration pneumonia
What is are readings/measurements that are needed during a seizure protocol ?
ABG
O2 sats
Blood glucose
What needs to be established in a seizure protocol?
IV access - and check and assess for patency too
What equipment and meds should you have set up for a seizure protocol?
Oral suction PRN
EEG
Diastat anxiolytic for muscle spasm
- make sure you know where all of these are
Patient is seizing. What do you do to provide them privacy?
Pull the drape but stay with them
What are some seizure precautions you can take for your patient?
Padded bedrails with pillows
Low bed
Lower light or environmental triggers
Reduce aspiration risk
Remove restraints
Pull curtain
Make sure curtain is pulled
Why should we ask patient about their seizure triggers?
So we can remove them
Should you have restraints on a pt with hx of seizure?
Do you want to hold the patient down?
No
No - don’t hold them down
IV anticonvulsant types of medications
Benzos
Hydantoins
Barbiturates
Most common rescue drug for seizures and its type/classifcation?
Lorazepam (ativan) which is a benzo
Hydantoins meds for seizures
Dilantin
Cerebyx
Patient has _hx of heart block_s. What seizure med is contraindicated ?
Cerebyx contraindicated for heart blocks. Can also cause pvcs and v. tach
You are going to give Phenobarbital barbiturate to your patient for seizures. What dosage do you need?
Higher dose because it is a short term drug and has drowsy side effects
What other property besides seizures can Phenobarbital be used for?
Sedative
What is the antidote for Benzos?
Flumenazil
Flumazenil is contraindicated in patients with _____.
Epilsepsy because it will cause a seizure (this is bc it is the antidote to benzos like ativan)
PO anticonvulsants
Clonazepam (klonopin)
Phenytoin (Dilantin)
Phenoarbital
Lamotrigine (lamictal)
Primidone (mysoline)
Valproic acid (Depakene)
Carbamazepine (Tegretol)
Keppra
Which seizures are treated by Phenytoin/Dilantin?
Partial
Generalized
When using Phenytoin/Dilantin, what do we need to educate the patient about?
They need to go tot he dentist/perodontist every 6 months because it can cause Gingival Hyperplasia
- increases calcium and reduces folic acid so gums get big and inflamed
What labs typically decrease with phenytoin/dilatin?
decreased platelets
decreased WBC
What type of seizures are Barbiturates used for?
Tonic clonic and acute seizures
What side effect do you want to monitor for with barbiturates that is the most important?
Respiratory depression so count respirations and O2 sats & do your patient rights when giving it. There is no antidote !
If a patient goes into resp. depression from barbiturates, what can you give as the antidote?
Nothing - no antidote. Be sure you’re giving it right!
Patient is having status Epilepticus. What medication do you anticipate?
Benzo’s - ativan
What types of seizures do we use benzo’s like ativan for?
Status epilepticus
Absent seizures
What is the deadly side effect of benzo’s?
Respiratory depression - consider the half life or how long it is in the body before using
- consider the flumazenil antidote
Antidote for benzos (like ativan)
Flumazenil (Romazicon)
What type of seizures do we use Valproates.Valproate Acid for?
Generalized
Partial
Absent
What is the major side effect for Vaproates/Valpraote Acid?
(Depakote/Depakene)
What labs to check?
Blood clotting
Liver toxicity
- check coagulation and liver enzymes
What form of Vaproates/Valpraote Acid can you give to kids or people who have swallowing issues?
(Depakote/Depakene)
Sprinkle form in apple sauce or pudding for kids or eldery with g-tubes.
What labs to check for Vaproates/Valpraote Acid?
(Depakote/Depakene)
D-dimer
AST
ALT
Why do we use keto to decrease seizures?
Alters metabolism** since epilepsy is believed to be a metabolic condition - it **decreases excitability of neurons.
What age group usually has to use keto for seizures? And what is the main issue?
Kids but adults can. Main issue is sustainability since it is a hard diet. And you have to read the labels.
Describe keto
High fat 75%
Low carbs 5%
Low protein 20%
What risks are involved with keto
Kidney stones
Bone fx
Constipation
What if a patient is a bad historian of their seizures?
Have family document
When assessing the patient for seizures, what do you need to ask?
Onset
How often
Was there an aura?
How long do they last
Description
Postictal period? and length?
Why do we monitor drug levels for seizure drugs?
toxicity
When monitoring meds what do we look at?
peak and trough
Possible drug interactions
Old meds
Birth control
Immunosuppressants
Antibiotics
Antipsychotics
Possible drug interactions that can occur with pain meds and seizure meds?
What should the patient be wearing?
Psych - Neuropathic ; gabapentin
Migraines
- point is polypharmacy is common for pain and so we need to make sure we check those
MEDICAL alert bracelet
What does status Epilepticus result in?
Increased metabolic demands>Cerebral hypoxia > >Respiratory arrest
Most common cause of status elepticus?
abrupt stoppage of taking seizure meds for whatever reason
Rescue drugs for seizures to stop asap
- Ativan (Lorazepam)
Valium
Cerebyx
Neuronal damage time frame for status epilepticus
20-60 min
High mortality rate in status epilepticus corresponds with
Anoxia -lack of oxygen and CNS infections
Postictal Cerebral edema : ICP and CPP
During this, patient will have an increase in ICP and therefore decrease in CPP ?
Posticital cerebral edema symptoms
Headache, dizzy, nausea, numbness, poor coordination, weakness
severe: dysphagia, memory loss, incontinence, altered LOC, seizures bc of compression
Diagnostics for posticial cereabral edma
physical assessment
MRI
CT
labs
Treatment options for Postical cerebral edema
Meds - anticoagulants
Fluids - hypertonic, 3%
Hypothermia - slow metabolism to preserve brain function
Surgery - like a ventriculstomy
Meds for Postictal Cerebral Edema treat
Anticoaugalnts
Fluids for Postictal Cerebral Edema
Osmotic therapy - high sodium to pull of fluid
Hypothermia treatment in Postictal Cerebral Edema for…
low temp to slow metabolism
What surgeries or procesudres for Postictal Cerebral Edema
Ventriculostomy or surgery
Nursing considerations for Postictal Cerebral Edema
HOB
fall precautions
pain management
monitoring icp/cpp
aspiration precautions
Will a tonic clonic seizure be one sided or on both sides?
It can be either
Will a tonic clonic seizure be one sided or on both sides?
It can be either
How common are tonic clonic?
Talked about a lot but not commonly seen
How common are tonic clonic?
Talked about a lot but not commonly seen
Is there a postical phase with tonic clonic?
Yes
Is there a postical phase with tonic clonic?
Yes
Is there a postical phase with tonic clonic?
Yes
Primary goal if seizure patient is aspiratin
Get them to their side so they don’t have aspiration pneumonia
Primary goal if seizure patient is aspiratin
Get them to their side so they don’t have aspiration pneumonia
Why should we ask patient about their seizure triggers?
So we can remove them
Why should we ask patient about their seizure triggers?
So we can remove them
Why should we ask patient about their seizure triggers?
So we can remove them
Patient is seizing. What do you do to provide them privacy?
Pull the drape but stay with them
Patient is seizing. What do you do to provide them privacy?
Pull the drape but stay with them
Patient is seizing. What do you do to provide them privacy?
Pull the drape but stay with them
What if a patient is a bad historian of their seizures?
Have family document
What if a patient is a bad historian of their seizures?
Have family document
