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2.0 Adult Nursing Exam 3 > Seizures > Flashcards

Seizures Flashcards

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1
Q

Define Seizure

A

Abnormal episodes of motor, sensory, autonomic, or psychic activity (or combo) that involves abnoral electrical discharges from neurons

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2
Q

What are the different classifications of seizures?

A

Partial: Simple/Complex
Generalized

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3
Q

What is a partial seizure?

A

One hemisphere of the brain that can either be simple or complex.

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4
Q

What is a generalized seizure?

A

Involves the whole brain

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5
Q

What is the main characteristic of Epilepsy ?

A

Recurring seizures

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6
Q

What causes Epilepsy?

A

Generally unknown: idiopathic

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7
Q

What are secondary causes of seizures?

A

These are pathologies and conditions that causes seizures

  • not the same as epilepsy
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8
Q

Causes of secondary seizures? (5)

A
  • brain tumor
  • alcohol withdrawals
  • electrolytes
  • metabolic dysfunction
    • drugs
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9
Q

Epilepsy risk factors

A

Stimulants/Caffeine

Drug/ETOH

Hormonal changes - menstruation, pregnancy

Electrolyte Imbalance - glucose, Na, Ca, Mg

Dehydration

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10
Q

Environmental triggers for seizures

A

Loud music

Flashing lights

Specific odors

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11
Q

Medication changes that illicit seizures?

A

Changes in dosages or not taking meds.

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12
Q

Antipsychotic med that triggers seizures?

Antidepressant med that triggers it?

A

Clozapine - antipsychotic

Buproprian - antidepressant

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13
Q

Antibiotics that can trigger seizures?

What other med classification can trigger seizures?

A

Cyclosporine, Quinolone

Antidopaminergics

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14
Q

Patient has seizure symptoms. What will we try to rule out with diagnostics?

A

Cerebral Mass - MRI CT

Infection - lumbar puncture and labs

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15
Q

What diagnostics are used to r/o cerebral mass?

A

CT

MRI

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16
Q

What diagnostics are used to r/o infection?

A

Lumbar puncture

Labs

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17
Q

What is the main diagnostic tool for seizures?

A

EEG - Electroencephalogram which measures electrical activity of the brain and converts to readable patterns

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18
Q

For an EEG, how long do stickers take?

A

Take 20-30 to place them but can take longer if it is the one time

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19
Q

Your patient is hooked up to EEG. And we are waiting for them to have the seizure. How can we induce the seizure?

A

Bright flashing light

Hyperventilation - not as common

Not letting them sleep

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20
Q

Patient has EEG ordered. What do you know your job will be as the nurse?

A

Clean

Educate

Confirm

Assisst

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21
Q

Before the EEG stickers are placed, what do you as the nurse need to do?

A

Clean the hair and make sure there’s no oils.

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22
Q

When cleaning the hair for an EEG, what should you not use?

A

Oils

Sprays

Conditioner

  • all of these are to oily and won’t allow the stickers to stick
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23
Q

What education do you need to provide for the patient and family when doing an EEG?

A

Educate to reduce fear and anxiety because these can affect the results due to tense muscles

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24
Q

When doing an EEG, what might you need to hold beforehand?

A

Certain medications

Diet

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25
Q

What medications should be withheld before an EEG for 24 hours?

A

Sedatives

Stimulants

Anticonvulsants

  • we want to see the seizure as natural as possible
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26
Q

What diet will we hold for an eeg?

A

Caffeine or tea

  • stimulants since they illicit seizures
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27
Q

T/F

Nurses don’t participate in the EEG Procedure

A

False. If anything, we can help assist with positioning and we need to be on standby for emergency meds .

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28
Q

Describe the Simple Partial seizure (focal aware)

A

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

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29
Q

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?

A

Simple partial seizure

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30
Q

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?

A

Jacksonian “march” seizure which is simple partial

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31
Q

What classification is the Jacksonian march seizure again?

A

Simple partial

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32
Q

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?

A

Complex partial - key is they lost unconscious.

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33
Q

What can a complex partial seizure evolve into?

A

Generalized tonic-clonic seizure

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34
Q

Because partial seizures affect one side of the brain, do you expect bilateral or unilateral seizure movements?

A

Unilateral or one sided - opposite of the side of the brain affected

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35
Q

What is a Generalized seizure? And how many types?

A

Seizure of both hemispheres ; 4 types

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36
Q

What are the types of Generalized seizures? (4)

A

Absence

Tonic

Clonic

Tonic-Clonic

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37
Q

What behavior would you expect with an Absent seizure?

A

Child having a brief and sudden lapse of consciousness that looks like they spaced out

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38
Q

What would you expect from a patient who has Tonic seizures?

A

The patient’s body and limbs go stiff

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39
Q

What would you expect your patient to look like during a clonic seizure?

A

Jerking of the body and the limbs

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40
Q

What does a tonic - clonic seizure look like?

A

Alternating between stiffness and jerking

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41
Q

Will a tonic clonic seizure be one sided or on both sides?

A

It can be either

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42
Q

How common are tonic clonic?

A

Talked about a lot but not commonly seen

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43
Q

Is there a postical phase with tonic clonic?

A

Yes

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44
Q

What age do tonic clonic seizures occur?

A

Any age - but less frequently seen.

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45
Q

What are the four types of generalized seizures again and what does it mean?

A

Absent, Tonic, Clonic, Tonic-clonic

Means whole brain

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46
Q

If a child is clenching their hands and stiff. What type of seizure is this?

A

Tonic - stiff

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47
Q

What is a postictal phase?

A

Portion of the seizure that comes after. Probably be sleepy, confused, amnesia, and dysphagia/slurred speech.

  • occurs after tonic clonic seizure
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48
Q

How long does positical phase last?

A

Usually lasts 30 min to 2 hours

Can last up to 24-72 hours

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49
Q

Patient is in the positical state and they ask for water.

What do you do?

A

You don’t give it to them - aspiration risk.

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50
Q

What do you need to assess during the Postictal state?

A

Respiratory rate - the longer the seizure, the more oxygen used up.

BP

LOC

Check for dysphagia

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51
Q

A patient is having a seizure. What times you need to document?

A

Onset time

Time it ends

(the length of the seizure)

52
Q

What do you need to document for the seizure?

A

Onset Time & length

What happened before such as auras

Describe what happens during the seizure

53
Q

What are some things you should document during the seizure?

A

Movements

Incontinence

O2 sat

Vomit - make sure they don’t aspirate

Injuries

54
Q

Primary goal if seizure patient is aspiratin

A

Get them to their side so they don’t have aspiration pneumonia

55
Q

What is are readings/measurements that are needed during a seizure protocol ?

A

ABG

O2 sats

Blood glucose

56
Q

What needs to be established in a seizure protocol?

A

IV access - and check and assess for patency too

57
Q

What equipment and meds should you have set up for a seizure protocol?

A

Oral suction PRN

EEG

Diastat anxiolytic for muscle spasm

  • make sure you know where all of these are
58
Q

Patient is seizing. What do you do to provide them privacy?

A

Pull the drape but stay with them

59
Q

What are some seizure precautions you can take for your patient?

A

Padded bedrails with pillows

Low bed

Lower light or environmental triggers

Reduce aspiration risk

Remove restraints

Pull curtain

Make sure curtain is pulled

60
Q

Why should we ask patient about their seizure triggers?

A

So we can remove them

61
Q

Should you have restraints on a pt with hx of seizure?

Do you want to hold the patient down?

A

No

No - don’t hold them down

62
Q

IV anticonvulsant types of medications

A

Benzos

Hydantoins

Barbiturates

63
Q

Most common rescue drug for seizures and its type/classifcation?

A

Lorazepam (ativan) which is a benzo

64
Q

Hydantoins meds for seizures

A

Dilantin

Cerebyx

65
Q

Patient has _hx of heart block_s. What seizure med is contraindicated ?

A

Cerebyx contraindicated for heart blocks. Can also cause pvcs and v. tach

66
Q

You are going to give Phenobarbital barbiturate to your patient for seizures. What dosage do you need?

A

Higher dose because it is a short term drug and has drowsy side effects

67
Q

What other property besides seizures can Phenobarbital be used for?

A

Sedative

68
Q

What is the antidote for Benzos?

A

Flumenazil

69
Q

Flumazenil is contraindicated in patients with _____.

A

Epilsepsy because it will cause a seizure (this is bc it is the antidote to benzos like ativan)

70
Q

PO anticonvulsants

A

Clonazepam (klonopin)

Phenytoin (Dilantin)

Phenoarbital

Lamotrigine (lamictal)

Primidone (mysoline)

Valproic acid (Depakene)

Carbamazepine (Tegretol)

Keppra

71
Q

Which seizures are treated by Phenytoin/Dilantin?

A

Partial

Generalized

72
Q

When using Phenytoin/Dilantin, what do we need to educate the patient about?

A

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
73
Q

What labs typically decrease with phenytoin/dilatin?

A

decreased platelets

decreased WBC

74
Q

What type of seizures are Barbiturates used for?

A

Tonic clonic and acute seizures

75
Q

What side effect do you want to monitor for with barbiturates that is the most important?

A

Respiratory depression so count respirations and O2 sats & do your patient rights when giving it. There is no antidote !

76
Q

If a patient goes into resp. depression from barbiturates, what can you give as the antidote?

A

Nothing - no antidote. Be sure you’re giving it right!

77
Q

Patient is having status Epilepticus. What medication do you anticipate?

A

Benzo’s - ativan

78
Q

What types of seizures do we use benzo’s like ativan for?

A

Status epilepticus

Absent seizures

79
Q

What is the deadly side effect of benzo’s?

A

Respiratory depression - consider the half life or how long it is in the body before using

  • consider the flumazenil antidote
80
Q

Antidote for benzos (like ativan)

A

Flumazenil (Romazicon)

81
Q

What type of seizures do we use Valproates.Valproate Acid for?

A

Generalized

Partial

Absent

82
Q

What is the major side effect for Vaproates/Valpraote Acid?

(Depakote/Depakene)

What labs to check?

A

Blood clotting

Liver toxicity

  • check coagulation and liver enzymes
83
Q

What form of Vaproates/Valpraote Acid can you give to kids or people who have swallowing issues?

(Depakote/Depakene)

A

Sprinkle form in apple sauce or pudding for kids or eldery with g-tubes.

84
Q

What labs to check for Vaproates/Valpraote Acid?

(Depakote/Depakene)

A

D-dimer

AST

ALT

85
Q

Why do we use keto to decrease seizures?

A

Alters metabolism** since epilepsy is believed to be a metabolic condition - it **decreases excitability of neurons.

86
Q

What age group usually has to use keto for seizures? And what is the main issue?

A

Kids but adults can. Main issue is sustainability since it is a hard diet. And you have to read the labels.

87
Q

Describe keto

A

High fat 75%

Low carbs 5%

Low protein 20%

88
Q

What risks are involved with keto

A

Kidney stones

Bone fx

Constipation

89
Q

What if a patient is a bad historian of their seizures?

A

Have family document

90
Q

When assessing the patient for seizures, what do you need to ask?

A

Onset

How often

Was there an aura?

How long do they last

Description

Postictal period? and length?

91
Q

Why do we monitor drug levels for seizure drugs?

A

toxicity

92
Q

When monitoring meds what do we look at?

A

peak and trough

93
Q

Possible drug interactions

A

Old meds

Birth control

Immunosuppressants

Antibiotics

Antipsychotics

94
Q

Possible drug interactions that can occur with pain meds and seizure meds?

What should the patient be wearing?

A

Psych - Neuropathic ; gabapentin

Migraines

  • point is polypharmacy is common for pain and so we need to make sure we check those

MEDICAL alert bracelet

95
Q

What does status Epilepticus result in?

A

Increased metabolic demands>Cerebral hypoxia > >Respiratory arrest

96
Q

Most common cause of status elepticus?

A

abrupt stoppage of taking seizure meds for whatever reason

97
Q

Rescue drugs for seizures to stop asap

A
  1. Ativan (Lorazepam)

Valium

Cerebyx

98
Q

Neuronal damage time frame for status epilepticus

A

20-60 min

99
Q

High mortality rate in status epilepticus corresponds with

A

Anoxia -lack of oxygen and CNS infections

100
Q

Postictal Cerebral edema : ICP and CPP

A

During this, patient will have an increase in ICP and therefore decrease in CPP ?

101
Q

Posticital cerebral edema symptoms

A

Headache, dizzy, nausea, numbness, poor coordination, weakness

severe: dysphagia, memory loss, incontinence, altered LOC, seizures bc of compression

102
Q

Diagnostics for posticial cereabral edma

A

physical assessment

MRI

CT

labs

103
Q

Treatment options for Postical cerebral edema

A

Meds - anticoagulants

Fluids - hypertonic, 3%

Hypothermia - slow metabolism to preserve brain function

Surgery - like a ventriculstomy

104
Q

Meds for Postictal Cerebral Edema treat

A

Anticoaugalnts

105
Q

Fluids for Postictal Cerebral Edema

A

Osmotic therapy - high sodium to pull of fluid

106
Q

Hypothermia treatment in Postictal Cerebral Edema for…

A

low temp to slow metabolism

107
Q

What surgeries or procesudres for Postictal Cerebral Edema

A

Ventriculostomy or surgery

108
Q

Nursing considerations for Postictal Cerebral Edema

A

HOB

fall precautions

pain management

monitoring icp/cpp

aspiration precautions

109
Q

Will a tonic clonic seizure be one sided or on both sides?

A

It can be either

110
Q

Will a tonic clonic seizure be one sided or on both sides?

A

It can be either

111
Q

How common are tonic clonic?

A

Talked about a lot but not commonly seen

112
Q

How common are tonic clonic?

A

Talked about a lot but not commonly seen

113
Q

Is there a postical phase with tonic clonic?

A

Yes

114
Q

Is there a postical phase with tonic clonic?

A

Yes

115
Q

Is there a postical phase with tonic clonic?

A

Yes

116
Q

Primary goal if seizure patient is aspiratin

A

Get them to their side so they don’t have aspiration pneumonia

117
Q

Primary goal if seizure patient is aspiratin

A

Get them to their side so they don’t have aspiration pneumonia

118
Q

Why should we ask patient about their seizure triggers?

A

So we can remove them

119
Q

Why should we ask patient about their seizure triggers?

A

So we can remove them

120
Q

Why should we ask patient about their seizure triggers?

A

So we can remove them

121
Q

Patient is seizing. What do you do to provide them privacy?

A

Pull the drape but stay with them

122
Q

Patient is seizing. What do you do to provide them privacy?

A

Pull the drape but stay with them

123
Q

Patient is seizing. What do you do to provide them privacy?

A

Pull the drape but stay with them

124
Q

What if a patient is a bad historian of their seizures?

A

Have family document

125
Q

What if a patient is a bad historian of their seizures?

A

Have family document

2.0 Adult Nursing Exam 3 (8 decks)

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