Seizures Flashcards
what are seizures?
abnormal episodes of motor, sensory, autonomic or psychic activity
what do seizures look like on an EEG?
abnormal uncontrolled electrical discharge from cerebral neurons
what are the different classifications of seizures?
- partial
- simple partial
- complex partial
- generalized
what is a partial seizure?
focused in one part of the brain
what is a generalized seizure ?
affects the whole brain
what is epilepsy?
condition characterized by recurrent seizures
what are some causes of secondary seizures?
- brain tumor
- ETOH
- electrolyte imbalance (Na+, Mag, BG)
- metabolic dysfunction
- drugs
what medication is contraindicated for people with epilepsy?
flumazenil
it is the antidote for bentos and stimulates the development of seizures
triggering factors for seizures?
- loud music
- flashing lights
- specific odors
- med dose changes
- forgot to take a med
what is the most common trigger for epilepsy?
med withdrawal, forgot to take their medication
what medications likely to cause epilepsy with withdrawal?
antidopaminergics - quetiapine, aripiprazole, haloperidol
atypical antipsychotics- clozapine
antidepressants- bupropion
antibiotics-cyclosporine, quinolone
what are some anti-dopaminergics?
aripiprazole, haloperidol
what are some atypical antipsychotics?
clozapine, risperidone, quetiapine
what are some antidepressants?
sertraline, buproprion
what is an absence seizure?
a seizure that looks like someone is zoned out?
what population is absence seizures most common in?
children
nursing considerations for prepping for an EEG?
C-clean hair (no lotions or conditioners)
E-education (educate patient and family)
C- confirm (confirm medications and diet orders)
A-assist (assist the tech or physician with positioning)
do nurses place stickers for an EEG?
no
what type of substances may need to be held for 24 hours prior to an EEG?
sedatives, stimulants, anticonvulsants, tea, coffee
what is a simple partial seizure also known as?
focal aware seizure
do patients with simple partial seizures experience an aura?
yes, often a smell, colors, or a vision
do patients with a simple partial seizure go unconscious?
no they have no impairment of consciousness
what type of seizure is a Jacksonian march seizure?
a simple partial
what does a Jacksonian march seizure look like?
focal seizures with unilateral clonic movements that start in one group of muscles and spread to adjacent groups
one sided clonic movements that move adjacently to the other side
what is a complex partial seizure also known as?
focal unaware
do patients having a complex seizure lose consciousness?
yessss
what are the 4 types of generalized seizures?
absence
tonic
clonic
tonic- clonic
what is an absence seizure?
brief, sudden lapses of consciousness, spaced out
do absence seizures cause convulsions?
no, just spacing out
what is a tonic seizure?
the body, arms, or legs may be suddenly stiff or tense
what is a clonic seizure?
jerking of body, or parts of the body
what is a tonic clonic seizure?
alternates stiffness with jerking
can be unilateral or bilateral
occurring at any age
loss of bladder control
what are tonic clonic seizures also known as?
grande mal
what does the postictal phase look like?
sleepy, confused, aggressive
how long is the postictal state?
30min-2hrs
can last 24-72 hrs
what happens in the postictal phase?
dysphasia, slurred speech, confusion, amnesia
what do we document ?
time of onset, how long it lasts, what happens before (aura), what happens during (movements, incontinence, 02 sat, vomiting)
what are protocols for seizures?
EEG, ABC’s, BG, IV access, labs, suction set up, AED
what drugs can you expect with a patient having seizures?
Ativan, keppra
what are seizure precautions?
padded bedrails, no restraints, suction, turn on side, remove triggers, bed in lowest position, loose clothing, suction and oxygen set up
what are the 3 categories of anticonvulsants?
benzodiazepines
hydantoins
barbiturates
what is the most common med used to stop seizures, and what type of drug is it?
Ativan (lorazepam) and is a benzodiazepine
what are the hydantoins we use for seizures?
dilantin, cerebyx
what type of drug Is phenobarbital?
barbiturate
what is the danger with cerebyx?
can effect ventricular automaticity
what can cerebyx cause?
PVC’s, vtach
what patients can we not give cerebyx too?
patients with a history of heart blocks
what type of dose would we give phenobarbital as for use as an anticonvulsant?
high dose to get anticonvulsant properties
what type of medication is clonazepam?
anti-epileptic
what type of medication is phenytoin?
anticonvulsant
what type of medication is phenobarbital?
barbituate or anticonvulsant
what type of medication is lamotrigine?
anti epileptic, used to treat epilepsy
what type of medication is primidone?
anticonvulsant
what type of medication is valproic acid?
anticonvulsant
what type of medication is carbamazepine?
anticonvulsant
what complication can dilantin cause?
gingival hyperplasia
why does dilantin cause gingival hyperplasia?
causes an increase in calcium and a decrease in folic acid, as well as a decrease in platelets and WBCs causing gingival hyperplasia
what type of drugs are used for status epilepticus?
benzodiazepines
what can barbiturates cause?
respiratory depression
what type of seizures are barbiturates used for?
tonic-clonic and acute seizures
what is the antidote for barbiturates?
there is not an antidote for barbs
what are benzos used for?
status epileptics and absence seizures
what is the antidote for bentos?
flumazenil
what are valproates?
depakote, used for generalized, focal and absence seizures
what can valproic acid cause?
blood clotting and liver toxicity
what labs might you look at when a patient is taking depakote?
AST, ALT, Platelets, coagulation panel
what type of drug is topiramate?
antiepileptic
what type of drug is clobazam?
an anticonvulsant treating seizures caused by Lennox-gaustaut syndrome
what type of drug is oxcarbazepine?
anticonvulsant
what type of drug is ethosuximide?
anticonvulsant
what type of drug is vigabatrin?
anticonvulsant
what type of drug is gabapentin?
used for nerve pain and anticonvulsant and pain for seizures
what type of drug is levetiracetam?
anticonvulsant
why is the keto diet effective in epilepsy?
epilepsy is believed to be a metabolic condition and changes in the blood, CSF, and ketosis from the keto diet can decrease the excitability of neurons and help to stabilize seizures.
what is the risk of the keto diet?
higher risk of kidney stones, bone fractures and constipation
what are some interventions related to seizures?
monitor drug levels and watch for toxicity
monitor for drug interactions
what meds can make epileptic drugs ineffective?
Birth control, immunosuppressants, antibx, antipsychotics
what is status epilepticus?
continuous series of seizures
what is the result of status epilepticus?
- metabolic demands
- cerebral hypoxia
- respiratory arrest
- concern for cerebral perfusion
treatment for status epilepticus?
diazepam
lorazepam
fosphenytoin
how long does it take for neuronal damage to occur?
20-60mins
what does status epilepticus cause?
postictal cerebral edema
what does postictal cerebral edema cause?
increased ICP, decreased cerebral perfusion
what s/s would you see with postictal cerebral edema?
HA, dizziness, nausea, numbness, poor coordination, weakness
what severe s/s may you see with postictal cerebral edema?
dysphasia, memory loss, incontinence, altered LOC, seizures
what does postictal cerebral edema put people at risk for?
it puts them at high risk of more seizures due to increased ICP
what is the tx for postictal cerebral edema?
medications, fluids, hypothermia, ventriculostomy
what type of meds may you see with postictal cerebral edema?
mannitol
3% NS
