Seizures Flashcards
Define a seizure
- Electrical discharge on neurons in the brain
- Interrupts normal function
- Paroxysmal
- Uncontrolled
- Often symptom of underlying illness
- Sudden onset: often have an underlying issue (i.e. tumor, etc.)
Define epilepsy
- Continuing predisposition to seizures with additional long standing wide spread secondary consequences
- May be due to:
- Spontaneous firing, scarring in focal area causing additional continued seizure activity at a higher rate or can be idiopathic in nature
- Reoccurring over and over again
- Little kids when they get a high fever tend to have a seizure
- Scarring in the brain that causes an abnormality
- CAT scan, MRI for testing
- Can have seizure disorder but not know the definitive cause or disorder
Epilepsy Statistics
- 4th most common neuro disorder
- In United States, 3 million people with epilepsy
- Higher incidence in children and those >60 years of age
- Males more likely to develop
- May have a genetic link/factors noted
- Tonic clonic (grand mal) = most common type of seizure
Common causes of seizures
- In Infants: can be due to birth injury, CNS defects, genetically linked or related to infection
- In children/adolescence: may be due to injury, tumors/neoplasms, drugs or infection
- In adults: Injury, tumor/neoplasm, infection, drug withdrawal
- Older adults: much of the same but think chronic disease as well: increase risk if positive for CVA and/or dementia due to restructuring of the brain.
- Long labor, baby is hypoxic for a while, having decels, maybe no variability, babies head got stuck may cause a seizure
- Infections in little ones
- In adults infection (i.e. meningitis), tumors, drugs (mainly street), alcohol and drug withdrawal
- CVA = cerebrovascular accident (stroke)
Prevention of Seizures
- Wear helmet if risk for head injury
- General health habits-Diet and exercise
- Assist to identify events or situations precipitating seizures, and avoid if possible
- Factors that increase risk for seizures: fatigue, alcohol use, inadequate sleep, hormonal changes and stress
- Instruct to avoid excessive alcohol
- Increased risk: sounds, bright lights, super fatigued, hormonal changes, stress, over stimulation
2 classes of clinical manifestations
- Generalized: tonic clonic where the whole body is involved, systemic, whole brain is affected, electrical impulses going off through the whole brain; Entire brain is affected; Loss of consciousness from seconds to minutes
- Focal: only a portion of the brain
Tonic-Clonic Seizure Phases
Aural Phase
* Bowel and bladder incontinence
* Diaphoresis
* Loss of consciousness
* Pallor, flushing, or cyanosis
* Peculiar sensations that precede seizure
* Tachycardia
* Warm skin
Tonic Phase
* Continuous muscle contractions
Hypertonic Phase
* Extreme muscular rigidity lasting 5–15 sec
Clonic Phase
* Rigidity and relaxation alternating in rapid succession
Postictal Phase
* Altered level of consciousness, lethargy
* Confusion and headache
* Repeated tonic-clonic seizures for several min
Time all seizures, notice sensory based seizures
Define a tonic-clonic seizure
- Characterized by loss of consciousness and falling
- Body stiffens (tonic) with subsequent jerking of extremities (clonic)
- Cyanosis, excessive salivation, possible tongue/lip biting
- No memory of seizure
- Post-ictal general soreness, weak, extremely fatigued
- Turn on side
- Call for help
- Call 911 if new onset or they have had too many in a row
Types of Generalized Seizures
Typical absence seizures
- Typically occurs in children and rarely into adolescence
- May cease or develop into another type (resolve without additional seizure activity or progress into more serious seizure)
- Staring spell for only a few seconds and usually goes unnoticed
- Brief loss of consciousness- patient unable to recall event
- May occur up to 100 times/day if untreated
Atypical absence seizures
- s/s similar to typical- however; rapid eye movement (motor symptoms) also occur with staring
Absence seizures most often in children, more than likely will grow out of it, may seem like kid is daydreaming, they may seem like they are staring off into space but they are seizures, some kids can have a 100 or more a day
Focal Seizures
- Partial seizures (AKA partial focal seizures)
- Caused by focal irritations (one hemisphere of the brain)
- Begin in specific region of cortex
- May spread and involve entire brain, accumulating in tonic-clonic
- Focal = partial
- Can spread if not controlled
2 Categories of Partial Seizures
Simple focal:
- simple motor or sensory phenomena with elementary symptoms
- no loss of consciousness
- lasting less than 1 minute
Complex focal:
- involve behavioral, emotional, affective, and cognitive function
- Alteration in consciousness
- Automatisms and lip smacking
- Followed by period of post-ictal confusion
- similar to absent seizures
- no loss of consciousness
- automatisms: physical behaviors they are not realizing they are doing
- move objects away from them
- don’t let them fall
- stay by their side
- recommend those with seizure disorders to wear a medical bracelet
Diagnostic Studies
- 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
- only helps if pt. has seizure with machine on
Nursing Assessment - History
- Risks:
- Birth defects or injuries at birth, anoxic episodes, CNS trauma, tumors, metabolic disorders, alcoholism, exposure to metals or carbon monoxide, hepatic or renal failure
- Compliance with anti-seizure medications
- Headaches, aura, mood or behavioral changes before seizure
- Anxiety, depression, loss of self-esteem, social isolation
Nursing Implementation - Acute Intervention
- Observation and treatment of seizure
- SAFETY
- Ensure patent airway
- Protect patient from injury during seizure, do not restrain, pad side rails
Remove or loosen tight clothing - Establish IV access
- Stay with patient until seizure has passed
- Anticipate giving phenobarbital, phenytoin (Dilantin), benzodiazepines (e.g., diazepam [Valium], midazolam [Versed], lorazepam [Ativan]) to try to stop seizures
- Suction as needed
- Assist ventilations if patient does not breathe spontaneously after seizure
- Anticipate need for intubation if gag reflex absent
Time
Ongoing care after seizure
- Monitor vital signs, level of consciousness, O2 saturation,
Glasgow Coma Scale results, pupil size and reactivity - Reassure and orient patient after seizure
- Never force an airway between patient’s clenched teeth
- Give IV dextrose for hypoglycemia
Seizure Complications
- Status epilepticus: state of constant seizure or condition when seizures recur in rapid succession without return to consciousness between seizures (> 5 min)
- Neurologic emergency
- Can involve any type of seizure
- Causes the brain to use more energy than is supplied
- Neurons become exhausted and cease to function
- Permanent brain damage can result
- Trauma during seizures can cause severe injury and death
- Tonic Clonic most dangerous
- Ventilatory insufficiency
- Hypoxemia
- Cardiac arrhythmias
- Hyperthermia
- Systemic acidosis - Many seizures in a row
- Lasts longer than 5 minutes
- May turn a little cyanotic
- Might stop breathing
- If they have several tonic clonic in a row they may not be breathing for a few minutes
- Pushing meds to get seizure to stop
