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Module 4 (MedSurg 2) > Seizures > Flashcards

Seizures Flashcards

1
Q

Seizures are a

A

Transient, uncontrolled electrical discharge of neurons in brain, interrupting normal function
- sudden

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2
Q

Causes of seizures

A

other disorders
febrile = mostly in kids

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3
Q

Metabolic disturbances associated with seizures

A

acidosis
electrolyte imbalance (NA)
HYPOGLYCEMIA
hypoxia
alcohol or barbiturate withdraw
Dehydration or water intoxication

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4
Q

The chronic version of seizures

A

epilepsy (NO CURE)

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5
Q

Extracranial disorders associated with seizures

A

HTN
Heart, lung, liver, and kidney disease
Systemic Lupus Erythematosus
DM
Septicemia (all spetic ptsbc of meds)

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6
Q

Seizure Disorders Causes

A

Genetic
Idiopathic
structural lesions
brian trauma
tumor in brain
vascular disease
Hx of metastatic brain seizures

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7
Q

Do you hold meals for seizure pts on EEG?

A

No, causes hypoglycemia

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8
Q

Seizures are not considered epilepsy if they occur bc of

A

metabolic disturbances
treat underlying cause

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9
Q

Epilepsy

A

Chronic disease with a continuing predisposition to seizures with consequences
unprovoked and unpredictable
- neuro bio
psychosocial
social (2.2 million Americans

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10
Q

Epilepsy higher in
age
ethnicity
gender

A

Young children and older adults
AA and socially disadvantaged populations
more in males

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11
Q

Epilepsy is detected by

A

EEG
brain activity

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12
Q

Epilepsy Patho

A

abnormal neurons
spontaneous firing
scar tissue (gliosis)

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13
Q

Locating seizure focus is critical for

A

successful surgical interventions

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14
Q

How do you determine where the seizure originated from?

A

at least 3 seizures during monitoring in the same spot
to determine the pattern of spread and extent of involvement

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15
Q

If they separate locations, then they will give

A

medication back and intervention is not surgery

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16
Q

If the seizure is only in one location, then

A

surgery could work better in the local term

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17
Q

S/S of Epilsepsy

A

seizures
determined by site of electrical disturbances
2 classes (general and focal)

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18
Q

Focal Seizures are located in

A

1 area

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19
Q

Generalized seizures are located in

A

multiple parts of the brain

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20
Q

Focal Seizures types

A

simple
complex

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21
Q

Generalized Seizures types

A

Tonic-Clonic
Absence
Myoclonic
Atonic
Tonic
Clonic

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22
Q

Which generalized seizures have probably altered consciousness?

A

tonic-clonic
absence

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23
Q

Which generalized seizures have brief or possibly altered consciousness?

A

myoclonic
tonic
clonic
atonic

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24
Q

Prodromal phase

A

only pt knows about it
behavior changes

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25
Q

Triggers of seizures

A

anything extreme/excessive (drinking and drug use, bright flashing lights, happiness, enjoyment, anger, staying up all night, stress, extreme exercising (cross-fit, weight-lifting competitions
sepsis
Induce seizures – by stopping meds slowly, sleep deprivation

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26
Q

Aural phase

A

sensory warning similar each time different between patients

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27
Q

Ictal phase

A

don’t know when the phase hits unless pt is on an EEG

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28
Q

Postictal phase

A

already happened and recovery

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29
Q

Tonic-Clonic Phase

A

LOC and falling
(Tonic)the body stiffens with subsequent jerking of extremities (clonic)
cyanosis, excessive salvation, biting down,a nd incontience

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30
Q

Management of Tonic Clonic seizures

A

seizure pads,
fall risk,
never leave them alone (regardless of privacy),
SUCTION and to the
SIDE-LAYING(aspiration),
O2,
working IV (not when seizing) check patency

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31
Q

The postictal phase for tonic-clonic is characterized as

A

muscle soreness
fatigue
sleep for hours
not feel normal for hours to days
no memory of seizures

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32
Q

Tonic and Clonic phases last how long

A

10-20 sec
30-40 sec

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33
Q

Typical absence seizures

A

occurs in children
precipitated by flashing lights and hyperventilation
staring spells “daydreaming
- no response or s/s

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34
Q

typical absence seizure can occur how many times a day

A

100-1000s a day
each less than 10 secs

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35
Q

The longer the seizure =

A

more brain death

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36
Q

Atypical absence seizures are characterized by

A

staring spell with eye blinking and chewing
slight responsive
jerking lip mvmt
more than 10 secs
continue into adulthood

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37
Q

Myoclonic seizures

A

sudden, excessive jerk or twitch of body and extremities
- forceful enough to cause fall
- brief few seconds
-occur in clusters
- altered LOC, CAUSES FALLS

38
Q

Atonic seizures aka

A

drop attack

39
Q

Atonic seizure

A

involves tonic or paroxysmal loss of muscle tone
Suddenly and person falls
lasts less than 15 secs
remain conscious resume activity immediately
risk for major head injury

40
Q

Tonic seizure

A

sudden onset of maintained increased tone in the extensor muscles
- in sleep only few seconds
affect both sides of the body
consciousness is usually preserved

41
Q

Clonic seizures

A

begin with LOC and loss of tone suddenly
Rhythmic limb jerking may or may not by symmetric
rare

42
Q

Focal seizures begin in

A

a specific region of cortex in one hemisphere and manifests in s/s of brian involved

43
Q

Simple focal seizures

A

remains conscious and alert
unusual feelings or sensations
- joy, sad, nausea, anger suddenly
- new senses of things not real

44
Q

Complex focal seizures

A

loss of consciousness or alteration in awareness
eyes remain open but no interaction
-strange behaviors
-automatisms: repetitive, purposeless actions
Do not remember an activity started before or continued during seizure
30 secs to 2 mins
tired and confused after

45
Q

Psychogenic seizures

A

misdx as epilepsy not false
Hx of abuse or traumatic event
Accurate diagnosis usually requires use of video-EEG monitoring

46
Q

Psychogenic seizures hx

A

Hx of abuse or traumatic event

47
Q

Psychogenic seizures need

A

counseling

48
Q

Status epilepticus (SE)

A

State of continuous seizure activity or condition when seizures recur in rapid succession without return to consciousness between seizures
neurologic emergency

49
Q

How long does Status epilepticus (SE) last

A

longer than 2-5 minutes

50
Q

Status epilepticus (SE) can occur with what type of seizures

A

any and all types

51
Q

Status epilepticus (SE) is an emergency. why?

A

The brain needs more energy due to the prolonged time of the seizure (2-5 mins) and stops functioning = leading to death or permanent brain damage

52
Q

Why is Status epilepticus (SE) more frequent in infants and the elderly?

A

comorbidities

53
Q

Dx assessments for seizures

A

Hx and Physical (birth to present)
seizure hx
EEG

54
Q

Drugs for Seizure Disorders
Focal

A

Carbamazepine
Fosphenytoin
Phenytoin
Valproic acid
Primidone
Phenobarbital

55
Q

Drugs for Seizure Disorders
Generalized

A

Carbamazepine
Phenytoin
Phenobarbital
Valproic acid
Levetiracetam

56
Q

Complications of seizure meds

A

sedation
mental dull
impaired memory and concentration

reason for fall risk and in beds

57
Q

Goal of seizure tx

A

suppress neurons or control with acceptable effects
Reduce seizures to a level that allows the patient to live as normal a life as possible

Balance the desire for complete seizure control with acceptable side effects

58
Q

How do AED drugs work?

A

suppress discharge of neurons with a seizure focus
suppress propagation of activity from the focus to the other areas of then brain

59
Q

AED does what to the body on a chemical level?

A

suppress of Na, Ca influx
promote K
Block glutamate receptors
Potentiate GABA

60
Q

What needs to be monitored on Antiepileptic drugs?

A

plasma drug levels
guide dosage adjustment
adherence
cause loss of seizure control
causes of toxicity

61
Q

Education of Rx AEDs

A

importance of adherence (50%)
plasma levels
maintain frequency chart
stop one med at a time if undesired

62
Q

New AED meds are

A

less complication
more expensive

63
Q

Phenytoin (Dilantin)

A

most widely used traditional
active against partial and generalized tonic-clonic
suppress seizures w/o depressing CNS entirely
selective inhibit of Na channels

64
Q

Phenytoin (Dilantin) Adverse Effects

A

Gingival hyperplasia
nystagmus (invol. eye mvmt) sedation, atatxia, diplopia, cog impaired
Measle like rash
Teratogen (need contraceptives)
cardiac dysrhythmias and hypotension

65
Q

Gingival Hyperplasia

A

growth of gum tissue
- severe cases of removal of gum tissue

66
Q

Phenytoin (Dilantin) decreases the effects of

A

contraceptives (need multiple forms)
warfarin
glucocorticoids

67
Q

What meds increase Phenytoin (Dilantin) levels?

A

diazepam
isoniazid
cimetidine
acute alcohols

68
Q

What meds decrease Phenytoin (Dilantin) levels?

A

Carbamazepine
phenobarbital
chronic alcohol

69
Q

Phenytoin needs to be administered with

A

food
after oral hygiene care

70
Q

Carbamazepine (Tegretol)

A

MOA: same as phenytoin but minimal effects on cognitive function
Used for bipolar disorder & trigeminal neuralgia
suppresses sodium influx

71
Q

Carbamazepine (Tegretol) Adverse effects

A

bone marrow suppression
attention for infections

72
Q

Valproic acid (Depakene, Depakote)

A

1st line drug for all partial & generalized seizures
used for bipolar disorder & migraine prevention

73
Q

Valproic acid (Depakene, Depakote)
adverse effects

A

hepatotoxicity
pancreatitis
teratogenic

74
Q

Phenobarbital

A

Reduce seizures without causing sedation

75
Q

Phenobarbital causes

A

physical dependence
low effect of warfarin and birth control
drowsiness with the metabolism of Vitamin D and K
nystagmus
ataxia

76
Q

Acute withdraw from Phenobarbital can cause

A

Status epilepticus

77
Q

Oxcarbazepine (Trileptal)
newer AED

A

block voltage-sensitive Na channels
Manage partial seizures
children and adults

78
Q

Oxcarbazepine (Trileptal)
adverse effects

A

dizzy
drowsy
avoid driving and other activities

79
Q

Lamotrigine (lamictal)

A

blocks Na and Ca channels
-life-threatening rash
-risk for suicide
- risk of seizures

80
Q

Gabapentin (Neurontin)

A

usually used for neuropathy, prophylaxis migraine, fibromyalgia, post-men hot flash
very well tolerated
primary or secondary therapy

81
Q

Gabapentin (Neurontin)
common side effects

A

somnolence
dizzy
ataxia
faigue
nystagmus
peripheral edema

82
Q

Pregabalin (Lyrica)

A

Neuropathic pain and neuralgia
partial seizure combined

83
Q

Pregabalin (Lyrica)
adverse life-threatening

A

angioedema

84
Q

Levetiracetam (Keppra)*****

A

not interact with other AEDs
unknown MOA
helps with seizures
not bing with neurotransmitters

85
Q

Topiramate (Topamax)

A

broad antiseizure

86
Q

What drugs are given for management of acute and Status Epilepticus

A

Lorazepam (Ativan)
given during seizure
effects last up to 72 hours
Diazepam (Valium)
short duration
Phenytoin (Dilantin)
Fosphenytoin (Cerebyx) less irritating
Magnesium Sulfate

87
Q

Epilepsy Therapies

A

surgical tx (neurosurgery and vagal nerve stimulation)

88
Q

Nursing Management of Seizures

A

free from injury
optimal functioning
satisfactory psychosocial functions
educate
rest and not extreme exercise
avoid stress
hx of risk factors

89
Q

Pt is prescribed phenytoin for epileptic seizures. Which of the following is the priority for pt teaching?
a -Teach pt to adjust the dose according to the presence of s/s
b -Tell pt to take meds with meals
c - Inform the pt about prevention of gingival hyperplasia
d -Teach pt to avoid the abrupt cessation of tx

A

d -Teach pt to avoid the abrupt cessation of tx

90
Q

In TX, how long do you need to wait to drive after a seizure?

A

3 months

Module 4 (MedSurg 2) (36 decks)

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