Seizures Flashcards
Seizures
- Abnormal episodes of motor, sensory, autonomic, or psychic activity (or a combination of these) resulting from a sudden, abnormal, uncontrolled electrical discharge from cerebral neurons
- SEIZURES MAY BE ASSOCIATED WITH AN UNDERLYING PATHOLOGICAL CONDITION
Classification of seizures:
- Focal: originates in one hemisphere
- Generalized: occur and engage bilaterally
- Unknown: epilepsy spasms
- βProvokedβ related to acute, reversible condition such as structural, metabolic, immune, infectious or unknown etiologies
Epilepsy
at least two unprovoked seizures occurring more than 24 hours apart.
Epilepsy PATHOPHYSIOLOGY:
- The underlying cause is an Abnormal, sudden, excessive, uncontrolled electrical discharge in the nerve cells in one section of the brain; these cells emit electrical discharges that result in change of LOC, motor/sensory ability and behavior.
- Epilepsy: chronic disorder with repeated unprovoked seizures.
- Chronic disorder
- Two or more seizures
- Group of syndrome, classified by specific patterns of clinical features
- Primary
- Secondary
- More common in children and older adults
Generalized seizure
- Both hemispheres
- lasts 2-5 minutes
Tonic Clonic (grand mal) seizure with LOC
- Aura or βsensationβ may precede onset of actual seizure
- Two phases lasting about 2-5 minutes
- First phase (Tonic phase) muscles become rigid or stiff of arms and legs and loss of consciousness
- Second phase (Clonic phase) rhythmic jerking of extremities- may bite the tongue, incontinent
- Followed by fatigue and lethargy (lasts about 1 hour or less )
- TONIC = stiff muscles; CLONIC = jerking of extremities
β- note time tonic started
β- guide to floor/ blow by O2
Absence (petite mal) Seizure
- Brief loss of consciousness (blank stare), immediate return to baseline
- Zone out and come back;
- Common in children.
- Often accused of daydreaming
- Brief (seconds) loss of consciousness (blank stare)
- Then continue what they were doing before seizure
- Followed by automatisms (or automatic behavior they have no control over)
- Lip smacking, picking at clothes
Myoclonic seizure
- Brief jerking or stiffening of extremities/Single or Bilateral
- Jerking of one extremity, may only last a few minutes
- brief; 1 or both sides affected
Atonic seizure
- Sudden loss of muscle tone, Falls lead to injury, Followed by postictal confusion
- Loss of muscle tone, falls to floor,
- Loss of consciousness for a few seconds, postictal confusion
Partial seizure
one hemisphere
Complex partial seizure
loss of consciousness
Simple partial seizure
stays conscious; may have aura
SECONDARY SEIZURE
CAUSED BY AN UNDERLYING LESION
- TUMOR
- BRAIN TRAUMA
OTHER CAUSES
- METABOLIC DISORDERS
- ACUTE ALCOHOL WITHDRAWALS
- ELECTROLYTE DISTURBANCES (HYPERKALEMIA, HYPOGLYCEMIA)
- HIGH FEVER
- SUBSTANCE ABUSE
Epilepsy risk factors/ Causes
- Cerebrovascular disease (stroke)
- Hypoxemia
- Fever (childhood)
- Head injury
- Hypertension
- Central nervous system infections (meningitis/ encephalitis)
- Metabolic and toxic conditions
- Metabolic disorders
- Brain tumor
- Drug and alcohol withdrawal
- Allergies
- electrolyte imbalance
- high fever
- stroke
Seizure Triggers:
- Missed medication (#1 reason)
- increased physical activity
- emotional stress/ anxiety
- Hormonal changes
- Dehydration
- Lack of sleep
- excessive/ extreme fatigue
- Photosensitivity
- certain foods and chemicals
- alcohol/caffeine consumption
Seizures Nursing Process Assessment:
- Duration
- Frequency
- Triggers
- Check serum drug levels & patient compliance
- Aura?
- Patient knowledge
Seizures Nursing Interventions:
- PATIENT SAFETY!
- O2 & suction at Bedside & IV access
- turn patient on side
PLAN OF CARE FOR A PATIENT EXPERIENCING A SEIZURE
- observation and documentation of patient signs and symptoms before, during, and after seizure
- Nursing actions during seizure for patient, safety, and protection
- After seizure care to prevent complications
POST SEIZURE (POSTICTAL)
- VITAL SIGNS
- NEURO CHECK (if asleep, try again in 15 min)
- KEEP ON SIDE
- ALLOW TO REST
- DOCUMENT
Seizures Patient Teaching
- do not stop meds
- do not take OTC meds without MD approval
- keep med alert bracelet on
- check serum drug levels in am before taking drug
- use two forms of contraceptives
- call MD if unable to take medication due to N/V
- Do not take alcohol while on medications
Seizures:
Assessment & Diagnostics
- Assessment and history
- CT
- MRI
- EEG
Seizure safety
- Donβt force anything into the mouth
- Turn on the side
- Loosen clothing
- Do not restrain
- Prevent injury
- *IV access
- *Suction
- *O2
Epilepsy Pharmacological: STOP THE SEIZURE
- Benzodiazepines:
β Ativan (lorazepam)
β Valium (diazepam) - MOA: enhance GABA
- Nursing implications: short term effect, monitor liver
- Adverse effects: sedation (check ABCβs)
- Benzos for acute onset β 4mg loading dose
- Slow IVP over 2 min Monitor (ABCβs)
Epilepsy Pharmacological: Anticonvulsant Medications (AEDβs)
- Suppress NA influx (prevents neuron firing)
- Suppress CA influx (suppresses current generated by CA
- Increase GABA (inhibits neurotransmitter)
Epilepsy Pharmacological: CONTROL/PREVENT SEIZURES
- Levetiracetam (Keppra)
β most common - Phenytoin (Dilantin)
β Not compatible with other drugs
β dont push fast
β monitor liver labs - Fosphenytoin
- Carbamazepine (Tegretol)
- Divalproex (Depakote)
Status Epilepticus
- Acute prolonged seizure activity
β wont stop seizing - Includes continuous seizures lasting at least 30 minutes
- Medical emergency
β Respiratory
β Irreversible brain damage - Causes
β Interruption of anticonvulsant medication, fever, concurrent infection, other illness
Epilepsy medical management
- STOP THE SEIZURE AS QUICKLY AS POSSIBLE
- ENSURE ADEQUATE CEREBRAL OXYGENATION
- AIRWAY MANAGEMENT
β noting in mouth
β use nasal trumpet
A CLIENT WITH A HISTORY OF SEIZURES IS PLACED ON SEIZURE PRECAUTIONS. WHAT EMERGENCY EQUIPMENT WILL THE NURSE PROVIDE AT THE BEDSIDE? SELECT ALL THAT APPLY.
A. OROPHARYNGEAL AIRWAY
B. OXYGEN
C. NASOGASTRIC TUBE
D. SUCTION SETUP
E. PADDED TONGUE BLADE
A, B, D
Losing brain cells during seizures
Check CIWA
