Seizures Flashcards
Pt is experiencing continued seziure activity is to be given midazolam. What other intervention should nurse prepare for?
Intubation and mechanical ventilation- continued seizure activity requires ICU admission which includes intubation/mechanical ventilation for managment
Priority nursing assessment for pt with new onset of seizures?
Monitor his LOC and vital signs (detects changes like ICP or another seizure)
Nurse’s priority for pt having a seizure?
Protect their head and maintain a safe environment to prevent injury
What is a seizure?
Abnormal neurons cause spontaneous firing spreading to the entire brain which causes a generalized seizure, change in LOC, motor/sensory ability, and behaviours. Seizures usually last <5 minutes. Some seizures are idiopathic while other are b/c of a pathological condition of the brain
What is epilepsy?
Common chronic repeated seizure disorder caused by abnormality in electrical neuronal activity or having an imbalance of neurotransmitters (GABA). Its often idopathic
Common chronic repeated seizure disorder caused by abnormality in electrical neuronal activity or having an imbalance of neurotransmitters (GABA). Its often idiopathic
2 types of epilepsy?
- Generalized seizures- both hemispheres of brain are affected (motor seizures-tonic, clonic, tonic clonic, myoclonic and atomic- sudden loss of muscle tone so you collapse to the ground)
- Generalized non motor seizures (absence seizures- sudden brief LOC change, no change in muscle tone)
Tonic and clonic seizures?
- Tonic phase- sudden LOC, sharp tonic muscle contractions (rigid, arms/legs extend, jaw clenched)
- Clonic phase- airway lost/laboured resp, contraction and relaxation of muscle in all extremities, hyperventilate, increased lacrimation, eyes roll back
What is a partial seizure and the 2 types?
Begins in one part of the cerebral hemisphere (focal or local seizure)
- Simple partial seizure- Doesn’t impair LOC, lasts <1 minutes, may involve motor/sensory/autonomic manifestations
- Complex partial seizure- involve period of postictal confusion, lasts >1 min (1-3), may blackout, lip smacking/automatisms (chew, rapid eye blink)
Causes of seizures?
Vascular (stroke, intracerebral hemorrhage), infection (fever, sepsis), trauma (penetrating injuries) toxins (alcohol withdrawal, drugs), autoimmune disorder, metabolic disorder, neoplasms, idiopathic (No known cause)
4 Phases of seizures?
- prodome (have signs of seizure, occurs hr/days before seizure, S+S: irritable, difficulty concentrating, headache, GI problems, know seizure is coming)
- aural (sensory warning, visual disturbances- flash light, blurr visions, smell changes, feel nauseated)
- ictal (full seizure, active seizure phase marked by abnormal electrical activity in brain, most critical phase of safety, want to maintain airway/prevent injury, push Ativan if seizure lasts >1 minute)
- postictal (recovery, lethargic, confused, can last minutes to hrs, headaches, muscle soreness, reorient patient, reassure safety)
Adverse effects of generalized seizures?
HTN (from SNS activation), lactic acidosis (from muscle clenching), hyperthermia, respiratory compromise, pulmonary aspiration/edema, self injury, rhabdomyolysis, irreversible neuro damage if >30 min
Dx for seizures?
Check CBC to rule out infection, electrolytes (hypo Na or K), drug levels from blood (what’s the level of drug in their blood and is it working), toxicology screen, CT scan, MRI, EEG (gold standard for dx seizures)
Priorities for seizures?
Assess LOC, mental status, drowsiness, and triggers. Assess seizure activity and make sure the pt is safe. Ensure airway/O2, assess VS/neuro checks, and monitor serum glucose
What do benzodiazepines do vs anti epileptic therapy?
B- abortive therapy that stops ongoing seizures if they last >5 minutes (lorazepam, diazepam)
AET- prevents future seizures (phenytoin, valproic acid, phenobarbital)
Interventions for safety with seizures?
Avoid placing objects in mouth, use suction post seizure, place pt in side lying position during seizure to prevent aspiration, pads on side rails, don’t hold limbs down, loosen restrictive clothing, and remove things that may cause injury
What is status epilepticus and what do you do?
Prolonged seizure that lasts >5 minutes. Causes are infection, metabolic disturbances, withdrawal from drugs/alcohol, TBI, mismanagement of medications. SE has increased mortality because pt unable to breathe/increased risk for permanent neuro damage within 20 minutes.
Treatment- IV push lorazepam/diazepam, fluids, O2 administration, VS, EEG, lab work (drug blood levels)
