Seizures Flashcards
Seizures are
Convulsions
Involuntary, violent spasms of large skeletal muscles of face, neck, arms, and legs
All convulsions are seizures but not all seizures are convulsions
Seizures
Disturbance of the brain’s electrical activity that may affect consciousness, motor activity and sensation
Causes of seiqzueres
Causes: infectious diseases, trauma, neoplasms, metabolic disorders (hypoglycemia, electrolyte imbalances), vascular disease (stroke), febrile, certain medications, idiopathic, secondary to another condition
Seizures occur when “seizure threshold” is exceeded
Epilepsy
Any disorder in which patient experiences recurrent seizures
Patients with epilepsy tend to have lower seizure thresholds than others
More than 50% of cases are idiopathic
Divided into categories based on symptoms, distribution of abnormal activity in brain
Generalized onset seizures
Multiple foci that spread abnormal neuronal discharges across both hemispheres of the brain simultaneously
4 types
4 types of generalized onset seizures
Tonic-clonic (motor) - most common
- Aura, intense muscle contraction, loss of consciousness
Absence (non-motor)
- Staring, transient loss of consciousness
Only need to know tonic and abscent
Atonic (motor)
- Short duration, characterized by patient stumbling or falling, no loss of consciousness
Myoclonic (motor)
- Contraction of major muscles, jerky motion, no loss of consciousness
Classification of seizure disorders
Two types
Complex (impaired awareness)
Altered level of consciousness, often with aura
May have motor, sensory and autonomic symptoms
Surgical Therapy and alternate therapy
If epilepsy cannot be controlled by drug therapy the patient may be a candidate for a surgical intervention.
Surgery is performed to remove the epileptic focus or _________________________________in the brain.
Vagal nerve stimulation
Nutrtional therapy of ketogenic diet
A diet used to prevent seizures.
Most successful in children.
Calculated to be high in fat and low in carbs and proteins.
Limits water to avoid dilution of ketones and carefully controls calories.
First aid for seizures
Stay with person
Comfort and speak calmly
Check for medical bracelt
Keep calm
Turn pt on side (rest on slides)
Drugs that Stimulate GABA Receptors
Barbiturates (ie pentobarb, phenobarb)
indicated primarily for tonic-clonic seizures, but also used as sedative, hypnotic and general anaesthetic purposes
Benzodiazepines (ie diazepam, lorazepam)
Indicated primarily for absence and myoclonic seizures but also used as anxiolytic and sedative
Often used in combination with other drugs
Higher seizure threashold
Gabapentin
Inhibiting Calcium channels - decreasing stiumlation (Neuronal activity)
Used for sezirues but most often for nerve pain
AE CNS depression, dizziness, drowsiness, and dry mouth
Nursing Considerations with Drugs that Stimulate GABA receptors (2 of 3)
Missing doses increases risk of seizures
Interventions
Monitor vital signs, especially blood pressure and respiratory rate
Monitor neurological status, especially level of consciousness
Monitor for signs of renal and liver toxicity
Monitor children for paradoxical response (hyperactivity) (children with ADHD have lower levels of GABA – increasing GABA actually increases their activity)
Monitor for signs of vitamin deficiency (D, B12 and folate)
What to insturct client in regarding seizures
Signs of impending seizure (aura, lethargy, stupor, visual changes)
Dizziness, drowsiness
Signs of toxicity (nausea, vomiting, diarrhea, rash, abdominal pain, jaundice, hematuria)
Signs of vitamin deficiency (clotting issues, anemia, joint pain, bone deformities, skin changes)
Instruct client to maintain dosage and schedule of administration
Barbituate therapeutic effect and uses
Indicated for most seizure types except absence seizure
Anxiolytic, sedative hypnotic
Mechanism of Action
Increases activity of GABAA receptor, reducing excitability of post-synaptic neurons and increasing seizure threshold
AE: NV Depression, confusion
OD: CNS depression
Diazepam (Valium) AE
Drowsiness, fatigue, dizziness
Vertigo
Ataxia
Laryngeal spasms
Urinary retention
Menstrual irregularities
IV delivery – risk of muscle weakness, hypotension, respiratory depression
Drugs tjat reduce Na influx
Desensitize Na+ channels thereby delaying opening of channels and reducing excitability of neurons
Hydantoins (ie phenytoin)
**Indicated for all seizures except absence
Phenytoin (Dilantin)
*Most common seizure medication useful in treating every kind of seizure except absence.
It is able to provide effective seizure suppression without CNS depression or the abuse potential.
Narrow therapeutic range
- Monitored by tracking serum drug levels
AE of phenytoin (dilantin)
Lethargy, drowsiness, dizziness
Headache
Bradycardia, hypotension
Agranulocytosis, leukopenia, thrombocytopenia
Valproic Acid (Depakene)
Therapeutic effects and uses
Absence, complex partial seizures
Migraine headaches
Bipolar disorder
Mechanism of Action
Increases GABA via several mechanisms, causing decreased excitability of neurons
Assess LOC/seizure actiivty for baseline
Sedation is sign of toxicity
AE of Valproic acid
Headache, sedation, dizziness
Serious Effects
Bone marrow suppression
Photosensitivity
Pancreatitis
Hepatotoxicity
