Seizures Flashcards
Diagnostic procedures
EEG, MRI, CAT scan, Blood tests, Lumbar puncture, Spect
EEG
Records electrical patterns of brain, identifies seizure type, identifies focus or source of seizure
EEG nursing actions
explain test, make sure hair is clean, electrodes will be attached to scalp with paste, instruct parents that child may have seizure during test
Cat scan
computerized tomography, contrast dye may be injected, computerized photos of brain are shown
Cat scan nursing actions
explain procedure, check for allergies (iodine), kids may receive a sedative bc they have to lie still for a long time, no special prep
Blood tests
cbc, electrolytes, liver function studies(gotta know this!)
Lumbar puncture (spinal tap)
performed to diagnose infection, removal of CSF by needle aspiration
Lumbar nursing actions preprocedure
written consent explained by dr with nurse as witness, determine patient ?s, have patient go to bathroom prior
Lumbar nursing actions during procedure
assist patient in position on side (knee to chest) or sitting up (chest down to knees with back arched like a cat), nurse holds patient to help maintain position entire time of procedure
Lumbar puncture nursing actions postprocedure
refer to hospital policy, research no definite benefits to bedrest after a spinal tap, bedrest is determined by dr doing spinal tap, monitor for complications: H/A, voiding difficulties, increased temp, backache, neck stiffness
Lumbar puncture complications
H/A after sitting up bc dr took too much CSF out. In order to stop it they have to inject patients own blood in spinal column, voiding difficulties, increased temp, backache, stiffness of neck, Rare: herniation of brain contents, spinal abscess, spinal hematoma, meningitis
Status Epilepticus
a series of generalized seizures that occur without full recovery of consciousness between attacks. Medical emergency. can last 30 mins
SPECT diagnostics
helps identify epileptic zone so it can be removed in surgery
Partial seizures
focal seizure, involve one area of brain
types of partial seizures
simple partial seizures & complex partial seizures
Simple partial seizures
remains conscious, usually reports aura, eyes/head turn from side of focus, psychic experiences, smells, pain
Complex partial seizures
loss of consciousness (few secs), unaware of behavior, don’t remember event when its over, involves series of rxns or emotional changes (ex they might just cry), complex sensory changes (Hallucinations, mental distortion, changes in personality), involuntary urination, chewing/lip smaking, diarrhea, onset usually late teens
Grand mal also called
tonic-clonic
Petit mal also called
absence seizures
Generalized seizures
both hemispheres are involved so you get a loss of consciousness
Generalized seizures examples
Tonic-clonic, Absence, Myoclonic, Febrile, Status Epilepticus
Tonic-clonic 4 phases
aura, tonic, clonic, postictal
Aura phase
subjective, may happen hrs before actual seizure, recognizable sensation before a seizure-signals to patient that their going to have seizure
tonic phase
10-20 secs involuntary muscular tension or contraction during seizure. Immediate loss of consciousness resulting in falls
clonic phase
30 secs. alternately contracting and relaxing the muscles during a seizure. Appears as an aggressive spasm
Postictal phase
occurs AFTER seizure, may have symptoms of H/A, sleep, amnesia, remain confused for several hrs, speech probs, this phase is reflective of what type of seizure that has occurred, recovery phase
Neonate examples of known causes of having seizures
Trauma & anoxia, metabolic disorders (hypoglycemia <40), Neonatal infection (herpes), Kernicterus
Febrile seizures temp
102-104: give kid motrin at night bc it lasts longer, cool kid down with tepid(lukewarm) h2o, have kid see dr to rule out meningitis, EEG is usually normal
Antiepileptic meds can do what to fetus?
create fetal anomalies
Females are most likely to have a seizure during what?
seizures increase during periods
Absence seizures
involve abrupt 3-5 sec periods of loss of consciousness, loss of consciousness seems like they are day dreaming, more common in kids, usually no muscle involvement, seldom falls, no incontinence, amnesia for episode may need to repeat whatever was said during episode
Absence seizures start at what age?
3 & frequently disappear by puberty
Atonic (Akinetic) seizures
sudden loss of muscle tone (can slip under water if in bath), unable to break fall, injury could result, momentary loss of consciousness
Myoclonic seizures
short, sporadic periods of muscle contractions that last for several minutes, no loss of consciousness, no postictal state, are, often secondary seizures, can be asymmetrical or symmetrical
Status Epilepticus treatment/nursing actions
notify DR immediately, establish patent airway, apply o2 as warranted, IV Valium (Diazapam) or Ativan as ordered, IV Dilantin (Phenytoin) and Phenobarbital may be ordered
Why is IV Valium (Diazapam) or Ativan ordered during a Status Epukepticus?
to stop motor movement -check respiration status frequently
When giving IV Dilantin (Phenytoin) never give more than ___mg/hr to prevent cardiac arrhythmias
50mg/hr
What is used as a last resort for treatment of Status Epilepticus?
General anesthesia
AFTER Status Eilepticus is over what are some nursing actions?
side-lying position, insertion of N/G tube to prevent aspiration, monitor BP & cardiac status, prevent hyperthermia, observe for s/s of med toxicity
Surgical interventions for Status Epilepticus
corpus callostomy is severed, removal of sections or lobes of brain responsible (focus) for seizure activity
Nursing diagnosis: Potential for Injury goal and nursing actions
Goal: Patient will be free from injury if seizure occurs. Nursing actions: 02 & suctioning at bedside, IV access, Padded side rails
Nursing diagnosis: Ineffective coping goal and nursing actions
Goal: patient will begin to develop strategies to cope with diagnosis before discharge. Nursing actions: support, identify past coping strategies, relieve anxiety thru teaching
An example of a barbiturate antiseizure med
Phenobarbital
