Seizures

Question 1

Seizure

Epilepsy

Answer 1

• periods of abnormal electrical discharges in brain that may cause involuntary movement or behavior, or sensory alterations
• chronic disorder characterized by recurrent seziures secondary to CNS disorder

Question 2

Seizure pathophysiology

Answer 2

• abnormal excessive concurrent electrical discharges from cortical neuronal netowrk of cells
• when multiple neurons become excited, they discharge abnormally
• can be caused by environmental, physical stimuli, CNS infection, ypoxia, and brain trauma

Question 3

Focal Seizures

Answer 3

• partial seizures

- abnormal electric activity in 1 hemisphere, most often in temporal, frontal, or parietal lobes

Question 4

Generalized seizures

Answer 4

• electrical activity that begins on both hemisperes simultaneously
• spasm movements are bilateral and symmetric

Question 5

Febrile seizures

Answer 5

• generalized seizures tha occur during rapid increase of temperature
• associated wth acute illness
• seen between 3 months-5 years
• often a family history is present
• Tonic clonic manifestations less than 15 mins

Question 6

Risk factors for infants developing epilepsy

Answer 6

• median age 5-6 yrs
• SGA
• neurological syndrome
• brain tumor/infections
• stroke
• cp
• autism
• FH
• drug abuse

Question 7

Tonic Phase manifestations

Answer 7

• unconsciousness, and continous muscular contraction
• BMR increases, increases demand for oxygen and glucose
• may become pale and cyanotic as result of hypoxia
• hypoglycemic

Question 8

2 types of seizures

Answer 8

• partial (focal)

- Generalized (tonic clonic)- most common in children

Question 9

Clonic Phase

Answer 9

-alternating muscular contraction and relaxation

Question 10

Postictal Period

Answer 10

• following seizure activity

- decreased LOC, sleepy but arousable

Question 11

Auras

Answer 11

• early warning sign of seizure
• sensory alteration such as odor, taste, or vision
• if feeling aura, pt should get on floor to prevent injury during seizure

Question 12

Simple Partial Seizures Etiology

Answer 12

-involves activation of only part of one cerebral hemisphere

Question 13

-Simple Partial Seizures manifestations

Answer 13

• no alteration in consciousness
• muscle movements may be restricted to one area
• may have abnormal sensations or hallucinations
• tachycardia, flushing, hypotension or hypertension
• sense of deja vu or fear or anger

Question 14

Simple partial seizure therapies

Answer 14

• antieleptic meds
• maintain safety
• assess manifestations and document
• vagal nerve stimulation therapy

Question 15

Complex partial seizure etiology

Answer 15

-same as simple partial, but usually in temporal lobe

Question 16

Complex partial seizure manifestations

Answer 16

• aura of visual, auditory, smell or psychic
• impaired consciousness that last several hours
• repetitive activity such as lip smacking, aimless walking, or picking at clothing called automatisms
• amnesia

Question 17

Complex partial seizure therapies

Answer 17

• antiepileptic meds

- maintain client safety

Question 18

Absence seizures (petit mal) etiology

Answer 18

-both hemispheres of brain as well as deeper structures such as thalamus, basal ganglia, and upper brainstem

Question 19

Absence seizures (petit mal) manifestations

Answer 19

• impaired LOC
• sudden brief cessation of motor activity with blank stare and unresponsiveness
• common in children
• last 5-10 sec, as long as 30 sec
• occasional to several hundred a day

Question 20

Absence seizure (petit mal) therapies

Answer 20

• antiepileptic meds

- maintain safety

Question 21

Tonic clonic seizures etiology

Answer 21

-most commonly seen in adults

Question 22

Tonic clonic seizures manifestations

Answer 22

-aura such as visual, gustatory, visceral, or sense or uneasiness
-sudden loss of consciousness
-tonic phase: sharp muscle contraction forcing air out of lungs, which may make client cry out, pupils fixed, incontinence, breathing ceases, last about 15-60 sec
-Clonic phase: alternating contraction and relaxation, hyperventilation, eyes roll back froths at mouth, aout 60-90 sec
Postical Phase: unconscious and unresponsive, relaxed breathing, confused and disoriented upon waking, tired, amnesia

Question 23

Tonic Clonic seizure therapies

Answer 23

• antiepileptic meds
• client safety
• suspension of driving
• helmets
• dont restrain
• pad bedrails
• diazepam, lorazepam, or phenobarbital

Question 24

Status Epilepticus etiology

Answer 24

• continuous seizure lasting longer than 30 mins

- requires immediate intervention

Question 25

Status Epilepticus manifestations

Answer 25

• continuous seizure activity
• can be any type,usually tonic clonic
• client in great danger of hypoxia, acidosis, hypoglycemia, hyperthermia, and exhaustion

Question 26

Status Epilepticus therapies

Answer 26

• maintain airway
• administer 50% glucose to prevent hypoglycemia
• diazepam, or lorazepam IV, repeat every 10 mins until seizure stops
• antiepileptics such as phenytoin
• phenobarbital

Question 27

2 ways AEDs act

Answer 27

• raise seizure threshold

- limit spread of abnormal activity in brain

Question 28

Goal of AED treatment

Answer 28

-protect the client from harm and to reduce or prevent seizure activity without impairing cognitive function or producing undesirable side effects

Question 29

Febrile Seizure treatment for children

Answer 29

• usually not treated with anticonvulsants
• Parental education on keeping fever low with antipyretics, keeping child cool and light clothing, and protect child from harm
• may have second seizure and treated with rectal diazepam
• if seizure last longer than 10mins, child needs to be monitored for electrolytes, glucose, blood gass, increasing fever, and abnormal blood pressure.

Question 30

Intraceable seizures

Answer 30

• seizures that continue to occur even with optimal medical management
• common in children
• often treated with multiple anticonvulsants and regular blood test

Question 31

Ketogenic diet

Answer 31

• used for children under 8 yrswith myoclonic and absence seizures
• high fat, protein, low carbs
• calories increased 75% and fluids decreased 80%
• causes ketosis which produces anticonvulsant effects
• common complications include constipation (treated with medium chain triglycerides), hyperlipdemia, and kidney stones (treated with increase fluid intake)

Question 32

Surgery for seizures

Answer 32

• remove tumor, lesion or portion of brain that is causing seizure, particularly when seizures are not responsive to meds
• cerebral hemispherectomy on children with intractable epilepsy
• vagal nerve stimulator for children who are unable to tolerate multiple medications and not candidates for surgery

Question 33

Nursing Diagnosis for Seizures

Answer 33

• Ineffective Breathing Pattern
• Ineffective Airway Clearance
• Risk for Trauma
• Chronic Low Self-Esteem
• Anxiety
• Ineffective Therapeutic Regimen Management
• Readiness for Enhanced Family Process

Question 34

Assessment before, during and after seizure (10)

Answer 34

1) what was the LOC?
2) what was the client doing prior seizure?
3) in what part of body did seizure start?
4) what there an epileptic cry?
5) automatisms? such as eye flutter, lip smacking, chewing
6) how long did it last? did movements involve both sides?
7) did head or eyes turn to side? which side?
8) were there changes in pupillary reactions?
9) if the client fell,was the head hit
10) was there foaming or frothing from the mouth?