Seizures Flashcards
Three major classes of seizures
Generalized onset
Focal onset
Unknown onset
Generalized can be
motor
Non motor
Characterized by loss of consciousness and falling to the ground
Tonic-Clonic seizure
Body stiffens
Tonic
Jerking of extremities
Clonic
Manifestations of tonic-clonic
Cyanosis
Excessive salivation
Tongue/cheek biting
Incontinece
Usually occurs only in children and rarely beyond adolescence
Typical absence seizure (non motor seizure; general onset)
Timing of (typical absence seizure)
Brief staring spell, lasts less than 10 seconds
Atypical absence manifestations
Eye blinking
Jerking movements of the lips
Lasts more than 10 seconds
Usually continue into adulthood
Characterized by rhythmic arm abduction (3 movements per second) leading to progressive arm elevation
Usually lasts 10 to 60 seconds
Myoclonic seizure
Begin in specific region of cortex in one hemisphere of brain
Produce manifestations based on function of area of brain involved
Focal-onset seizures
Focal-onset seizures described by level of awareness
Focal awareness seizures
Focal impaired awareness seizures
Patients remain conscious and alert
Have unusual feelings or sensations that can take many forms
Focal awareness seizures
Patients have loss of consciousness or a change in awareness
Eyes are open but cannot interact
Focal impaired seizures
Atonic:
helmet
State of continuous seizure activity or condition when seizures recur in rapid succession without return to consciousness between seizures
Status epilepticus (SE)
Neuro emergency; any type of seizure
Any seizure lasting longer than 5 minutes
Prolonged or repeated tonic-clonic seizures
Convulsive status epilepticus
Convulsive status epilepticus can lead to
respiratory insufficiency hypoxemia dysrhythmias hyperthermia systemic acidosis
Continuous seizure activity despite administration of first and second line therapy
Refractory status epilepticus (RSE)
putting them in a coma
Immediate medical care if:
Status epilepticus occurs
Significant bodily harm occurs
The event is a first-time seizure
Neurologic assessment involves testing for toxicity
Nystagmus
Hand and gait coordination
Cognitive functioning
General alertness
Medical Treatment of Status Epilepticus
Initially, rapid-acting IV lorazepam (Ativan) or diazepam (Valium)
diet helps control seizures
Ketogenic
Precipitating factors
Metabolic acidosis or alkalosis Hyperkalemia Hypoglycemia Dehydration Water intoxication
Ictal or Post-Ictal Phase
Bitten tongue, soft tissue damage, cyanosis Abnormal respiratory rate Apnea (ictal) Absent or abnormal breath sounds Airway occlusion Hypertension, tachycardia/bradycardia Bowel incontinence Excessive salivation Urinary incontinence
Acute care
- Open and maintain patent airway, support head, turn to side, loosen constrictive clothing, ease to floor
- Do not restrain patient or place any objects in their mouth
- May require positioning, suctioning, or oxygen after seizure
Nursing management; RN
Teach patient about risk for seizures, drug plan
Assess and record seizure details
Assess and position patient and give antiseizure drugs
Make appropriate referrals
Collaborates with physical, occupational, or respiratory therapist
Ambulatory Care
Prevention
Medical alert bracelets
Referrals to agencies
Most important thing to check:
check for injury; bit their tongue
Checking
RR Breath sounds airway occlusion HTN tachycardia
May require what after seizure?
Positioning
Suctioning
Oxygen
Note what during seizure:
the timing
