Seizures and Meningitis Flashcards
seizure
a burst of uncontrolled electrical activity between neurons, results in transient abnormal movements, muscle tone, behavior, sensation and/or altered LOC
focal seizure
originate from one specific location in the brain and affect 1 hemisphere (“partial seizures” can be w/ or w/out loss of consciousness
focal seizure without loss of consciousness
- previously “simple partial seizure”
- affects one hemisphere of brain
- pt remains alert and able to recall the event
- usually seconds to 2 minutes
- s/s: blank staring, unilateral extremity movement, odd sensation, or autonomic signs
- may forewarn a larger impending seizure
focal seizure with loss of consciousness
- previously “complex partial seizures”
- affects one hemisphere of brain
- patient not aware of surroundings
- typical duration 1-2 minutes
- s/s: automatisms = hallmark movements such as lip smacking, swallowing, picking with fingers, verbal sounds
generalized seizures
- not isolated to 1 area of the brain, both hemispheres affected
- always result in loss of consciousness
tonic-clonic
initial stiffening of muscles followed by rhythmic jerking movements
tonic
abrupt loss of consciousness and muscle stiffening without the myoclonic jerking. Often has autonomic changes.
atonic
sudden loss of muscle tone, often causing a fall
myoclonic
rhythmic muscle jerking which can be symmetric or asymmetric
causes of seizures
- infectious state/fever
- sleep deprivation
- illicit drug use
- hyponatremia
- withdrawal from antiepileptic meds, etoh
- stroke
- low blood sugar
- head trauma
- brain tumor
- epilepsy
epilepsy
CNS system disorder caused by abnormal electrical impulses in the brain which result in seizures
- diagnosis requires 2 unprovoked seizures (NO other identifiable cause exists)
tx of epilepsy - meds and education
antiepileptic drugs (AEDs)
- can cause leukopenia or liver dysfunction - routine labs: CBC, AST, ALT, etc
- dentist: gingival hyperplasia can occur w/ phenytoin
- important to take same time daily
- tolerance can build over time - lab monitoring of drug levels
tx of epilepsy - non pharm
- vagal nerve stimulation: implanted device gives bursts of electricity to vagus nerve -reduces seizures 20-40%
- deep brain stimulation: electrodes placed in brain parenchyma, generator in chest. electrical impulses disrupts random bursts which cause seizures
- ketogenic diet
- CBD
SEEG
minimally invasive insertion of electrodes into brain to pinpoint where seizures originate
bedside care of epileptic pt
gather info: preceding sx (aura), LOC, duration, tonic/clonic movements
precautions: bed in low, padded bed rails, have at least 1 IV, oxygen and suction ready in room
what to do during seizure
move everything out of pts way - don’t restrict movement
- O2 and suction ready
- pt on side
- nothing in mouth
- document onset
preictal
before the seizure
ictal
during the seizure
post ictal
time after the seizure - pt may have continue to have decreased LOC, be fatigued, have muscle soreness, difficulty reading/writing/speaking
seizure threshold
lowest amount of stimulation required to induce a seizure
- some meds can lower the threshold (some abx, some pysch meds, SSRIs, Propofol, Cyclosporin)
status epilepticus
medical emergency - seizure lasting >5 min or more than one seizure in 30 min timeframe without return to neurologic baseline
tx: 1st choice Benzos (Lorazepam or Midazolam)
psychogenic non-epileptic seizures
episodes appear like seizures, but are caused by psychological factors (somatoform disorder)
- 20-30% of intractable seizures
- often caused by trauma, EEG doesn’t show epileptic activity
tx: work with psychiatrist, EMDR
meningitis types
inflammation of meninges
- bacterial: strep, N. meningitidis (have vaccines) avg age 20
- viral: most common (usually <5 yrs old)
- fungal: uncommon, usually seen in immunocompromised pts
s/s meningits
- altered mental status
- HA maybe with N/V
- malaise
- fever
- Nuchal rigidity (neck) - Kernig’s sign, Brudzinski’s sign
- nystagmus
- photophobia
- seizures
- red macular skin rash
Kernig’s sign
resistance to extension of leg while hip is flexed
Brudzinski’s sign
flexion of hips and knees in response to neck flexion
diagnosing mengingitis
- CBC: elevated WBC
- blood cultures: to determine if infx spread as result of sepsis
- brain MRI: shows meningeal inflammation
lumbar puncture
looks at CSF and its cellular components
- bacterial: low glucose, high protein, high WBC. CSF appears cloudy/turbid. Opening pressure high
- viral: normal glucose, somewhat elevated protein and WBC. CSF appears clear/yellow like normal. Opening pressure normal.
tx meningitis
bacterial: abx
viral: resolves on its own, can take OTC meds for fever or body aches (acetaminophen)
nursing actions meningitis
- if have altered mental status - ensure airway protected, ABCs maintained
- VS and neuro checks q 4 to check for ICP
- droplet precautions w. bacterial
- strict I&O
- HOB >=30 degrees
- decrease environmental stimuli
meningitis vaccines
- Hib: children >2 mos old and others immunocompromised
- PCV13: infants <2 yr old
- PPSV23: everyone >65 and >2 if immunocompromised
- meningococcal conjugate: 1st dose 11/12 and booster at 16
