Seizures - Exam 6 Flashcards
What is status epilepticus?
A state of continous seizure activity or when seizures occur in rapid succession without return to consciousness between seizures
What are the types of generalized seizures?
- Generalized tonic-clonic
- Absence
What are the types of focal/partial seizures?
- Simple partial seizures (no impairment of consciousness)
- Complex partial seizures (impariment of consciousness)
What are characteristics of generalized seizures?
- Sudden onset
- Bilateral, symmetrical movements
- Excessive neuronal electrical discahrges that are synchronous throughout entire brain
What are characteristics of focal/partial seizures?
- Come on gradually
- Abnormal electrical discharges begin in a focal area of the brain that is dysfunctional (chemically or structurally)
- Focal/partial seizures can secondarily generalize
What is aura?
A simple partial seizure that is usually a sensation or sensory phenomenon that reflects the complicated connections and integrative functions of that area of the brain. The most common sensation is a strange feeling at the bottom of the stomach that rises toward the throat. This feeling may be accompanied by odd or unpleasant odors or taste, complex auditory or visual hallucinations, or ill-defined feelings of elation or strangeness (eg deja vu, a feeling a familiarity in a strange environment). Many patients have an aura before a complex partial or generalized seizure. This is call prodromal in some patients
What is ictal?
Seizure activity: The physical manifestations of abnormal electrical brain activity. Nursing interventions should include: maintaining patient safety, positioning patient on side, observation and documentation of body, facial and eye movement, respiratory effort, and urination/defecation. The ictal phase is usually less than 5 minutes in duration and is self-limiting
What is postictal?
The period of recovery following a seizure. The patient may be drowsy, be uncoordinated and have transient aphasia or confusion and display some sensory or motor impairment. This phase can last a few minutes to a few hours
What is included in seizure precautions?
- Side rails up X 4
- Side rails and other hard objects in room padded
- Can place mats on floor
- Suction set up available
- Oxygen available
- Waterproof pad on mattress/crib
- Appropriate supervision and/or video monitoring
What are seizure precautions for a patient in the community?
- Swim with a companion
- use of protective helmet and padding for cycling, skateboarding, etc
- Supervision with use of heavy machinery/equipment
- Medical identification
- Avoidance of seizure triggers
How does the nurse document seizure activity?
- What happened before the seizure?
- How did it start?
- What do abnormal behaviors/movements look like?
- How long did it last?
- How does it end?
- What happens after the event?
- Is awareness of the environment/level of consciousness altered?
- Document specific information related to each seizure
dilantin (Phenytoin)
Classification: anticonvulsant, antidysrhythmic
Mechanism of action: Inhibits spread of seizure activity in motor cortex by altering ion transport. Increases AV conduction
Use: Generalized tonic-clonic seizures, status epilepticus
Side/Adverse effects: drowsy, dizzy, slurred speech, nystagmus, diplopia, blurred vision (s/sx of toxicity), hypotension, VF, N/V, hepatitis, gingival hyperplasia, hirsutism, Stevens-Johnson’s syndrome
Routes: PO/IV/NG
Nursing Implications:
- Take same time each day
- Monitor for toxicity
- Monitor therapeutic drug levels
- Given in own IV line with filter
diazepam (Valium) (Diastat)
Diastat is the rectal version
Classification: centrally acting antianxiety, anticonvulsant, skeletal muscle relaxant
Mechanism of aciton: potentiates action of GABA
Use: after a seizure, prolonged seizure, anxiety, ETOH withdrawal, rectally for acute repetitive seizure, usually for ped/home use
Side/adverse effects: neutropenia, resp. depression, orthostatic hypotension, N/V/D, CNS depression
Nursing Implications:
- VS
- Cehck for hypotension by checking BP
- Mental status changes
- Rectal administration not more than 5 times per month
Lorazepam (Ativan)
Classification: antianxiety, benzodiazepine
Mechanism of action: potentiates action of GABA, absorbed and eliminated faster than other benzodiazepines
Use: seizures, status elipticus, alcohol withdrawl, sedation, usual IVP med of choice for patient in adult acute care setting
Side/adverse effects: dizzy, drowsy, orthostatic hypotension, tachycardia, hypotension, apnea, blurred vision, confusion
Nursing Implications:
- BP
- HR
- Mental status
- IVP given slowly
- Instruct patient to change positions slowly
- Caution in hepatic or renal disease
Are there any driving license restrictions in NYS for an individual who has a seizure and/or epilepsy?
Can not have had seizure in last 12 months
What should the patient know about medicaitons?
- Take consistently
- Do not stop abruptly
- Report side effects
- blood level checks as ordered by dr
- gerontologic considerations