Seziure Disorders Flashcards
What is a seizure ?
Sudden abnormal, excessive, electrical discharge of neurons in the brain
What is going on in the brain when a seizure is happening?
Paroxysmal; uncontrolled electrical discharge of neurons in brain that interrupts normal function
Seizure may accompany other discords or occur ___ without apparent cause
Spontaneously
Are seizures resulting from metabolic disturbances, like
Acidosis
Electrolyte imblanese
Hypoglycemia
Hypoxemia
Alcohol
Dehydration
Water intoxication
Considered epilepsy/seizures ?
And why?
No
Because it’s a underlying condition
And usually can be treated when underlying condition is fixed
What are the 4 extracranial diseases associated with seizures?
Heart ->
Lung ->
Liver ->
Kidneys ->
Hypertension
Systemic lupus erythematosus
Diabetes mellitus
Septicemia
What does epilepsy mean?
A seizure disorder
Since epilepsy is a seizure disorder, what else does that tell us? Define it
Usually caused by?
Condition in which a person has a spontaneously recurring seizures
And underlying chronic condition
In the United States, about ___ million people have epilepsy
And incidence increased in ___
3 million
Older adults
Etiology and pathophysiology
Many possible causes vary by ___
Mainly found in which race ?
Which type of people ?
Male or female?
High risk of epilepsy are in which disease?
Age
African American
Socially disadvantage
Makes
Alzheimer’s & stroke
For patients who don’t know the seizure disorder, it’s known to be called as?
Idiopathic generalized epilepsy (IGE)
Common causes during the first 6 months of life are ? (4) for seizures
Severe birth injury
Congenial birth deficits (CNS)
Infections
Inborn errors of metabolism
Common causes from ages 2-20
(4)
Birth injury
Infection
Trauma
Genetic factors
Common causes between 20-30
(3)
Structural lesions
- trauma
- brain tumor
- vascular disease
Common causes after 50?
(2)
Stroke
Metastatic brain tumors
In epilepsy, Abnormal neurons undergo spontaneous firing.
Where does firing of these neurons go to? (2)
( if activity involves whole brain, generalized seizure occurs )
What is the cause of this abnormal firing?
Adjacent or distant areas of the brain
Unknown
What is normally found in area of brain from which eplieptic activity arises?
Gliosis ( scar tissue )
Gliosis (scar tissue) is thought to interfere with normal what?
And this makes it more likely to ?
Chemical and structural environment of neurons
Fire abnormal neurons ( or have another seizure )
Notes
Genetic link
Genetic abnormalities may be the most important factor contributing to IGE, but difficult to separate from environmental or acquired influences
Some types of epilepsy run in families
Others type of IGE are related to specific genes
More than 500 genes play a role
What are the 3 classification of a seizure?
Determined by site of electrical disturbances
Divided into 2 major classes
Generalized and focal
Treatment is driven by type of seizure
Clinical manifestations of seizures may progress through several phases
Which are 4 of them ( name and define )
Notes
- not all patients have every phase
Prodromal - signs that precede seizures
Aural - sensory warning
Ictal phase - seizure
Postictal- rest and recovery
What are the 7 generalized onset seizure?
Tonic-clonic
Typical absence ( petit-mal )
Atypical absence
Myoclonic
Atonic
Tonic
Clonic
What is the most common seizure?
Tonic clonic
Tonic clonic ( also named as grand mal )
Is characterized by?
What is the tonic phase and time?
What is the clonic phase and time?
What are the 3 symptoms that occur?
Loss of consciousness and falling
Body stiffens ( 20secs )
Subsequent jerking of extremities
(30-40secs)
Cyanosis
Excessive salivation
Tongue/cheek biting
In the postictal phase ( after seizure, recovery and rest )
Patients are characterized by? (2)
Patient may sleep for ___
May not feel ___ for hours to days
They will no ___ of seizures
Muscle soreness and fatigue
Hours
Normal
Memory
What is a typical absence seizure ?
Usually happens only in?
May ceases as the child ?
Can be precipated by ? (2)
Usually occurs only in childern and rarely beyond adolescence
May cease as the child matures or develop into another type
Can be precipitated by flashing lights & hyperventilation
What is the typical symptoms of petit mal?
How does it last?
Often goes?
May occur up to how many times a day ?
What machine demonstrated pattern unique to this type of seizure?
Staring spell “daydreaming”
Few seconds
Unnoticed
100times
EEG
What is atypical absence seizure characterized by?
They usually have a what?
What type of behavior during seizure?
What behavior after ?
Staring spell with other manifestations that last longer than typical absence seizures
Brief warnings
Peculiar
Confusion
What is a myoclonic seizure?
This can be forceful enough that patients will end up ?
It can be brief seizure but also can occur in?
Charactered by sudden; excessive jerk of the body and extremities
Falling
Clusters
What’s atonic seizure?
This begins ___ and person falls
When does consciousness usually return?
( patients can resume normal activity immediately )
This has the greatest risk for ?
Involved tonic episode or paroxysmal loss of muscle tone
Suddenly
By the time the person hits the ground
Head injury
Tonic seizures are?
Patients often fall!!
Sudden onset of maintained increased tone in the extensor muscles
What is clonic seizures?
Followed by?
Begin with loss of consciousness and suddenly loss of muscle time
Limb jerking
What is a focal seizure caused by?
Where does it begin?
What does it produce?
Focal irritations
Specific region of cortex of brain
Signs and symptoms related to the function of the area if the brain involved
Focal seizures are also called?
Partial or partial focal seizures
Focal seizures are divided into 2
Simple and complex
Describe each forms of LOC
(1)(2)
Person remained conscious
Person has loss or change of LOC
Produce a dreamlike experience
What is simple focal seizure ?
It’s a sudden and unexplainable??
Patients may??
Person experiences unusual feelings or sensation that can take many forms
Feelings of joy, anger, sadness and nausea
Hear,smell, taste, see or feel things
What is complex focal seizures
Patient will display what?
They’ll be doing ?
They have automatisms ( means ?)
Do they remember ?
How does it last?
Strange behavior
Lip smacking
Repetitive movements that may not be appropriate
Does not remember
Usually last for a few seconds
Notes
If there is aura or warning before tonic clonic seizure. The aura or warning is really a partial seizure that generalized secondarily
Postictal ( Todd’s paralysis ) can develop focal weakness that resolves eventually
Focal
Psychogenic seizures ( pseudo seizures ) or psychogenic nonepilepitic seizures occur how?
They resemble epileptic seizures
And they are accurate diagnosis how?
Triggered by Emotional events
Video or EEG
NOTES & 1 question
People with seizure disorder have a higher mortality rate than general populations, especially those who suffer from a fall or loss consciousness.
Often death are due to accidents during a seizure
( sudden unexpected death in epilepsy ) SUDEP or otherwise known as???
Status epilepticus
What is status epilepticus?
A state of constant seizure or seizures occurring in rapid succession without return of consciousness between seizures
Status epilepticus is the most serious
___
It’s what type of emergency?
Can involve/occur in what?
Subclinical is what?
Complication of epilepsy
Neurologic
Any type of seizure
Status epilepticus in sedated patient
( usually easy to miss )
Status epilepticus causes the brain to what?
Causes neurons to?
This resulted in?
Use more energy than is supplied
Become exhausted and cease to function
Permanent brain damage
Tonic clonic status epilepticus
Also known as
Convulsive status epilepticus is the most common and most dangerous
Why/causes? (5)
And usually is fatal.
Cause
ventilators insufficient
Hypoxemia
Cardiac arrhythmias
Hyperthermia
Systemic acidosis
Notes ; complications
Severe injury and death from trauma during seizure
- patients who lose consciousness are at greatest risk
Persons with epilepsy have a mortality rate 2-3 times the rate of the general population
What is the most common complication of seizure disorders?
Notes
- social stigma still exists
- discrimination/limitations
- driving sanction
Effect on lifestyle
What are disgsnostic studies we can use? (6)
History
EEG
Magnetoencepharkography
CBC
CT/MEI
MRA/PET
NOTES
EEG will help determine the type of seizures and pinpoint the seizure focus
- many patients did not have abnormal findings
Magnetoencephalography
- greater sensitivity for detecting small magnetic field generated by neuronal a gory
CBC, serum chemistries and lice and kidney function to help rule out metabolic disorders
Most seizures do not require emergency medical care because they are self limited and rarely cause bodily injury?
True or false?
True
When we should intervene with seizures are when 3 things occur?
Which are
Status epilepticus
Significant body harm
First time seizure
Seizures disorders are primarily treated with?
Which the goal of therapy is to?
Notes
- medications control seizures about 70% of patients
- 30% of patients who don’t respond are considers to be medically refractory epilepsy
( drug resistant epilepsy )
Anti seizure drug
Prevent seizures & toxic side effects
How does drugs ( anti seizure meds ) help patients?
Notes
- about 1/3 of patients require a combination regimen for adequate control
- therapeutic drugs ranges are guides
- serum drugs levels are helpful
Stabilizing nerve cells membranes and preventing spread of the epileptic discharge
True or false
Drugs for seizures disorder must be taken regularly and continuously often for a lifetime?
True
So we as nurses much teach our patients to make sure of what? (2)
Follow the drug regimen
What to do when dose is missed
Notes
Primarily drug for treatment of generalized tonic clonic and focal seizures
Phenytoin ( Dilantin )
carbamazepine ( Tegretol )
Phenobarbital ( Luminal )
Divalproex ( Depakote )
Primidone ( Mysoline )
Notes
Primary drugs used to treated absence and myoclonic seizures
Ethosuzimide ( Zarontin )
Divalproex ( Depakote )
Clonazapam ( Klonopin )
Notes
Broad spectrum drugs can be effective for multiple seizure types
Gabapentin ( Neurontin )
Lamotrigine ( lamictal )
Topiramate ( Topamax )
Tiagabine ( Gabitril )
Levetiracetam ( Keppra )
Zonisamide ( Zonegran )
What is pregabqlin (Lyrica) used for ?
Add ones for control of focal seizures that are not successfully managed with a single med
What do we use for status epilepticus medications?
Examples included? (2)
Which is followed by?
Benzodiazepines
IV Lorazepam( Ativan )
Diazapam (Valium)
Long acting drugs - phenytoin or phenobarbital
Because of many anti seizure drugs they have a long half life
Which means it can be given ?
And patients will have an easier time ?
1-2X a day
Following medication compliance
Anti seizure drugs should not be discontinued abruptly why?
Because it can precipate seizures
What are common side effects of discontinued antiseziure drugs? (5)
CNS
diplopia
Drowsiness
Ataxia
Mental slowing
When patients are having medications for there seizures, it’s important that nurses will assess for toxicity or side effects.
Doing what type of assessment? (5)
NONCOMPLIANCE IS A CONCERN!!
Nystagmus
Hand and gait coordination
Cognitive functioning
General alertness
Gingival hyperplasia with phenytoin
Gerontologic considerations
The incidence is ??
You have to have caution with anti seizure drugs because?
Phenytoin may be an issue for older adults why?
Notes
Phenobarbital, Tegretol, Mysoline negatively affect cognitive function
Drug interactions with carbamazepine, phenytoin, phenobarbital
Higher !!
Changes and metabolism
Compromised liver function
Notes
Newer anti seizure meds may be safer for older adults
And have fewer effects on cognitive function and less drug interactions
Gabapentin
Lamotrigine
Oxcarbazepine
Levetiracetam
There are surgical interventions to remove the epileptic focus or prevent spread of epileptic activity in the brain
What are the 2 benefits of surgery?
Cessation or seizures
Reduction in frequent of seziured
What is the most common surgical intervention?
Most patients (70%) of patients usually are what?
JUST TO NOTE, NOT ALL TYPES OF EPILEPSY BENEFIT FROM SURGERY!
Anterior temporal lobe resection
Seizure free after this procedure
What are the 3 requirements of surgery?
Diagnosis
Adequate trial with drug therapy without satisfactory results
Electroclinical syndrome define
There are other forms of therapy’s such as (3)
Vagal nerve stimulation
Ketogenic diet
Biofeedback
How does vagal nerve stimulation help? (2)
Only used to adjunct to medications when surgery is not feasible
Electrode implanted in neck patient activated with magnet when seizure is sense
Interrupts synchronization of epileptic brain wave activity and stop excessive discharge of neurons
What is the ketogenic diet?(2)
How does it work
High fat
Low carb
Ketones pass into the brain and replace glucose as an energy source
Biofeedback is what?
To help patients maintain a certain brain wave frequency
Notes
What is the nursing assessment ?
What do we want to ask?
Brith defects
Anoxic episodes
CNS trauma
Stroke
Metabolic disorders
Alcoholism
Exposure to metals
Hepatic or renal failure
Compliance with anti seizures medications, barbiturate or alcohol withdrawal cocaine
Family history
Headaches
Depression
Anxiety
Decreased sexual drive
What are the 5 precipitating factors for a seizure?
M HK HG DE WI
Metabolic acidosis or alkalosis
Hyperkalemia
Hypoglycemia
Dehydration
Water intoxication
When a patient is having a seizure what will we do for our assessment? (6)
AAAABC
Airway occlusion
Absent breathe sounds
Abnormal repository’s rate
Apnea ( itcal )
Bitten tongue
Cyanosis
We’ll notice that a patient will be? (8)
Hypertensive
Tachy/Brady
Bowel/urinary Incontience
Excessive salivation
Weakness
Paralysis
Ataxia
Abnormal CT, MRI, EEG
For tonic clonic we will notice? (7)
Loss of consciousness
Muscule tightening
Jerking
Dilated pupils
Hyperventilation
Apnea
Postictal somnolence
For absence we will notice? (2)
Altered consciousness
Monitor facial motor activity
Nursing assessment
Focal seizures
Simple(4)
Aura
Focal sensory, motor, cognitive or emotional phenomena
Motor seizure- unilateral marching
Starts in a small area with a tingling sensation and marches across the body
Nursing assessment
Focal seizures
Complex (2)
Altered consciousness with inappropriate behaviors ( automatisms)
Amenisa if event
( can’t remember )
What are the 3 nursing diagnosis?
Ineffective breathing
Ineffective self health management
Risk of injury
Notes
Planning
- patient be free from injury
- have optimal mental/physical functions while taking anti seizure meds
- have satisfactory psychosocial functioning
Health promotion
We want to tell patients to wear?
To follow what?
Assist to identify ?
Avoid what?
Helmets
Diet/exercise
Events or situations that trigger
Alcohol, fatigue and loss of sleep
Notes
Acute intervention
Observe, treated and document!
Maintain patent airway
Support head
Turn to side
Loosen constrictive clothing
Ease to floor
Do not restrain patient or place anything in mouth
May require positioning and suctioning or oxygen after seizure
Notes
Ambulatory and home care
Emotional support and identifications of coping mechanism to adjust to personal limits imposed by the disease
- medical alert brackets
- referrals to agencies and organization
Evaluation is ? (5)
Good breathing pattern
No injury
Acceptance of disorder
Compliance
Therapy
