T3-Blueprint: Seizures Flashcards
Seizure manifestation can be caused by?
Hyponatremia
Hypernatremia
Late: Hypoglycemia
Where does a partial seizure arise from?
Any area of cerebral cortex (frontal, parietal, temporal most affected)
Partial: characterized by what? (4)
- Localized motor symptoms
- Somatosensory
- Psychic
- Autonomic symptoms
*or a combo
What is the key sign of a partial seizure?
Child starts picking at his/her clothes
The key sign to a child have a partial seizure is the child picking at their clothes. What are some other signs and characteristics?
- May have an aura before
- Lasts a minute or two
- May create automatic movements child is unaware of
What are the 3 types of partial seizures?
- Simple partial seizure
- Complex partial seizure
- Simple or complex seizures secondarily generalized
What is a simple partial seizure?
Simple symptoms and no alteration of consciousness
What is a complex partial seizure?
Complex symptoms and impairment of consciousness
What is a simple or complex seizure secondarily generalized?
Simple or complex seizures that evolve into generalized (tonic clonic usually)
What type of seizure is a tonic clonic (grand mal)?
Generalized
What can cause a tonic clonic seizure?
Febrile seizures
Generalized: How long does tonic phase of tonic clonic last and what is tonic?
Lasts 10-20 seconds
Stiffening of the body
Generalized: How long does clonic phase of tonic clonic last and what is clonic?
Lasts 30 seconds (or longer)
Clonic muscle activity
Generalized: What are classic seizure symptoms of tonic clonic?
- Eyes roll upward
- Immediate LOC
- Falls to ground
- Stiffening of body
- Tonic contraction of body, flexed harms, legs/head/neck extended
- May utter a cry
- Increased salivation
Generalized: Tonic clonic
Is there moderate or violent jerking?
Jerking
Generalized: tonic clonic
What happens at the mouth?
Foaming at the mouth
Generalized: Tonic clonic
What goes on with GI tract?
Incontinence of urine and feces
What is parent education regarding children with tonic clonic seizures?
Make sure the teachers know to cover the child up, let the class out for recess after an attack so the child isn’t embarrassed
Generalized: What are 4 phases of tonic clonic and what happens with each?
- Aura phase
- early seizure phase - Tonic phase
- Stiffening - Clonic phase
- Jerking - Postloctal
- After seizure; sleepy, but able to be aroused
Continuous seizure that lasts more than 30 minutes or a series of seizures
Statis elepticus
T/F: The child regains consciousness during a status elepticus attack
FALSE–it is too brieft to allow the child to regain consciousness between the time one event ends and the next begins
What is the danger with status elepticus seizures?
Cardiac arrest and brain damage
Generalized: What age to absence (petit mal) usually occur?
4-12
Generalized: Absence–Who is it more common in? When does it cease?
Girls; puberty
Is there a LOC with absence?
Yes brief–5-10 seconds
What are some characteristics of absence seizures?
- Minimum/no muscle tone loss
- May drop a held object
- 20+ attacks daily
T/F: Absence seizures may even go unrecognized unless watching for it
TRUE–absence are mistaken for inattentiveness or daydreaming
Absence seizures have a slow onset?
No–abrupt onset with 20 or more attacks daily!!
Absence: ____ for episdoe
Amnesia
What is another name for atonic and akinetic seizures?
Drop attacks
What is the onset for atonic and akinetic (drop attack) seizures?
2 and 5 years old onset
Define atonic and akinetic (drop attack)?
Sudden, momentary loss of muscle tone and postural control
Atonic and akinetic (drop attack): When does this normally occur?
In morning after waking
Atonic and akinetic–Are they able to break their fall by putting out their hand?
No–leads to injury to face, head, and shoulder
What seizure: sudden, brief contractures of muscle or group of muscles
Myoclonic
Myoclonic are ____ episodes and may or may not be ___ and ___
Seizure episodes; may or may not be symmetric and LOC
What is a rare disorder that happens between 6-8 months of life?
Infantile spasms
Who is infantile spasms common in?
Boys
What happens in infantile spasms?
Numerous seizures during the day w/o drowsiness or sleep
Infantile spams: poor outlook on ____
Normal intelligence
Can an infant with infantile spasms sit? stand?
Sit-yes
Stand-no
Infantile spams: suded dropping forward of _____ with ___ flexed forward and ___drawn up
Sudden dropping forward of HEAD AND NECK with TRUNK flexed and KNEES drawn uo
Infantile spams: Flexion of what?
Neck trunk, or legs
Who gets phenytoin?
Partial or tonic clonic seizures
Who gets carbamazepine?
Partial or secondary generalized
Who gets valproic acid?
All types of seizures
What can be added to IV diazepam/lorazepam to control seizures/status epilepticus
Fosphenytonic sodium
Who gets ethosuximide?
Absence, myoclonic
Treatment of status elepticus at home? Whats good about this?
Rectal diazepam (prefilled rectal gel syringe); no resp. depression when used as recommended
What is treatment of status epilepticus at the hospital?
IV diazepam or lorazepam is DOC
*lorazapem may now be the best—longer duration of action and less resp. depression in children 2+
What is treatment of infantile spasms?
ACTH-gel form
*injection–parents can be taught to give this at home
What is the first action of seizures?
AIRWAY
How should we place person to maintain an open airway?
SIDE-LYING position to maintain open airway and prevent aspiration of secretions
EEGs are done to document abnormal activity. What are some guidelines to instruct the patient about this?
- No caffeine before EEG b/c it can alter results
- No analgesics
- Normal foods can be eaten
- Wash hair–remove oils that permit adherence of electrodes
Why do we check the serum levels in seizure patients?
To check for med compliance
T/F: Anyone can have febrile seizures and outgrow them
True
Nursing actions. What do we do if a seizure starts on our watch?
- Immediately look watch and note time
- Protect child from hurting themselves
- Begin oxygen
- Call for help
- Note duration
- Look for objective facts (deviation of eyes, what portion of body affected, type of movement)
What is a Ketogenic diet?
High fat
Low carb
Adequate protein
What is the shift when on a Ketogenic diet?
Body shifts from using glucose as energy source and using fat instead
T/F: Ketogenic diet is a rigorous diet
Yes, but it works!!
What kind of brain therapy is used to help treat seizures?
Vagus Nerve Stimulation
What is VNS?
Implantable device that reduces seizures in individuals who have not had effective control with drug therapy
How does VNS work?
SQ implantation in chest and electrodes are tunneled underneath skin to deliver electrical impulses to vagus nerve
Pt./caregiver can activate the device using a magnet on the onset of seizure
