T3 - Seizures in Children (Josh) Flashcards
Most seizures happen when?
first years of life
Seizure results from what/
overly active and hypersensitive neurons in brain that trigger electrical discharges
Categories of seizures:
General
Partial
Unclassified (ex: neonatal)
Examples of General Seizures:
Tonic-Clonic (Grand Mal)
Abseence (Petite Mal)
What is the Tonic and the Clonic in Tonic-Clonic?
Tonic = stiffening of body
Clonic = clonic muscle actiivty
– involves recurrent and continuous generalized seizure activity with dangers of cardiac arrest and brain damage.
Status epilepticus
– refers to rare disorder seen in the first few months of life that is characterized by flexion of the neck ,trunk or legs.
Infantile spasm
Examples of Partial Seizures
Simple Partial
Complex
– characterized by maintenance of consciousness . They may also include a focal motor compartment- abnormal movement of leg, sensory component- smell , sound, taste and autonomic component- sweating, or psychic component -deja vu or anger.
Simple partial seizures-
– begin as simple and progress to unconsciousness. The child may stop whatever she’s doing and engage in purposeless movement- lip smacking or wandering.
Complex seizures
Name the seizure:
Staring, eyes roll upward, change in LOC
Teacher may think student isn’t paying attention in class
Absence (petit mal)
Name the seizure:
alteration of consciousness and may include lip smacking, or repetitive motion (picking, pulling)
Complex Partial Seizure
Phases of a Grand Mal
Aura Phase
Tonic Phase
Clonic Phase
Postictal Phase
First phase of Grand Mal
Aura Phase (Early Seizure Phase)
the child may see, hear, smell or taste something unusual.
This phase may not occur in some children.
Second phase of Grand Mal
Tonic Phase (Stiffening Phase)
In this phase the child may experience a change in color, lose consciousness or become very stiff and rigid.
you may notice arching of the back, and extending of arms and legs. the child may fall if standing. the child may give a high pitched, shrill cry or snap his/her jaw shut, sometimes biting the tongue.
(Do not put anything in the child’s mouth).
Third phase of Grand Mal
Clonic Phase (Jerking phase)
Child may have rapid jerking movements on both sides of his/her body, tightening (flexing).
Breathing may be fast and loud with increased or decreased heart rate. The child may clench fists and teeth, and drip his/her head backwards. You may notice sweating and drooling.
This phase may last 2-5 minutes.
Fourth phase of Grand Mal
Postictal Phase (After Seizure Phase)
In this phase the child will slowly regain consciousness after several minutes, relaxing his/her muscles.
The child may complain of tiredness, muscle aching, or headache. He/she may seem confused, or may sleep.
(you should be able to arouse the child.)
What typically happens w/ a tonic-clonic?
incontinence
How many phases are there w/ Grand Mal (Tonic Clonic)?
Four
- Aura Phase
- Tonic Phase
- Clonic Phase
- Postictal Phase
Videos
watch the vids in the ppt
Types of labs for seizures
EEG will document abnormal activity
CBC Blood chemistry to identify underlying disorder such as metabolic disturbances.
Serum medication levels to monitor therapeutic levels of meds
Nursing management of Seizure Disorders:
Assess the child and obtain a thorough history
Administer prescribed meds
Document all seizure activity
Help prevent seizures
Promote optimal growth and development and minimize child’s anxiety
Prepare the family for alternatives treatments when necessary such as surgery and vagus nerve stimulator.
Assess for safety and provide interventions as needed per patient seizure plan such as meds , oxygen and suction
Provide emergency interventions such as CPR
What should we do while we’re holding the patient during seizure?
time it (look at watch)
protect child from hurting self
begin O2
Call for help
Objective facts (deviation of eyes, what portion of body, types of mvmt)
Should we restrain child?
Don’t try and restrain a seizing child, just keep him safe and away from harm.
Should we put a tongue blade to protect from biting tongue?
no
Don’t put anything in his or her mouth, this is unnecessary and can cut the mouth, injure a tooth, cause vomiting, or result in a serious bite of your finger.
Can they actually swallow tongue in seizure?
no
T/F: Most seizures are dangerous.
False
most are harmless
T/F: we should hold tightly and hinder patient during seizure.
False
don’t hinder patient movement during seizure
Should we let the child sleep after the seizure.
Yes, if they want to
- the brain is temporarily exhausted and there is no point in trying to keep the child awake
What should we teach parents of children w/ frequent seizures?
activity restriction may be necessary
wear helmets
Seizure Meds
see slide 23 about page #s
Ketogenic diet
see slide 24 about page #
What about ketogenic diet must we teach parents?
The family must make an effort to make the high-fat diet appealing to the child on a ketogenic diet, despite their personal feelings about eating large amounts of food such as mayonnaise
VNS is designed to prevent seizures by –
sending regular mild pulses of electrical energy to the brain via the vagus nerve
VNS is –
Vagus Nerve Stimulation
– is sometimes called the “pace maker for the brain”. It is placed under the skin on the chest wall and a wire runs from it to the vagus nerve in the neck.
Vagus Nerve Stimulation (VNS)
How is VNS used?
The neurologist programs the strength and timing of the impulses according to each patient’s individual needs.
The settings can be programmed and changed without entering the body just by using a programming wand connected to a laptop computer.
The devise is programmed to go on for a certain period and then to go off for another period. The devise runs continuously, usually the patient is not even aware.
A/E of VNS.
- don’t hold magnet close to it (activates it outside programed interval)
- sleep apnea
- voice alteration
- coughing
- pharyngitis
- throat pain
