Topic 12: Epilepsy & Seizure Disorders

Question 1

Seizure

Answer 1

transient, uncontrolled electrical discharge of neurons in the brain that interrupts normal function

Question 2

Seizure disorder (epilepsy)

Answer 2

a group of neurogenic diseases marked by recurring seizures

Question 3

Metabolic disturbances associated with seizures include

Answer 3

acidosis, electrolyte imbalances, hypoglycemia, hypoxemia, alcohol or barbiturate withdrawal, dehydration or water intoxication

Question 4

Status epilepticus

Answer 4

a state of constant seizure or condition when seizures recur in rapid succession without return to consciousness between seizures (neurologic emergency), a seizure lasting longer than 5 minutes

Question 5

4 phases of stroke

Answer 5

prodromal
sural
ictal
postictal

Question 6

Prodromal phase

Answer 6

sensations or behavioral changes that precede seizure by hours or days

Question 7

Aural phase

Answer 7

with sensory warning that is similar each time a seizure occurs and is considered a part of the seizure

Question 8

Ictal phase

Answer 8

from first symptom to the end of seizure activity

Question 9

Postictal phase

Answer 9

the recovery period after the seizure

Question 10

Tonic-clonic seizure

Answer 10

stiffening-jerking; a major motor seizure involving all muscle groups; previously termed grand mal (big bad) seizure

Question 11

tonic-clonic aural phase manifestations

Answer 11

o Bowel and bladder incontinence
o Diaphoresis
o LOC
o Pallor, flushing, cyanosis
o Peculiar sensations that precede seizure
o Tachycardia
o Warm skin

Question 12

Tonic phase of tonic-clonic seizure manifestations

Answer 12

o Continuous muscle contractions
o Body stiffens for 10 to 20 seconds

Question 13

· Hypertonic phase of tonic-clonic seizure manifestations

Answer 13

o Extreme muscular rigidity lasting 5-15 seconds

Question 14

· Clonic phase of tonic-clonic seizure manifestations

Answer 14

o Extremities jerk for another 30 to 40 seconds
o Rigidity and relaxation alternating in rapid succession

Question 15

In post-ictal phase of tonic-clonic seizure manifestations

Answer 15

· muscle soreness, feels tired, may sleep for several hours, confusion, HA

Question 16

Absence seizure manifestations

Answer 16

· Usually occurs only in children
· Characterized by brief staring spell that resembles daydreaming

Question 17

Focal-onset seizure manifestations

Answer 17

· Begin in 1 hemisphere of the brain in a specific region in the cortex
· Causes sensory, motor, cognitive, or emotional manifestations based on the function of the involved area of the brain
· Level of awareness
· May be conscious and alert, but have unusual feelings or sensations
· Sudden unexplainable feelings of joy, anger, sadness, or nausea

Question 18

Status epilepticus manifestations

Answer 18

· Lasting longer than 5 minutes
· Goal is to end clinical and electrical seizure activity

Question 19

· Decorticate posturing

Answer 19

characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. occurs when the brainstem is not inhibited by the motor function of the cerebral cortex.

Question 20

Decerebrate posturing

Answer 20

-“extensor posturing”;
-abduction of arms, elbow, and wrist extension

Question 21

diagnostic assessment

Answer 21

Drug testing
EEG
MRI, CT, PET Scan, X-Ray
CSF

Question 22

nursing interventions

Answer 22

· Ensure patient airway
· Protect patient from injury. DO NOT RESTRAIN. Pad side rails
· Remove or loosen tight clothing
· Establish IV access
· Stay with patient until the seizure has passed
· Anticipate giving, phenobarbital, phenytoin, and benzodiazepines (diazepam, lorazepam) to try and stop seizure
· Suction as needed
· Assist ventilation if patient does not breathe spontaneously after seizure
· Anticipate need for intubation if gag reflex is absent

Question 23

Ongoing Monitoring

Answer 23

· Monitor VS, LOC, O2 saturation, Glasgow coma scale results, pupil size and reactivity
· Reassure and orient patient after seizure
· Never force an airway between patients clenched teeth
· Give IV dextrose for hypoglycemia

Question 24

Health Promotion

Answer 24

· Wear helmet if risk for head injury
· General health habits (diet, exercise)
· Assist in identifying events or situations precipitating seizures and avoid if possible.
· Instruct to avoid excessive alcohol, fatigue, and loss of sleep.
· Help the patient to handle stress constructively.

Question 25

Acute Care

Answer 25

· Observe and record details of the event because the diagnosis and treatment depend on this description
o What events preceded? When did it occur? How long was each phase? What occurred during each phase?
· Note exact onset of seizure
· Maintain airway fir patient
· Protect patient’s head
· Turn patient to side
· Loosen constrictive clothing
· Ease patient to floor
· Do not restrain patient
· Do not place any objects in the patient’s mouth
· After seizure: reposition patient to maintain airway, suctioning, O2

Question 26

Ambulatory Care

Answer 26

· Prevention of recurring seizures is the major goal in treatment.
· Instruct on importance of adherence to medication, not to adjust dose without physician.
· Keep regular appointments.
· Teach family members emergency management
o Not necessary to call an ambulance or send a person to the hospital after a single seizure unless it was prolonged, another seizure immediately follows, or extensive injury occurred
· Emotional support and identification of coping mechanisms to adjust to personal limitations imposed by the disease
· Medical alert bracelets
· Referrals to agencies and organizations

Question 27

Vagal nerve stimulation:

Answer 27

· surgically implanted electrode in the neck is programmed to deliver electrical impulses to the vagus nerve, patient activates the electrode with a magnet when they sense a seizure is imminent

Question 28

diet for seizure

Answer 28

· Ketogenic diet: high fat, low carb diet that helps control seizures in some people

Question 29

Seizure precautions

Answer 29

· Oxygen
· Suction equipment
· Airway
· IV access
· Side rails up and padded

Question 30

Status Epilepticus interventions

Answer 30

· Prolonged seizures that last more than 5 min or repeated seizures over course of 30 min - medical emergency!
· Establish airway
· ABGs
· IV push lorazepam, diazepam
· Rectal diazepam
Loading dose IV phenytoin

Question 31

Medication for tonic-clonic seizure activity may include:

Answer 31

· Lorazepam (Ativan)
· Diazepam (Valium)
· Diastat
· IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)

Question 32

Patient teaching fro anti-seizure drug therapy

Answer 32

· Drugs for seizure disorder must be taken regularly and continuously, often for a lifetime.
· Antiseizure drugs should not be discontinued abruptly as this can precipitate seizures.

Question 33

common SE of anti-seizure drugs

Answer 33

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