Topic 12: Epilepsy & Seizure Disorders Flashcards
Seizure
transient, uncontrolled electrical discharge of neurons in the brain that interrupts normal function
Seizure disorder (epilepsy)
a group of neurogenic diseases marked by recurring seizures
Metabolic disturbances associated with seizures include
acidosis, electrolyte imbalances, hypoglycemia, hypoxemia, alcohol or barbiturate withdrawal, dehydration or water intoxication
Status epilepticus
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
4 phases of stroke
prodromal
sural
ictal
postictal
Prodromal phase
sensations or behavioral changes that precede seizure by hours or days
Aural phase
with sensory warning that is similar each time a seizure occurs and is considered a part of the seizure
Ictal phase
from first symptom to the end of seizure activity
Postictal phase
the recovery period after the seizure
Tonic-clonic seizure
stiffening-jerking; a major motor seizure involving all muscle groups; previously termed grand mal (big bad) seizure
tonic-clonic aural phase manifestations
o Bowel and bladder incontinence
o Diaphoresis
o LOC
o Pallor, flushing, cyanosis
o Peculiar sensations that precede seizure
o Tachycardia
o Warm skin
Tonic phase of tonic-clonic seizure manifestations
o Continuous muscle contractions
o Body stiffens for 10 to 20 seconds
· Hypertonic phase of tonic-clonic seizure manifestations
o Extreme muscular rigidity lasting 5-15 seconds
· Clonic phase of tonic-clonic seizure manifestations
o Extremities jerk for another 30 to 40 seconds
o Rigidity and relaxation alternating in rapid succession
In post-ictal phase of tonic-clonic seizure manifestations
· muscle soreness, feels tired, may sleep for several hours, confusion, HA
Absence seizure manifestations
· Usually occurs only in children
· Characterized by brief staring spell that resembles daydreaming
Focal-onset seizure manifestations
· 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
Status epilepticus manifestations
· Lasting longer than 5 minutes
· Goal is to end clinical and electrical seizure activity
· Decorticate posturing
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.
Decerebrate posturing
-“extensor posturing”;
-abduction of arms, elbow, and wrist extension
diagnostic assessment
Drug testing
EEG
MRI, CT, PET Scan, X-Ray
CSF
nursing interventions
· 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
Ongoing Monitoring
· 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
Health Promotion
· 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.
Acute Care
· 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
Ambulatory Care
· 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
Vagal nerve stimulation:
· 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
diet for seizure
· Ketogenic diet: high fat, low carb diet that helps control seizures in some people
Seizure precautions
· Oxygen
· Suction equipment
· Airway
· IV access
· Side rails up and padded
Status Epilepticus interventions
· 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
Medication for tonic-clonic seizure activity may include:
· Lorazepam (Ativan)
· Diazepam (Valium)
· Diastat
· IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)
Patient teaching fro anti-seizure drug therapy
· 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.
common SE of anti-seizure drugs
diplopia, drowsiness, ataxia, and mental slowing gingival hyperplasia
