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Nursing 272: Final Semester > Unit 1: Seizures > Flashcards

Unit 1: Seizures Flashcards

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1
Q

Seizure

A
  • uncontrolled, sudden, excessive discharge of electrical activity
  • manifestations range from behavior changes to loss of consciousness
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2
Q

Manifestations of a seizure

A

-can range from behavior changes to loss of consciousness

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3
Q

Cryptogenic Seizure

A

a seizure of unknown etiology

-no association w/ previous insults to the CNS that are known to increase risk of seizure activity

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4
Q

Cryptogenic

A

of unknown etiology

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5
Q

Possible causes of cryptogenic/unprovoked seizures

A
  • Possible genetics affecting sodium channels

- Possible mutations affecting activity of the neurotransmitter GABA

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6
Q

Psychogenic Seizures

A

“psychiatric conversion disorder”

-have no abnormal electrical discharges

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7
Q

Epilepsy

A
  • chronic disorder

- two seizures unprovoked by any immediately identifiable cause occurring more than 24 hours apart

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8
Q

Nonepileptic Seizures

A
  • “secondary seizures”

- those provoked by other disorders and conditions

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9
Q

Causes of Provoked Nonepileptic Seizures

A
  • Structural (lesions to the brain)
  • Trauma
  • Infection
  • Surgery
  • Tumors
  • Stroke
  • Inadequate oxygen to the brain
  • metabolic (electrolyte disturbances)
  • substance abuse
  • prescription meds
  • toxins
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10
Q

Types of Seizures

A
  • Absence Seizure
  • Atonic-Seizure
  • Tonic-Clonic Seizure
  • Myoclonic Seizure
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11
Q

Absence Seizures

A

sudden interruption of activities; may have a blank stare

  • absence of activities
  • sudden onset
  • possibly a brief upward deviation of the eyes
  • unresponsive when spoken to
  • duration: few seconds to half a minute
  • rapid recovery
  • of generalized onset
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12
Q

Atonic Seizure

A

sudden loss of muscle tone: head, trunk, jaw, or limbs

-lasting 1-2 seconds

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13
Q

Tonic-clonic Seizures

A

sequence w/ muscle contraction (tonic) followed by repetitive muscle jerking (clonic)

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14
Q

Myoclonic Seizures

A

sudden involuntary contraction of muscle groups

-spasticity

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15
Q

Clinical Manifestations

A
  • ranges from rhythmic jerking of all extremities and loss of consciousness (tonic-clonic) to episodes of apparent day dreaming (absence)
  • unilateral, rhythmic muscle movements
  • automatisms (repetitive unconscious movements; lip smacking, chewing, or swallowing)
  • sudden loss of motor tone (atonic)
  • incontinence
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16
Q

Phases of a seizure

A
  • pre-ictal
  • ictal
  • post-ictal
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17
Q

Pre-ictal Phase

A

just before the initiation of a seizure

  • experience an aura; sensory change prior to the seizure activity
  • pleasant or unpleasant odors
  • visualizations/hallucinations
  • sense of “butterflies” in the stomach
  • sense of Deja vu
  • intense feeling a seizure is about to happen
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18
Q

Ictal Phase

A

actual seizure activity

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19
Q

Post-ictal Phase

A

period after seizure

  • lasts 5 to 30 minutes
  • altered state of consciousness
  • drowsiness, confusion, disorientation, nausea, hypoxia, headache, and migraine
  • recovery phase of seizure
  • experience exhaustion and depression following seizure; taking 1 to 2 days for full recovery
  • poor attention span; may have diminished short-term memory
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20
Q

Diagnosis of Seizures

A
  • via imaging (CT, MRI)
  • laboratory work up to r/o causes (lesions, tumors, metabolic, and other disorders)
  • EEG monitoring for abnormal electrical activity
  • stress (found when deprived of sleep), causes an increase in cortical activity and is a key trigger for seizures
21
Q

Surgical Management

A
  • Vagal Nerve Stimulator (VNS)
  • Deep Brain Stimulation
  • Remove offending brain tissue
22
Q

Vagal Nerve Stimulator (VNS)

A
  • stimulation that is constant or activated by magnet for those that have an aura
  • stimulation of the vagus nerve (CN X) can control seizure activity via alterations in the release of norepinephrine, increasing levels of GABA (inhibitory neurotransmitter), and/or by the inhibition of aberrant cortical activity in the reticular activating system
  • generator implanted into a small “pouch” in the left chest below the clavicle
  • access to the vagal nerve is established via incision in the neck
  • generator either continuously stimulates the vagus nerve, or the patient carries a small hand-held magnet with which he can activate the program with the presence of an aura
  • post-op or within 2-week period, generator is activated and programmed specifically to patient
23
Q

Deep Brain Stimulation

A

used to treat uncontrolled seizure activity

  • implanting electrodes into the brain that release electrical impulses
  • electrodes are placed in deep brain structures (thalamus, hippocampus, and internal capsule) and are programmed to activate when the seizure activity is sensed
24
Q

Partial Corpus Callostomy

A

removal of brain tissue that has been identified as containing a seizure focus through surgical excision or laser ablation

  • for intractable seizures that have been localized to a specific area of the brain
  • a craniotomy is performed and the connection between the R and L hemispheres of the brain is disrupted partially or totally severed
  • procedure reduces the frequency and severity of the seizures b/c electrical activity can no longer spread from one hemisphere to the other
25
Q

Pre-op for Partial Corpus Callostomy

A

-before procedure, patient evaluated in a dedicated epilepsy monitoring unit; w/ surgically placed EEG electrodes on the surface of the brain to specifically identify areas of the brain tissue involved in seizure activity

26
Q

Medical Management

A
  • Antiepileptic Medications (AEDs) or Anticonvulsants (mainstay or therapy)
  • Ketogenic Diet
27
Q

Antiepileptic or Anticonvulsant Medications

A
  • almost always provide complete control of seizures
  • never should be abruptly stopped; can precipitate status epilepticus
  • all suppress CNS
  • Carbamazepine (Tegretol)
  • Gabapentin (Neurontin)
  • Lamotrigine (Lamictal)
  • Levetiracetam (Keppra)
  • Phenytoin (Dilantin)
  • Valproate (Valproic Acid, Depakote)
28
Q

Carbamazepine (Tegretol)

A
  • control of seizures
  • decrease incidence of seizures
  • Side Effects: hepatitis, aplastic anemia (body stops producing enough new blood cells), allergy, dizziness, ataxia (impaired balance, coordination), blurred/double vision, nausea, and behavioral changes
  • Interventions: monitor for visual changes, monitor liver function, CBC, do not crush or chew sustained-release capsules
29
Q

Gabapentin (Neurontin)

A
  • control of seizures
  • decrease incidence of seizures
  • Side Effect: somnolence, fatigue, dizziness, ataxia (impaired balance, coordination), weight gain
  • Interventions: monitor for increased appetite and weight gain; monitor for dizziness, ataxia
30
Q

Lamotrigine (Lamictal)

A
  • control of seizures
  • decrease incidence of seizures
  • for absence, tonic-clonic, myoclonic seizures
  • Side Effect: somnolence, dizziness, nausea, rash
  • Interventions: monitor for dizziness, nausea/vomiting; rash can be life-threatening when given w/ valproic acid (depakote)
31
Q

Levetiracetam (Keppra)

A
  • control of seizure
  • decrease incidence and severity of seizure
  • tonic-clonic
  • Side Effect: fatigue, ataxia, loss of appetite, cough/runny nose
  • Interventions: monitor for ataxia, monitor for loss of appetite
32
Q

Phenytoin (Dilantin)

A

-control of seizure
-diminished seizure activity
-treatment/prevention of tonic-clonic
-Side Effects: gingival hyperplasia, nystagmus, hirsutism, myelosuppression, ataxia, rash, folate deficiency, drug-induced lupus
-Interventions:
>serum levels monitored
>total serum levels 10-20 mcg/ml
>Dilantin (free) levels: 90% bound to protein (1-2 mcg/ml)
>at high doses can develop nystagmus
>increases levels and prolongs half-life of coumadin
>monitor CBC
>monitor for gingival hyperplasia (care w/ teeth brushing)

33
Q

Valproate/Valproic Acid (Depakote)

A
  • control of seizures
  • suppression of seizure activity
  • absence, myoclonic, tonic-clonic
  • Side effects: tremors, hair loss, elevated liver enzymes, liver failure, pancreatitis, amenorrhea, thrombocytopenia (low platelets)
  • Interventions: monitor for tremor, monitor for hair loss, monitor liver function, monitor CBC, monitor coagulation
34
Q

Ketogenic Diet

A
  • high in fat (up to 90%)
  • low in carbohydrates
  • induces ketosis
35
Q

Complication: Status Epilepticus

A

seizure activity lasting longer than 5 minutes, or two or more seizures w/o full recovery of consciousness

  • seizures lasting longer than 30 minutes can cause respiratory failure, brain damage, and death
  • causes: head trauma, hydrocephalus, acute drug or alcohol withdrawal, metabolic disturbances, or abrupt withdrawal of anticonvulsive medications
  • Airway, breathing, circulation (ABC) interventions must be initiated immediately
  • pts are intubated, and ABGs monitored
  • establish peripheral IV
  • Lorazepam (Ativan) or Midazolam (Versed) both benzodiazepines are first line in immediate tx of seizure
  • to stabilize the patient, a loading dose of phenytoin (Dilantin) or Levetiracetam (Keppra) (anticonvulsants) is administered along w/ around the clock dosing
  • when refractory to all interventions, patient placed on high doses of Propofol (Diprivan) or placed in a pentobarbital coma; monitoring of cardiovascular status and continuous EEG monitoring
36
Q

Nursing Management: Assessment + Analysis

A

clinical manifestations of seizures vary depending on the etiology of the disorder and the area of brain involved

  • tonic movement
  • clonic movements
  • loss of consciousness (LOC)
  • aura
  • automatisms (lip smacking, chewing)
  • loss of motor tone
37
Q

Nursing Diagnoses

A
  • Risk for ineffective breathing pattern r/t decreased LOC secondary to the postictal state
  • Risk for injury r/t tonic-clonic motor activity
  • Ineffective coping r/t uncertainty and inability to control seizures
38
Q

Nursing Assessments

A
  • Airway
  • Vital Signs
  • Seizure Activity
  • Presence of Aura
39
Q

Assessments: Airway

A

during the seizure and postictal state, the patient may have a compromised airway secondary to decreased level of consciousness

40
Q

Assessments: Vital Signs

A
  • BP, HR, and Oxygen saturation monitored during and after seizure
  • elevations in HR and BP may develop during the seizure
  • respiratory changes including airway compromise may develop after seizure
41
Q

Assessments: Seizure Activity

A

observe start of movements & activity before, during, and after seizure

  • observe type of movements
  • time the seizure
  • accurately diagnose and treat seizure
42
Q

Assessments: Presence of Aura

A

may experience an aura in advance of a seizure, allowing patient to assume a safe position

43
Q

Nursing Actions/Interventions

A
  • Set up suction equipment at bedside
  • Have oxygen available at bedside
  • Safety Measures
  • IV access
  • Document Specifics of Seizure
44
Q

Interventions: Set up suction

A

may be unable to protect their airway after seizure activity

-may require suctioning of the oral airway

45
Q

Interventions: Have oxygen available

A

during the postictal phase, the pt may require supplemental oxygen to maintain the oxygen saturation within normal limits

46
Q

Interventions: Safety Measures

A
  • bed in lowest position, suction at bedside, oral airway at bedside
  • not forcing any object into the mouth (for fear of biting tongue, breaking teeth, causing injury etc.)
  • loosening of restrictive clothing
  • turn patient to the side (left; reduce risk of aspiration)
  • do not restrain patients movement; can guide movement to prevent injury
47
Q

Interventions: IV catheter per order

A

IV access may be needed to administer medications to stop the seizure activity

48
Q

Interventions: Document Specifics of Seizure; Observed seizure activity

A
  • documentation should provide the date, time, and duration
  • clear description of seizure
  • sequence of seizure progression
  • preictal and postictal observations
49
Q

Nursing Teachings

A
  • Medication Regimen
  • Medic alert bracelet
  • Driving Restrictions

Nursing 272: Final Semester (79 decks)

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