Week 10 - Epilepsy/Seizures Flashcards
what are seizures
- results in abnormal, uncontrolled electrical activity
- most common pediatric neurological disorder
- on their own, are a consequence thats related to a separate, underlying health issue = imp to determine the cause
- rarely an isolated pathological pieces w exception of epilepsy
what can cause seizures (5)
- infections
- neurological impairment
- metabolic disturbances (ex. electrolytes, dehydration)
- trauma (ex. head injuries)
- toxins (ex. pre/postnatal)
what determines how a seizure presents
- depends on where in the brain it originates
seizures can be..(2)
- isolated (acute, one time)
2. recurrent (epileptic)
seizures can be..
- isolated (acute, one time)
2. recurrent
what are 2 causes of isolated (acute) seziures
- structural (acquired) –> known event ex. head injury
2. idiopathic –> unknown cause
what are 3 causes of recurrent seizures
- symptomatic = known cause
- idiopathic = unknown cause, thought to be genetic
- cryptogenic = abnormality in unknown part of the brain
what are examples of cryptogenic, recurrent seizures (11)
- electrolyte disorders
- hyper/hypo glycemia
- hypoxia
- alcohol withdrawal
- sleep deprivation
- cocaine
- fever
- congenital brain abnormality
- tumour
- birth injuries
- maternal drug use or infection
what is the difference between a seizure and epilepsy
- seizure = event
- epilepsy = chronic illness involving recurrent, unprovoked seizures
what are 3 classifications of seizures
- partial/focal seizures
- generalized
- unclassified
what is a focal/partial seizure
- localized seizures
- seizures that start in one area or group of cells in one side of the brain
what are 2 types of partial seizures? what is the difference between the two?
- simple = no loss of conscious, child is awake and aware of the seizure, no impaired consciousness
- complex = loss of conscious, child is confused or awareness is affected in some way during the seizure , little to no recollection of event
describe how focal seizures impact the body
- causes unilateral symptoms
ex. general motor, sensory, or both symptoms in 1 side of the body
what often happens w children who experience a focal seizure
- many child who experience a focal seizure will have it progress to a generalized one in the same episode
what is a generalized seizure
- seizure that involves the whole brain
- on EEG, pronounced, abnormal electrical activity all over
what is a risk associated w generalized seizures
- high risk for status epilepticus
describe the general signs of generalized seizures (2)
- involves loss of consciousness
- experience postictal state –> abnormal condition that lasts for a period that begins when a seizure subsides and ends when the patient returns to baseline
what are 5 types of generalized seizures
- petit mal/absence
- grand mal (tonic clonic)
- myoclonic
- atonic
- infantile spasms
what is a petit mal/absence seizure (5)
- involves brief, sudden lapses of consciousness –> about 5-10 seconds
- common in children
- often involve staring blankly into space for a few seconds
- involves minor movements: blinking, eyelids flutter, twitching mouth, lip smacking, chewing
- involves no memory afterwards
what do absence seizures typically precipitate from
- from controllable behaviors: ex. dehydration, exhaustion, hypoglycemia
what do absence seizures look like from ab observational POV
- mistaken for not paying attention or day dreaming
what is included in care for absence seizures
- supportive unless more investigation is needed
what is a grand mal (tonic cloni) seizure?
- sudden, violent in nature seizure that involves phases:
- seizure that involves a tonic phase, clonic phase, and postictal phase
describe the tonic phase of a tonic-clonic seizure (grand mal) (5)
- 10-20 sec.
- eyes roll back
- immediate loss of consciousness
- fall risk as muscles stiffen and lose control
- pt becomes apneic –> may be cyanotic
describe the clonic phase of a tonic-clonic seizure (4)
- variable duration: from few seconds to 30 min
- involves violent jerking of body
- may be incontinent
- may foam at the mouth = aspiration risk
describe the postictal phase of a tonic-clonic seizure (7)
- kind of like a recovery phase:
- body begins to relax
- difficult to rouse
- may be confused
- no recollection of event
- very tired & exhausted afterwards
- variable regaining of consciousness
describe care during a tonic-clonic seizure (4)
- ensure safety
- move anything that the pt could hit their head on or fall from
- do not put anything in mouth
- turn pt on side for safety (d/t aspiration risk r/t foaming at the mouth)
describe post-tonic clonic seizure care (6)
- hydration
- assurance
- let them know what happened
- rest
- monitor ABCs
- place pt on side
what is a myoclonic seizure
- seizure characterized by brief, jerking spasms of a muscle or muscle group
- brief, shock-like jerks of a muscle or group of muscles
what is an atonic seizure
- type of seizure that causes sudden loss of muscle strength
- aka drop seizures
- sudden lack of muscle strength or tone = person falls to the ground
what is an infantile spasm seizure
- seizure disorder in babies
- seizure with sudden stiffening of the body and brief bending forward or backward of the arms, legs, and head
what is a type of unclassified seizures
- pseudo-seizures
what is a pseudoseizure
- seizures that may look like epileptic seizures but are not epileptic
- instead causes by psychological factors
what is status epilepticus
- life-threatening medical emergency
- includes a seizure lasting >30 min or
- repeated seizures with no return to normal LOC between
what happens if status epilepticus is left untreated
- progresses to coma or death
what seizure most often causes status epilepticus
- generalized tonic-clonic
why is status epilepticus considered a medical emergency
- seizure = increased electrical firing in the brain = increased metabolic activity = brain using up glucose and O2 = decreased glucose and O2
what is included in treatment for status epilepticus (5)
- monitor ABCs
- airway
- apply O2
- IV access
- rapid admin of IV meds
what meds are first line for status epilepticus
- IV diaxepam
- IV ativan (lorazepam)
what is an imp nursing consideration r/t admin of IV diazepam and lorazepam for status epilepticus
- very effective in halting seizure
- but have resp depression s/e = careful monitoring of VS and resp status
what other meds may be given for status epilepticus (3)
- SL ativan
- buccal or intranasal midazolam
- IV phenytoin (only when other meds are ineffective)
what is epilepsy
- chronic seizure disorder
- defined as at least 2 unprovoked seizures occurring greater than 24 hrs apart
what is a febrile seizure (3)
- episode of uncontrollable jerking movements & loss of consciousness caused by fever above 38*
- usually occurs when temp starts to rise
- generally lasts a few minutes and stops on its own
who are febrile seizures most common in
- toddlers 12-18 months old
what is the cause of febrile seizures (4)
- unknown
- family history
- viral illness
- linked to developing brain reaction to fever
what advise can be given to pts r/t febrile seizures (8)
- stay calm
- place child on side
- keep safe
- time episode
- look for any changes to color
- observe movement; any lack of?
- following the seizure, call doctor for follow up appt (if it lasts a short amt of time and the child regains normal behaviors)
- use acetaminophen or ibuprofen for fever
at what point should the parents of a child experiencing a febrile seizure call 911
- if it lasts more than 5 min
what is included in diagnostics for seizures (9)
- consider precipitating events (fever, sleep deprivation, emotional stress, flashing lights, video games, etc.)
- EEG (determine focal seizures)
- MRI
- CT
- metabolic work up –> blood/urine tests
- chromosomal studies
- LP
- toxicology screen
- labs
what is a con to EEG
- important, but if the seizure is not actively occurring it may not be helpful
what does a MRI look for r/t seizures
- structural abnormalities
why are labs & tox screens completed as a diagnostic for seizures
- to rule out obvious causes
what is the goal of management for seizures not r/t epilepsy
- determine & treat the cause
- or remove precipitating factor
ex. fever = antipyretic
what is the goal of mngmt for epilepsy (2)
- control seizures
- reduce frequency & severity without causing adverse effects to maintain normal life
what is included in mngmt of epilepsy (5)
- anti-seizure meds (50% well uncontrolled, 30% decreased)
- surgery
- implanted devices
- ketogenic diet
- CBD oil
when might surgery be done as treatment for epilepsy
- if cause is d/t tumor, hematoma, brain lesion
- or if despite max med therapy, relief is not achieved
what is required w anti-seizure meds
- serum lvls to determine efficacy
what should caregivers be educated on r/t anti-seizure meds
- anti-seizure meds are titratable and may be gradually increased over time to achieve desired effect
- must be weaned off, do not stop taking abruptly
describe nursing care during the ictal phase of seizures (14)
- record when it begins and ends
- ABCs **
- recognize apnea and cyanosis
- O2 therapy to avoid apnea
- suction if they vomit
- safety (stay w pt)
- VS –> O2 sats
- observe and record symptoms
- EEG monitoring (if not unexpected)
- 2nd nurse on standby if need to call code
- reassure the pt
- place nothing in their mouth
- place on their side
- hook to dinamap
describe nursing care during the post-ictal phase of seizures (6)
- documentation (esp. if they lost consciousness)
- timing (how long it lasted, start & end)
- continuous VS
- observe post-ictal behavior
- allow rest on their side
- anticipatory interventions (esp. if know what kind of seizure & the cause)
what post-ictal care should be done once the pt is awake (5)
- assessment
- call bell in reach or tell parents where it is
- safety checks
- treat cause (ex. fever)
- provide parental support and education
what assessments should be done in the post-ictal phase (6)
- LOC
- neuro status
- neuro vitals
- PERRLA
- motor strength
- sensation
what parental support and education should be provided post-ictal phase (4)
- instructions on meds
- when to seek medical attention (if greater than 5 min)
- alleviate fears
- PEMs
a nursing diagnosis r/t seizures is risk for injury . what are some nursing interventions to ensure the child does not experience injury as a result of seizure activity (7)
- administer anti-seizure meds
- teach family & child about meds
- monitor for adverse effects of meds
- stress importance of adherence to meds
- teach pt and family to identify and avoid situations that are known to precipitate a seizure
- initiate seizure precautions in the hospital
- educate family to initiate seizure precautions at home
- teach family seizure first aid
what seizure precautions should be initiated to avoid injury r/t seizures (3)
- pad side rails of bed, crib, wheelchair
- keep bed relatively free of objects
- set up suction and oxygen in room
what bathroom safety seizure precautions should the family initiate at home (3)
- showers instead of baths
- use shower seat if falls occur during typical seizure
- leave bathroom door unlocked
what kitchen safety seizure precautions should parents implement (3)
- cooking when someone else is nearby
- use back burners of stove to prevent accidental burns
- use shatterproof containers as much as possible
what sport safety seizure precautions should parents implement (3)
- wear protective equipment
- have others nearby
- do not climb higher than 3 meters (10 feet) without special equipment
what should you teach the family about seizure first aid (9)
- if child is at risk of falling at beginning of episode, ease child to floor
- loosen tight or restrictive clothing
- turn child to side-lying position
- prevent child from hitting head on objects
- time seizure
- allow seizure to end spontaneously
- reassure child when awakening from seizure
- do not attempt to restrain child or use force
- call EMS if seizure lasts longer than 5 mins, for repeated seizures, or if child does not wake up after movements have stopped
a nursing diagnosis r/t seizures is risk for aspiration and ineffective breathing pattern . what are some nursing interventions to ensure the child’s airway remains patent (7)
- place child in side-lying position on flat surface
- remain w patient
- remove secretions, food, and liquid from mouth
- in postictal state monitor O2 sats
- admin O2 as necessary
- admin rescue breaths if spontaneous respiration do not return shortly after seizure subsides
- admin meds intended to stop seizure longer than 5 min (lorazepam, diazepam, dilantin)
a nursing diagnosis r/t seizures is anxiety/fear in parents. what are some nursing interventions for this (5)
- allow parent to remain w child during seizure
- instruct parent on proper protection interventions during child’s seizure activity
- provide info regarding nature (type) of seizure, therapeutic interventions, and lifestyle modifications
- encourage family involvement in daily care of the child
- involve parents in discussion of fears, anxieties, and resources and support options
