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NURS 3512 - Class 7-12 > Week 10 - Epilepsy/Seizures > Flashcards

Week 10 - Epilepsy/Seizures Flashcards

1
Q

what are seizures

A
  • 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
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2
Q

what can cause seizures (5)

A
  • infections
  • neurological impairment
  • metabolic disturbances (ex. electrolytes, dehydration)
  • trauma (ex. head injuries)
  • toxins (ex. pre/postnatal)
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3
Q

what determines how a seizure presents

A
  • depends on where in the brain it originates
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4
Q

seizures can be..(2)

A
  1. isolated (acute, one time)

2. recurrent (epileptic)

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5
Q

seizures can be..

A
  1. isolated (acute, one time)

2. recurrent

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6
Q

what are 2 causes of isolated (acute) seziures

A
  1. structural (acquired) –> known event ex. head injury

2. idiopathic –> unknown cause

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7
Q

what are 3 causes of recurrent seizures

A
  1. symptomatic = known cause
  2. idiopathic = unknown cause, thought to be genetic
  3. cryptogenic = abnormality in unknown part of the brain
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8
Q

what are examples of cryptogenic, recurrent seizures (11)

A
  • electrolyte disorders
  • hyper/hypo glycemia
  • hypoxia
  • alcohol withdrawal
  • sleep deprivation
  • cocaine
  • fever
  • congenital brain abnormality
  • tumour
  • birth injuries
  • maternal drug use or infection
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9
Q

what is the difference between a seizure and epilepsy

A
  • seizure = event

- epilepsy = chronic illness involving recurrent, unprovoked seizures

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10
Q

what are 3 classifications of seizures

A
  1. partial/focal seizures
  2. generalized
  3. unclassified
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11
Q

what is a focal/partial seizure

A
  • localized seizures

- seizures that start in one area or group of cells in one side of the brain

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12
Q

what are 2 types of partial seizures? what is the difference between the two?

A
  1. simple = no loss of conscious, child is awake and aware of the seizure, no impaired consciousness
  2. complex = loss of conscious, child is confused or awareness is affected in some way during the seizure , little to no recollection of event
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13
Q

describe how focal seizures impact the body

A
  • causes unilateral symptoms

ex. general motor, sensory, or both symptoms in 1 side of the body

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14
Q

what often happens w children who experience a focal seizure

A
  • many child who experience a focal seizure will have it progress to a generalized one in the same episode
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15
Q

what is a generalized seizure

A
  • seizure that involves the whole brain

- on EEG, pronounced, abnormal electrical activity all over

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16
Q

what is a risk associated w generalized seizures

A
  • high risk for status epilepticus
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17
Q

describe the general signs of generalized seizures (2)

A
  • 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
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18
Q

what are 5 types of generalized seizures

A
  1. petit mal/absence
  2. grand mal (tonic clonic)
  3. myoclonic
  4. atonic
  5. infantile spasms
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19
Q

what is a petit mal/absence seizure (5)

A
  • 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
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20
Q

what do absence seizures typically precipitate from

A
  • from controllable behaviors: ex. dehydration, exhaustion, hypoglycemia
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21
Q

what do absence seizures look like from ab observational POV

A
  • mistaken for not paying attention or day dreaming
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22
Q

what is included in care for absence seizures

A
  • supportive unless more investigation is needed
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23
Q

what is a grand mal (tonic cloni) seizure?

A
  • sudden, violent in nature seizure that involves phases:

- seizure that involves a tonic phase, clonic phase, and postictal phase

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24
Q

describe the tonic phase of a tonic-clonic seizure (grand mal) (5)

A
  • 10-20 sec.
  • eyes roll back
  • immediate loss of consciousness
  • fall risk as muscles stiffen and lose control
  • pt becomes apneic –> may be cyanotic
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25
Q

describe the clonic phase of a tonic-clonic seizure (4)

A
  • variable duration: from few seconds to 30 min
  • involves violent jerking of body
  • may be incontinent
  • may foam at the mouth = aspiration risk
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26
Q

describe the postictal phase of a tonic-clonic seizure (7)

A
  • 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
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27
Q

describe care during a tonic-clonic seizure (4)

A
  • 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)
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28
Q

describe post-tonic clonic seizure care (6)

A
  • hydration
  • assurance
  • let them know what happened
  • rest
  • monitor ABCs
  • place pt on side
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29
Q

what is a myoclonic seizure

A
  • seizure characterized by brief, jerking spasms of a muscle or muscle group
  • brief, shock-like jerks of a muscle or group of muscles
30
Q

what is an atonic seizure

A
  • 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
31
Q

what is an infantile spasm seizure

A
  • seizure disorder in babies

- seizure with sudden stiffening of the body and brief bending forward or backward of the arms, legs, and head

32
Q

what is a type of unclassified seizures

A
  • pseudo-seizures
33
Q

what is a pseudoseizure

A
  • seizures that may look like epileptic seizures but are not epileptic
  • instead causes by psychological factors
34
Q

what is status epilepticus

A
  • life-threatening medical emergency
  • includes a seizure lasting >30 min or
  • repeated seizures with no return to normal LOC between
35
Q

what happens if status epilepticus is left untreated

A
  • progresses to coma or death
36
Q

what seizure most often causes status epilepticus

A
  • generalized tonic-clonic
37
Q

why is status epilepticus considered a medical emergency

A
  • seizure = increased electrical firing in the brain = increased metabolic activity = brain using up glucose and O2 = decreased glucose and O2
38
Q

what is included in treatment for status epilepticus (5)

A
  • monitor ABCs
  • airway
  • apply O2
  • IV access
  • rapid admin of IV meds
39
Q

what meds are first line for status epilepticus

A
  • IV diaxepam

- IV ativan (lorazepam)

40
Q

what is an imp nursing consideration r/t admin of IV diazepam and lorazepam for status epilepticus

A
  • very effective in halting seizure

- but have resp depression s/e = careful monitoring of VS and resp status

41
Q

what other meds may be given for status epilepticus (3)

A
  • SL ativan
  • buccal or intranasal midazolam
  • IV phenytoin (only when other meds are ineffective)
42
Q

what is epilepsy

A
  • chronic seizure disorder

- defined as at least 2 unprovoked seizures occurring greater than 24 hrs apart

43
Q

what is a febrile seizure (3)

A
  • 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
44
Q

who are febrile seizures most common in

A
  • toddlers 12-18 months old
45
Q

what is the cause of febrile seizures (4)

A
  • unknown
  • family history
  • viral illness
  • linked to developing brain reaction to fever
46
Q

what advise can be given to pts r/t febrile seizures (8)

A
  • 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
47
Q

at what point should the parents of a child experiencing a febrile seizure call 911

A
  • if it lasts more than 5 min
48
Q

what is included in diagnostics for seizures (9)

A
  • 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
49
Q

what is a con to EEG

A
  • important, but if the seizure is not actively occurring it may not be helpful
50
Q

what does a MRI look for r/t seizures

A
  • structural abnormalities
51
Q

why are labs & tox screens completed as a diagnostic for seizures

A
  • to rule out obvious causes
52
Q

what is the goal of management for seizures not r/t epilepsy

A
  • determine & treat the cause
  • or remove precipitating factor
    ex. fever = antipyretic
53
Q

what is the goal of mngmt for epilepsy (2)

A
  • control seizures

- reduce frequency & severity without causing adverse effects to maintain normal life

54
Q

what is included in mngmt of epilepsy (5)

A
  • anti-seizure meds (50% well uncontrolled, 30% decreased)
  • surgery
  • implanted devices
  • ketogenic diet
  • CBD oil
55
Q

when might surgery be done as treatment for epilepsy

A
  • if cause is d/t tumor, hematoma, brain lesion

- or if despite max med therapy, relief is not achieved

56
Q

what is required w anti-seizure meds

A
  • serum lvls to determine efficacy
57
Q

what should caregivers be educated on r/t anti-seizure meds

A
  • 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
58
Q

describe nursing care during the ictal phase of seizures (14)

A
  • 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
59
Q

describe nursing care during the post-ictal phase of seizures (6)

A
  • 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)
60
Q

what post-ictal care should be done once the pt is awake (5)

A
  • assessment
  • call bell in reach or tell parents where it is
  • safety checks
  • treat cause (ex. fever)
  • provide parental support and education
61
Q

what assessments should be done in the post-ictal phase (6)

A
  • LOC
  • neuro status
  • neuro vitals
  • PERRLA
  • motor strength
  • sensation
62
Q

what parental support and education should be provided post-ictal phase (4)

A
  • instructions on meds
  • when to seek medical attention (if greater than 5 min)
  • alleviate fears
  • PEMs
63
Q

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)

A
  • 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
64
Q

what seizure precautions should be initiated to avoid injury r/t seizures (3)

A
  • pad side rails of bed, crib, wheelchair
  • keep bed relatively free of objects
  • set up suction and oxygen in room
65
Q

what bathroom safety seizure precautions should the family initiate at home (3)

A
  • showers instead of baths
  • use shower seat if falls occur during typical seizure
  • leave bathroom door unlocked
66
Q

what kitchen safety seizure precautions should parents implement (3)

A
  • cooking when someone else is nearby
  • use back burners of stove to prevent accidental burns
  • use shatterproof containers as much as possible
67
Q

what sport safety seizure precautions should parents implement (3)

A
  • wear protective equipment
  • have others nearby
  • do not climb higher than 3 meters (10 feet) without special equipment
68
Q

what should you teach the family about seizure first aid (9)

A
  • 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
69
Q

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)

A
  • 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)
70
Q

a nursing diagnosis r/t seizures is anxiety/fear in parents. what are some nursing interventions for this (5)

A
  • 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

NURS 3512 - Class 7-12 (49 decks)

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