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Chapter 6
Unit 2: Nursing care of clients with neurosensory disorders
| Question | Answer |
|---|---|
| Seizures and Epilepsy (Pg. 62) Define seizures: | Abrupt, abnormal, excessive & uncontrolled electrical discharge of neurons within the brain that may cause alterations in LOC &/or changes in motor/sensory behavior |
| What is epilepsy? | Defines a syndrome characterized by chronic recurring abnormal brain electrical activity |
| Epileptic seizure 3 broad categories: | Generalized, partial (focal/local), unclassified (idiopathic) |
| Risk factors (Pg. 62) | Genetic, acute febrile state, head trauma, cerebral edema, AEDS, infection, metabolic disorder, toxins, brain tumor, hypoxia, acute drug/alcohol withdrawal, fluid & lyte imbalance |
| Triggers (Pg. 63) | Increased physical activity, excessive stress, hyperventilation, overwhelming fatigue, acute alcohol ingestion, excessive caffeine intake, exposure to flashing lights |
| 1. Generalized seizure | "Tonic-clonic", may begin with aura -begins for a few secs w tonic part (stiff) & loss of consciousness, breathing may stop -1-2 min clonic episode (rhythmic jerking of extremities), breathing may be irregular, cyanosis, cheek/tongue bite,incontinence |
| What is an aura? | Alteration in vision, smell, hearing, or emotional (feeling) -Associated with generalized seizures at times |
| Postictal phase | After seizure; a period of confusion and sleepiness |
| Tonic seizure: | Only tonic phase experienced -30 secs to several minutes -loss of consciousness -less common than tonic-clonic |
| Clonic seizure: | Only clonic phase experienced -several mins -muscles contract and relax -less common than tonic-clonic |
| Absence seizure: (pg. 63) | Common in children, loss of consciousness lasting few secs -Blank staring -eye fluttering/lip smacking, automatisms |
| Automatisms is? | Picking at the clothes, lip smacking (client is not aware) -associated with absence seizures sometimes |
| Myoclonic seizure: | Brief jerking or stiffening of the extremities, symmetrical or assymetrical -secs long |
| Atonic or akinetic seizure: | Few seconds of muscle tone lost -followed by period of confusion -usually results in falling |
| 2. Partial seizure: | "Focal/local" -Complex or simple |
| Complex partial seizure: | Associated automatisms -can cause loss of consciousness for several minutes -amnesia may occur immediately prior to or after seizure |
| Simple partial seizure: | Consciousness is maintained -unusual sensations, deja vu, autonomic abnormalities; like changes in HR, flushing, unilateral extremity movements, pain or offensive smell |
| 3. Unclassified seizure | "Idiopathic" -Doesn't fit into other categories -Account for 1/2 of all seizures -Occur for no reason |
| Lab tests: | Alcohol, illicit drug levels, HIV testing, toxins screen if suspected |
| Dx procedures for seizures: | EEG (electroencephalogram) -Records electrical activity and may identify the origin or seizure activity & MRI/CT/PET/CSF, can rule out potential causes |
| Nursing care: During a seizure -protect, A, secretions, position & why, clothing | -Protect from injury, move furniture, hold head in lap if on the floor -Position to provide patent airway & turn on side to decrease aspiration risk -Be prepared to suction secretions -Loosen tight clothing -Don't attempt to restrain |
| During a seizure care con't -Jaw, tongue blades, document | -Don't open jaw or insert airway (can damage teeth/lips, etc.) -Don't use padded tongue blades -Document onset, duration & client findings/observations prior to, during, and after (LOC, apnea, cyanosis, motor activity, incontinence) |
| Nursing care -Post seizure (Pg. 65) -position, neuro, precautions | "Postictal" -Maintain side-lying to prevent aspiration & help drain secretions -Check VS, neuro checks, any injuries? -Reorient/calm client -Precautions: bed lowest position, padding on side rails -Did client have an aura? -trigger? |
| Seizure medications: | AED (antiepileptic drugs) Ex. phenytoin (Dilantin) |
| Initial goal for med therapy: | Control w 1 med, if it doesn't work, increase dose or add/substitute w another med |
| How are therapeutic levels of the meds determined? | Blood tests, routinely done |
| When should meds be taken? | Same time every day |
| What can some AEDs cause? | Oral gum overgrowth, routine oral hygiene/dentist visits can help |
| What does Phenytoin decrease the effectiveness of? | Oral contraceptives |
| What does Phenytoin decrease the absorption of and increase the metabolism of? | Warfarin (Coumadin) -Don't give with |
| Surgical interventions for seizures (pg. 66) | Placement of a vagal nerve stimulator and excision of the portion of the brain causing the seizures for intractable seizures OR Surgical removal or interruption of brain tissue causing the seizures |
| What is a vagal nerve stimulator? | Device implanted into the left chest wall -Connected to an electrode placed on the left vagus nerve -Performed under general anesthesia |
| How is the VNS programmed? | To administer intermittent stimulation of the brain via stimulation of the bagel nerve at a rate specific to the client's needs -Avoid MRIs, microwaves, shortwave radios |
| What can the client do with this VNS to help w seizures? | Can hold a magnet over the implantable device to initiate it and can abort the seizure or lessen its severity |
| Surgical removal/interruption of brain tissue -Requires, awake or asleep? | Requires an open craniotomy -Client can be awake to ensure only abnormal brain tissue is removed |
| What is done during the surgical removal? | EEG monitoring or brain stimulation activities -To identify abnormal tissue - |
| Nursing actions: | -Education -AED monitoring of therapeutic levels -Medication tag -Driving laws for seizure hx |
| Seizure complications: | Status epilepticus |
| What is status epilepticus? | Prolonged seizure activity occurring over a 30-min time frame -low o2 levels, brain inability to return to normal state -acute condition requiring immediate tx |
| Nursing actions during status epilepticus | Maintain an airway, give o2, IV access, ECG monitor, pulse ox & ABGs |
| Meds to give during status epilepticus? | Loading dose of diazepam (Valium) or Lorazepam (Ativan) followed by a con't infusion of phenytoin (Dilantin) |
Created by:
mary.scott260!
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