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Med Surg Final 2

Seizures & GERD

Tonic/Clonic Seizure most common generalized seizure characterized by loss of consciousness & falling to the ground if the pt is upright, followed by stiffening of the body (tonic phase) for 10-20 sec & subsequent jerking of the extremities (clonic phase) for 30-40 sec
Typical Absence (petit mal) Seizure generalized seizure that usually consists of a brief staring spell that lasts a few seconds, & is often unnoticed; if untreated may occur 100 x a day; usually only occurs in children & stops in adolescence or evolves into another type of seizure
Atypical Absence Seizure generalized seizure that usually consists of a brief staring spell accompanied by othe S/S, including brief warnings, peculiar behavior during the seizure, or confusion after the seizure
Atonic Seizure generalized seizure that usually involves either a tonic episode or a paroxysmal loss of muscle tone & begins suddenly with the person falling to the ground, when consciousness usually returns; normal activity can be resumed immediately; some wear helmets
Myoclonic Seizure generalized seizure that is characterized by a sudden, excessive jerk of the body or extremities, which may be forceful enough to hurl the person to the ground; they are brief & may occur in clusters
Tonic Seizure generalized seizure that usually involves a sudden onset of maintained increased tone in the extensor muscles; these pt often fall
Clonic Seizure generalized seizure that usually begin with loss of consciousness & sudden loss of muscle tone, followed by limb jerking that may or may not be symmetric
Simple Partial Seizure partial seizure that does NOT invole loss of consciousness & rarely lasts longer than a minute; they may involve motor, sensory, or autonomic phenomena or a combination of these
Complex Partial Seizure partial seizure that can involve a variety of behavioral, emotional, affective, & cognitive functions; they involve some alteration in consciousness; distortions of visual or auditory sensations & vertigo can also occur, as well as deja vu or memory loss
Temporal Lobe Seizure type of complex partial seizure where the discharging focus is usually in the temporal lobe; can last longer than a minute & are frequently followed by a period of postictal confusion
Psychomotor Seizure the most common type of complex partial seizure that involves lip smacking and automatisms (repetitive movements that may not be appropriate; afterward, pt has no memory of the seizure
Psychogenic Seizure resemble epileptic seizures but are actually psychiatric in origin; involuntary & are a physical manifestation of a psychologic disturbance; pt may be misdiagnosed as epileptic
Generalized Seizure seizure that involves both sides of the brain and is characterized by bilateral synchronous epileptic discharges in the brain; pt may lose consciousness for a few seconds up to several minutes
Partial Seizure seizure caused by focal irritations; unilateral manifestations that arise from localized brain involvement
What are some examples of nursing dx for a pt who has seizures? ineffective breathing pattern, risk for injury, ineffective coping, ineffective self-health management (pg. 1498-1499 in Nursing Care Plan 59-2)
What are some of the aspects of nursing care for a pt with a seizure disorder? Collect subj & obj data of the seizure's occurrence; during the seizure, you should maintain patent airway, protect pt's head, turn pt to the side, loosen constrictive clothing, ease pt to floor if seated, DO NOT restrain the pt or place objects in mouth
What should you teach a pt with a seizure disorder? take drugs as prescribed & report SE; use nondrug techniques (relaxation therapy); be aware of resources in the community; wear med alert ID; avoid alcohol intake, fatigue, & loss of sleep; eat reg meals & snacks between feeling shaky, faint, or hungry
How are seizure disorders primarily treated? with antiseizure drugs **therapy is aimed at prevention because cure is not possible**
What meds are used for status epilepticus? Ativan & Valium (short-acting drugs) **followed by administration of long-acting drugs such as phenytoin or phenobarbital**
What meds are used for tonic-clonic & partial seizures? phenytoin (Dilantin), carbamazepine (Tegretol), phenobarbital, & divalproex (Depakote)
What meds are used for absence & myoclonic seizures? ethosuximide (Zarontin), divalproex (Depakote), & clonazepam (Klonopin)
What is status epilepticus? a state of continuous seizure activity or a condition in which seizures recur in rapid succession without return to consciousness between seizures - subclinical seizures show no external signs of seizure due to pt sedation
What are the diagnostic studies you would look at to dx epilepsy or a seizure disorder? accurate & comprehensive description of seizure and pt hx (BEST), EEG, CT scan, MRI, SPECT, MRS, MRA, & PET **look at ABGs in pt with status epilepticus**
What complication can result from status epilepticus? brain damage -ventilatory insufficiency, hypoxemia, cardiac dysrhythmias, hyperthermia, & systemic acidosis can occur with tonic-clonic status epilepticus
What is the most common type of complication with a seizure disorder? psychosocial effect on pt
What other tx besides meds are there for pt with seizures? surgeries - resection of epileptogenic tissue (partial), sectioning of corpus callosum (atonic), hemispherectomy or callosotomy (intractable unilateral multifocal epilepsy); therapies - vagal nerve stimulation used in adjunct w/ meds (pg 1497)
What are the S/S of GERD? heartburn (pyrosis), dyspepsia, hypersalivation, persistent reflux that occurs more than twice a week, resp. symptoms (cough, dyspnea, wheezing, etc.), hoarsenes, sore throat, globus sensation ("lump in throat") & regurgitation
What are ways to successfully manage GERD? diet modifications (avoid anything that decreases LES pressure), smoking cessation, certain medications, antireflux surgery, endoscopic mucosal resection, photodynamic therapy, cryotherapy, & radiofrequency ablation (kills cells through heating)
What is a hiatal hernia? a herniation of a portion of the stomach into the esophagus through an opening, or hiatus, in the diaphragm; can be asymptomatic
Sliding Hiatal Hernia junction of stomach & esphagus is above the hiatus of the diaphragm, & part of the stomach slides through the hiatal opening in the diaphragm; occurs when pt is supine & usually goes back into abd cavity when pt stands upright; most common type
Paraesophageal (or rolling) Hiatal Hernia esophagogastric junction remains in the normal position, but the fundus & the greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophagus **paraesophageal hernia is a medical emergency**
What are surgical procedures available for hiatal hernias? herniotomy (excision of the hernia sac), herniorraphy (closure of the hiatal defect), antireflux procedure, & gastropexy (attachment of the stomach subdiaphragmatically to prevent reherniation)
It is important to remember that with a hiatal hernia: reduce intraabd pressure by eliminating constricting garments, avoid lifting & straining, eliminate alcohol & smoking, elevate HOB, reduce bodyweight if overweight, and use antisecretory agents & antacids
Med that increases LES pressure cholinergic - ex: bethanechol (Urecholine)
Med for promotility prokinetic - ex: metoclopramide (Reglan) **helps push food along**
Acid neutralizing med antacids (Gelusil, Maalox, Mylanta)
Antisecretory meds 1. H2-receptor blockers *-dine* - ex: cimetidine, famotidine, nizatidine, ranitidine 2. PPIs *-zole* - ex: dexlansoprazole, esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole
Cytoprotective meds 1. Alginic acid-antacid - ex: Gaviscon 2. Acid protective - ex: sucralfate (Carafate)
Created by: Ariel H