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Precept: Seizures

Seizures

QuestionAnswer
Seizure are sudden, abnormal and excessive electrical discharges from the brain that can change motor or autonomic function, consciousness, or sensation. Seizures can develop at any stage of a person’s life, and they can occur at various intervals.
Partial Seizures  Start in a specific part of the brain Have focal discharges that can be monitored There are 2 types of partial seizures:o Simple: in which the patient doesn’t lose consciousnesso Complex: in which the patient loses consciousness
Generalized Seizures Affect the whole brain from the onset of the seizure to its completion
Absence (or petit mal) and Myoclonic Seizures are nonconvulsive generalized seizures
Tonic-clonic (or grand mal) Seizure is convulsive
AURA’s Sensory experiences that precede a seizure. Patient’s may suddenly report unusual Symptoms such as a smell of burn toast, feeling as if spiders are crawling on their arms, or experiencing any other odd odors, taste or sensation. They may have a feeling
Ictus is the seizure itself
Postictal Phase follows the seizure.  If the patient is conscious during the postictal phase, he’ll most likely be:o confusedo tiredo unaware of the previous events. o Weakness or Paralysis---can follow any type of seizure
Simple Partial Seizures  Person is fully aware Unable to control what’s happening Symptoms often correspond to the brain lobe involved and the actions it controls.  EEG monitoring is the most common way to determine where a seizure originates in the brain.
Frontal Lobe Seizure o Movement of an extremity o Change in speech o Pt states their head was repeatedly and involuntarily turning to one side or that an arm or hand became stiff. o May experience a Jacksonian March: abnormal motor movements that start in a small area,
Parietal Lobe Seizure  Tingling or a feeling of warmth down one side of the body.  Arm and leg movement may occur.  Numbness or tingling that may last for a few minutes, goes away during the postictal phase
Occipital Lobe Seizure  See flashing lights, fireballs, and bright colors shooting across ½ of the visual field.
Complex Partial Seizure  Can’t respond appropriately to commands Won’t remember the event.  May appear fully awake.  Can originate anywhere in the brain. Most occur in the Temporal Lobe.
Automatisms  Chewing Lip smacking Picking motions of the hands Bizarre behavior such as undressing in public, laughing uncontrollably and wandering off for hours.  Hallucinations.  These things may go unnoticed unless the seizure progresses to a secon
Absence (or petit mal) o Commonly affect children age 4 to adolescence. o May stop talking mid sentenceo Stares blankly o Lip smackingo Eye blinkingo Come without warningo Brief lapse of consciousnesso Doesn’t remember the evento Doesn’t fallo Can continue som
Myoclonic Seizures  Children and the elderly most commonly experience these seizures.  Sudden brief jerking of a muscle group or groups.  Can affect pinky finger to the torso.  Jerking movement is small and rhythmic, which lasts a few seconds Can occur frequent
Tonic seizure activity is a type of muscle spasm or contraction in which the arms flex and the legs extend.
Clonic seizure activity alternates between contraction and relaxation.
Clonic phase development  Periods of muscle relaxation occur between tonic muscle contractions.  Periods of relaxation gradually lengthen until the end of the seizure.
During the Postictal phase  Person lies very still.  Very flaccid muscles.  Excessive salivation may cause stridulous breathing.  Airway may be obstructed partly by secretions or totally by his tongue.  Will gradually regain consciousness over minutes to hours.  May
First step in determining if a patient has epilepsy  Take a thorough history—can help R/O other conditions that mimic seizure such as syncope.  Physical and Neurological exam  Lab studies: to R/O common metabolic causes of seizures.  Imaging Studies—R/O structural abnormalities that cause seizur
Therapy Options  Long term drug treatment is recommended for patients who have recurrent seizures with an unknown cause that can’t be reversed. A neurologist selects drugs and dosages based on the patient’s age, weight and the type, frequency, and cause of the seizur
Potential Adverse Reactions to AED’s  Nausea Vomiting DiarrheaTo deal with minimal adverse reactions the doctor may adjust the drug dosage. If adverse reactions are serious, he’ll switch the pt to a new drug. Tapering doses of the old drug while a new one replaces it prevents
Status Epilepticus continuous seizure activity lasting for longer than 30 minutes, or repetitive discrete seizures with impaired consciousness between seizures
The sustained seizure activity can cause  Cardiopulmonary dysfunction Metabolic derangementsHyperthermia that can lead to permanent brain damage.
Triggers of Status Epilepticus  Physiologic causes such as:o Drug withdrawal or toxicityo Metabolic disturbanceso CNS tumorso Refractory epilepsyo Head injuryIn these cases, focus on treating the underlying event, anticonvulsant therapy alone won’t work for metabolic con
Drug Therapy for Status Epilepticus  IV Lorazepam, combined with Phenytoin or Fosphenytoin If seizures continue after this therapy adjunctive therapy with Phenobarbital or anesthesia with Midaxolam or Propofol may be needed. Pt will need continuous EEG monitoring and treatment for se
Living with Epilepsy  Make the hospital environment as safe as possible.  Be alert for signs of an impending seizure: aura’s Teach pt to avoid seizure triggers such as caffeine.  Teach pt about his medications.  Teach pt to avoid OTC meds unless approved by prim
Care of a person having a seizure  Protect the patient, don’t restrain him.  Provide privacy to protect him from onlookers.  Remove harmful objects from his vicinity. If the pt is engaged in any activity that might be harmful, direct the pt away from the activity.  If in a hos
Secondary generalized seizure If a partial seizure transforms into a generalized seizure, spreading diffusely through the cortex
Temporal Lobe controls memory, sound, smell and emotions. Emotional changes are the biggest symptom. Pt’s may have sudden intense feelings, such as fear or bliss, feeling of déjà vu.
EEG most definitive test to diagnose epilepsy and identify a seizure’s location and focus. o An EEG should be given within 24 hours of a suspected seizure. o Recording session may take only 20 to 30 minutes, but most doctors prefer 24 hours of documentat
Carefully observe the seizure, document Assessment findings (progression of the seizure) o Time the length of the seizure. o Respiratory patterno Cyanosis / apneao Loss of B&Bo Vital signso Auraso Time to return to preseizure statuso Neurocheck
If the patient isn’t breathing or is pulseless after the seizure Initiate CPR
Created by: littlemina
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