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Med-Surg I
Chp. 45 Interventions for Cts w/ Problems of the CNS: The Brain II
| Question | Answer |
|---|---|
| Seizure | abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brainthat may alter consciousness, motor sensory ability, or behavior |
| Epilepsy | chronic disorder characterized by RECURRENT unprovoked seizure activity; may be caused by abnormal electrical neuronal actvity, imbalance of neurotransmitters, especially GABA |
| Generalized seziures (involve both hemispheres); Tonic-clonic seizure | last 2-5 mins, begins w/ tonic phase(body stiffens or rigidity of muscles in arms and legs) immediate loss of consciousness; Clonic=rhythmic jerking of all extremities follows it |
| Tonic Seizures | abrupt increase in muscle tone, loss of consciousness, and loss of autonomic signs lasting from 30 seconds to several minutes |
| Clonic seizures | lasts several minutes and is cracterized by muscle contraction and relaxation |
| absence seizure THINK Day dreaming | more common in children and tends to run in families; brief preiods of loss of consciousness and blank staring |
| Myoclonic seizure | brief jerking or stiffening of extremities, may occur singly or in groups; lasts for a few seconds, contractions may be symmetic or asymmetric |
| atonic (akinetic)seizure | sudden loss of muscle tone, lasts seconds, followed by postictal (after the seizure) confusion. These seizures cause the cliet to fall and may result in injury |
| partial seizure | focal or local seizures, begin in PART of one cerebral hemisphere |
| Complex partial seizure | cause the client to lose consciousness or "black out" for 1-3 minutes; characteristic behavior AUTOMATISMS (the client is not aware of the behavior) ex: lip smacking, patting, picking at clothes, after seizure they expeirence amnesia |
| Simple partial seizure | ct reamains consious throughout the episode; often reports an aura before teh seizure takes place |
| Unclassified or idiopathic seizures | occur for no known reason and do not fit inot the generalized or partial classification |
| primary or idiopathic epilepsy | NOT associated with any identifiable brain lesion, secnodary epilepsy results from an underlying brain lesion, most commonly a tumor or trauma |
| Causes of Seizures not considered epilepsy | Metabolic disorders; acute alcohol withdrawal (Mrs. Herrod's alcoholic patient); electrolyte distrubances (hyperkalemia, water intoxication, hypoglycemia); heart disease |
| Risk factors that trigger a seizure | increased physical activity, emotional stress, excessive fatigue, alcohol or caffeine consumption, or certain foods or chemicals |
| preictal phase | presence of an aura before the seizure |
| Assessment of seizures | determine type of seizure; events surrounding the seizure; info from client and family; perictal phase; diagnositic tests to confirm diagnosis of epilepsy (EEG, CT, MRI, or PET scan); Lab studies to identify metabolic or genetic disorders |
| What should you do before administering an AED? | check ct's lab values for most current blood level of the medication; be aware of drug-drug and drug-food interactions; Meds need to be taken on time to maintain theraputic blood levels and maximal effectiveness |
| What drug should NOT be given w/ Dilantin?? | Warfarin! If interactions occur make sure to document adverse effects and report to the health care provider |
| Common Antiepileptic Drugs; Carbamazepine (Tegretol) | for partial, generalized tonic-clonic seizures: monitor for headache dizziness, diplopia or blurring vision, N/V and leukopenia |
| Common Antiepileptic Drugs; Diazepam (Valium) | for all types of seizures; Monitor airway, breathing and circulation |
| Common Antiepileptic Drugs;Phenytoin (Dilantin) | for all types of seizures EXCEPT ABSENCE, MYOCLONIC, and ATONIC seziures; for status epilepticus |
| Seizure Client and Family Education | AED drugs must not be stopped even if seizures have stopped; discontinuing may lead to recurrence of seizures or the life threatening complication of status epilepticus |
| Seizure Precautions | Oxygen and suctioning equipment w/ an airway be readily available; insert a saline lock in clients who do not have IV access and are at generalized tonic-clonic seizures |
| Seizure Precautions | side rails up x 2...padded?? may be embarrassing to ct and family; bed in lowest position |
| Seizure Management | Simple partial seizure; observe ct and document the time the seizure lasted; turn ct on side during a generalized tonic-clonic seiz. or complex seiz. because he/she may lose consiousness |
| NOT UNUSUAL for cynosis during this type of seizure; it is usually self-limiting and no treatment is needed | generalized tonic-clonic seizure |
| Status epilepticus | prolonged seizure lasting more than 5 minutes or repeated seizures over the course of 30 mins |
| Status epilepticus drugs | Lorazepam (Ativan) 2-4mg given over a 2 min period, can receive up to 8mg; Dizepam rectal gel (Diastat) stops motor movement |
| General anesthesia is given for this type seizure when all else fails... | Status Epilepticus |
| Surgical Mangement for medically intractable simple or complex partial seizures with or without secondary generalization | Vagal Nerve Stimulation=stimulating device is implanted in the left chest wall, an electrode is attached to the left vagus nerve under skin. |
| Corpuscallostomy | sugical treatment for tonic-clonic or atonic seizures; surgeon sections the anterior two thirds of the corpus callosum, preventing neuronal discharges from passing between the two hemispheres of brain |
Created by:
prettydee1908
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