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Chapter 6

Unit 2: Nursing care of clients with neurosensory disorders

QuestionAnswer
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!