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Seizure management
LPN Med Surg II 2009
| Question | Answer |
|---|---|
| What is the CNS made up of | Brain and spinal cord. Doesn't include the peripheral nerves in the arms, legs, muscles, and organs |
| Recognition of right/left differentiation, sensation, recognition of body parts | Parietal Lobe |
| Personality, judgment, humor, social mores, affect, motor movement, expressive speech | Frontal Lobe |
| Interpretation of written language. Visual interpretation | Occipital Lobe |
| Hearing, comprehension of spoken and written language, long term memory | Temporal Lobe |
| What is the brainstem composed of? | Thalamus and Hypothalamus. If you have a problem with brainstem you are dead. |
| Thalamus | Lowest level of crude conscious awareness. |
| Hypothalamus | Regulates ANS, stress response, sleep, appetite, temp, water balance, emotion |
| Function of the spinal cord | Conveys message between brain and periphery. |
| What protects the CNS? | Skull, Meninges-membranes, Cerebrospinal fluid-protective cushion, Blood brain barrier-preventing stuff from getting in, Blood supply-oxygen |
| Regulates events that are automatic or involuntary, such as the activity of smooth and cardiac muscles and glands. | Autonomic Nervous System |
| Two parts of the ANS | Sympathetic: fight or flight Parasympathetic: rest and digest |
| Begins when you first see a person, used to establish a neurologic baseline, determine changes from the baseline, determining emergent neurologic changes | Physical Assessment |
| Fails to respond to verbal and painful stimuli | Comatose state |
| Assessment Basics | Start with minimal stimulus and proceed to maximal stimulus as the condition warrants |
| Assessment Basics | A meaningful neurologic assessment requires adequate stimulation. |
| Assessing Motor Function | Muscle strength, Coordination, Balance, Babinski |
| A positive Babinski’s reflex | is normal in neonates and in infants up to 24 months old. Not normal for adults, indicates corticospinal damage. |
| Babinski sign | Adults curl down, Infants curl up or out/fan |
| Glasgow Coma Scale | Scored between 3 and 15 (3=worst, 15=best) Composed of three parameters: Best eye response, Best verbal response, Best motor response |
| Glasgow Coma Scale | Greater than or equal to 9 not in coma. 8 is critical score. Less than or equal to 8 at 6 hrs.-50%die, Greater than or equal to 12=minor injury |
| Myelography | Inject dye/air into spinal subarchnoid space than x-ray. Contrast (water soluble) could evoke seizure if reaches brain in bolus. Put pt. in fowler's head up. |
| Cerebral angiography | Inject dye into carotid than x-ray |
| MRI Magnetic resonance imaging | Differentiate types of tissues, Greater contrast than CT |
| MRI Magnetic resonance imaging | Most commonly used in radiology to visualize the internal structure and function of the body. Unlike CT, it uses no ionizing radiation, but uses a powerful magnetic field. |
| EEG Electroencephalogram | Detects lesions and abnormal electrical activity (seizures) Used to detect and indicate "brain death" Withhold many meds 1-2 days prior. |
| Lumbar puncture | Insertion needle through L3-L4 or L4-L5. Obtain CSF-evaluate, Measure ICP, Instill air, dye medications, Side Effect: headache, lie down for at least an hr after. |
| Inside the skull | Brain tissue 3 lbs. Blood (75cc) (2+oz) Cerebrospinal fluid (75cc) (5+tbsp) |
| How does intracranial pressure increase? | Head injury, brain tumors, hemorrhage in brain |
| ICP Initial Changes | Change level of consciousness, speech, delayed responses, lethargy |
| ICP Late Changes | Bradycardia, hypertension, bradypnea (Cushing's triad) |
| Body can regulate to a point | Systolic BP 50-150, ICP <40 (normal 10-20) |
| (Increased ICP Monitoring) Ventriculostomy | catheter inserted into ventricle of non-dominant side of brain, measures pressure |
| (Increased ICP Monitoring) Subarchnoid Bolt | Hollow device inserted into subarachnoid space |
| (Increased ICP Monitoring) Epidural monitor | Pneumatic flow sensor (decreased infections) |
| Mannitol (osmotic diuretic) | Reduce cerebral edema-diuretic action |
| Corticosteroids (Decadron) | Reduce inflammation, decrease edema |
| Hypertonic saline | Reduce edema by rapid mvmt of water out of ventricles (brain) into bloodstream |
| Nursing the ICP Patient | Reduce fever, fluid restriction, maintain o2, elevate HOB, avoid valsalva maneuver, prevent infection |
| Seizures | Abnormal, sudden excessive discharge of cerebral neurons |
| Seizure causes | Genetic, hypoxemia, head injury, hypertension, brain tumor, ETOH and drugs |
| Tonic Clonic Seizure(grand mal) | Tonic Stiff 10-20 sec. Clonic Jerking 30-40 sec. Loss of consciousness, may be incontinent |
| Absence Seizure (petit mal) | Brief (seconds) Little or no change in muscle tone, may occur >100 times/day, more common in children, appears to be daydreaming |
| Myoclonic Seizure | Fall to floor, Brief jerking, stiffening of extremities |
| Atonic/Akinetic Seizure | Atonic-without movement (drop attacks) momentary loss of muscel tone |
| Aura | First sign that a seizure is going to occur. |
| Dilantin | Drug of choice (seizure) SE: GI, rash, bleeding gums, alcohol deactivates med. |
| Valium | Seizure med., relief of restlessness, decrease seizure activity |
| Luminal | Seizure med. SE drowsiness, nystagmus, resp depression |
| Tegretol | Limits nerve impulses by limiting sodium ions across membrane, SE blurred vision |
| Klonopin | Decrease freq. duration in minor motor seizures, SE: lethargy, ataxia, vertigo |
| Drug Interactions | antibiotics, folic acid, narcotics, oral contraceptives |
| Seizure meds. | Avoid sudden withdrawal |
| Epilepsy | Recurring seizures (2) often starts prior to age 20, meds. Dilantin, Depakote |
| Status Epilepticus | Series of generalized seizures with no recovery in between lasting > 30 min. |
| Status Epilepticus most common cause: | Med withdrawal, May cause death |
| Seizure Precautions | 1. Close to nurse station 2. Suction equip. ready 3. Oxygen ready 4. Pad side rails of bed 5. Avoid clutter in room |
| Seizure Precautions | 6. Keep bed in low position side rails up 7. Instruct pt. not to get out of bed 8. call bed accessible 9. avoid restraints |
| Primary headaches (Non-organic) | Not caused by other diseases migraine, tension, and cluster headaches |
| Secondary headaches (organic) | Caused by associated disease, may be minor or life threatening. Infections-meningitis, lesions, tumors, cerebral hemorrhage |
| Migraine Phases: Aura | Evolves over 5-20 min. Can be visual, sensory or motor, headache within an hour. Perfect time for meds. |
| Migraine Triggers | chocolate, tyramine foods, hot dogs, skipped meals, loud noises, weather changes, perfumes, high altitude, drugs, cocaine, ETOH |
| Migraine Therapy | move to cool, quiet, dark environment, naproxen, Ibuprofen, Narcotics, Reglan |
| Transient Ischemic Attack (TIA) | Rapid onset, short duration, no permanent neurologic deficit, S/S vision loss, aphasia, confusion, slurred speech |
| Ischemic Stroke | Narrowing of arteries in neck or head, blood clots can cause blockage, high cholesterol |
| Stroke tests | CT scan, EKG, Carotid ultrasound, TEEDon't leave on affected side too long |
| Hemorrhagic Stroke | Sudden increase in pressure, more fluid in brain, can lead to death, high B/P, ruptured aneurysm, trauma, infections, tumors, blood clotting |
Created by:
angienoriega
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