Question | Answer |
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) |