Unit 2: Nursing care of clients with neurosensory disorders
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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)
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
mary.scott260!
Popular Nursing sets