Transcript Seizure
Fion Kung
Define
seizure
Types of seizure
Understand current treatment and prevention
Understand the diagnostic test
Nursing diagnosis, outcome and intervention
NCLEX style questions
According
to the Centers for Disease
Control and Prevention
Epilepsy is the fourth most common
neurological disorder in the U.S. after
migraine, stroke, and Alzheimer's disease.
Ten percent of the American population will
experience a seizure in their lifetime.
Epilepsy affects 2.2 million Americans
Epilepsy affects 65 million people worldwide.
50-70% of all cases of epilepsy is of unknown origin
Some known causes:
Birth trauma
Infectious diseases
Ingestion of toxins
Brain tumors
Inherited disorders
Cerebrovascular accident
A
single sudden temporary event that consists
of uncontrolled, electrical neuronal discharge
in the brain
It interrupts the normal function in the brain
When a person has recurrent seizures, they
are called epilepsy
Affect variety of mental and physical functions
Two
categorized
Partial (Focal)
Generalized
Absence
seizures
Brief alteration in consciousness
Mild increase or decrease in muscular tone
Blinking or rolling eyes, a blank stare, slight mouth
movements
Usually last 5-30 seconds
Tonic-clonic
seizures
Loss of
consciousness
Stertorous
respirations
Dilated pupils,
hypertension, fast
heart rate
Tonic phase
Clonic phase
Severe seizure activity known as
“status epilepticus” and is a medical
emergency characterized by either
continuous seizures lasting at least 5
minutes or 2 or more separate seizures
where recovery is incomplete.
Epilepticus can culminate in severe
neurological injury due to cerebral
hypoxia and death can occur from
respiratory and/or cardiovascular
failure.
Electroencephalography
(EEG)
Computed tomography scan (CT)
Magnetic resonance spectroscopy (MRS)
Magnetic resonance imaging (MRI)
Antiepileptic
Drugs (AEDs)
Dilantin (phenytoin)
Phenobarbital
Tegretol (carbamazepine)
Surgery
Ketogenic
diet
Vagus nerve stimulation therapy
Acute
confusion related to postseizure state
Social isolation related to unpredictability of
seizures, community-imposed stigma
Risk for ineffective airway clearance
Risk for falls
Risk for powerlessness
Risk for trauma
Readiness for enhanced knowledge
Readiness for enhanced self-care
Rest and maintain functional capacity
Remain free of falls
Remain free of injuries
Prevent seizure
Monitor level of self-care
Keep
the bed in low position with siderails up,
and use the padded siderails
Monitor the vital signs, behaviors,
consciousness
Give the antiepileptic drugs as ordered
Reinforce learning through educational followup
Use combination of teaching methods
Show respect for the person and support the
person’s awareness.
Getting
enough sleep
Controlling stress
Take the anticonvulsant medications daily. Do
not stop suddenly
Avoid brain injury
Avoid fall
Move things out of the
way so patient won't
injure him or herself.
Loosen any tight
clothing around the
neck.
Put a pillow or
something soft under
the head.
Lay him or her on one
side.
Time the seizure
Don't put anything in the
mouth.
Don't try to hold the child
down.
Don't give mouth-tomouth resuscitation until
the seizure is over
Allow
the patient to rest
Check for the vital signs, consciousness
Conduct post seizure evaluation
Check if it was the first seizure
Check what was the patient doing prior to the
seizure
Check for other illness
Review current medications
CC:
“Patient admitted to ER with loss of
consciousness related to seizure”
PMH:
hypertension
FMH: Father has stroke and died on his 68.
mother is healthy.
Allergies: aspirin
Phenytoin
(Dilantin) 3 times per day
Therapeutic effect: reduction of seizure
activity.
Side effects: suicidal thoughts, StevensJohnson Syndromes, diplopia, dizziness,
headache, confusion, hypotension
(Davis’s Drug Guide (2012)
Nursing
Diagnosis:
Risk for falls
Risk for trauma
Acute confusion related to postseizure state
Goal/Outcome:
Remain free of falls
Remain free of injuries
Rest and maintain functional capacity
Keep the bed in very low position with siderails up,
and use the padded siderails
Monitor the vital signs, behaviors, consciousness
Give the antiepileptic drugs as ordered
Call light/personal assistance systems in reach
Provide quiet place for patient to rest
Assess the patient’s behavior and cognition
systematically and continually throughout the day ad
night
Generalized
seizure is happening in only one
part of the brain.
A. True
B. False
What
of the following does not prevent
seizures?
A. Get enough sleep
B. Controlling stress
C. stop the anticonvulsant medications when
there is no seizure symptom present
D. prevent fall
The
nurse answers a call bell and finds a
frightened mother whose child, the patient, is
having a seizure. Which of these actions should
the nurse take?
A. The nurse should insert a padded tongue blade
in the patient’s mouth to prevent the child from
swallowing or choking on his tongue.
B. The nurse should help the mother restrain the
child to prevent him from injuring himself.
C. The nurse should call the operator to page for
seizure assistance.
D. The nurse should clear the area and position
the client safely.
The
nurse is caring for the male client who
begins to experience seizure activity while in
bed. Which of the following actions by the
nurse would be contraindicated?
A. Loosening restrictive clothing
B. Restraining the client’s limbs
C. Removing the pillow and raising padded
side rails
D. Positioning the client to side, if possible,
with the head flexed forward
The
most important responsibility of the nurse
when a patient has a seizure is to:
A. Maintain the head-tilt-chin lift method.
B. Provide oxygen immediately
C. Prevent injury of the patient
D. Prevent status epilepticus
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Leone, M. (2011). Treatment of first tonic-clonic seizure does not affect
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Faught , E., Duh, M., Weiner, J., Guerin, A., & Cunnington, M. (2008).
Nonadherence to antiepileptic drugs and increased mortality: findings
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Guerin & Cunnington, 2008)
Ackley, B. J., & Ladwig, G. B. (2010). Mosb'ys guide to nursing diagnosis .
(5th ed.). Mosby. (Ackley & Ladwig, 2010)
Mary, F., (n.d). Review Article: Evidence-based models of care for
people with epilepsy. Epilepsy And Behavior, 231-6.
doi:10.1016/j.yebeh.2011.10.019
Rebecca, E., Review Article: care plan for people with
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