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Seizure Disorders
Objectives
• Identify the various types and causes of seizures.
• Use the nursing process to develop a plan of care for the
patient experiencing seizures.
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Seizures
 Seizures are episodes of abnormal motor, sensory, autonomic, or psychic activity
(or a combination of these) resulting from sudden excessive discharge from
cerebral neurons.
 The international classification of seizures differentiates between two main types:
partial seizures that begin in one part of the brain, and generalized seizures that
involve electrical discharges in the whole brain.
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International Classification of Seizures
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Causes..
 The underlying cause is an electrical disturbance in the nerve cells in one section
of the brain, causing them to emit abnormal, uncontrolled electrical discharges.
 The characteristic seizure is a manifestation of this excessive neuronal discharge.
There may be associated loss of consciousness, excess movement or loss of
muscle tone or movement, and disturbances of behavior, mood, sensation, and
perception.
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 The specific causes of seizures are varied and can be categorized as idiopathic
(genetic, developmental defects) and acquired.
Among the causes of acquired seizures are hypoxemia of any cause, including
vascular insufficiency, fever (childhood), head injury, hypertension, central
nervous system infections, metabolic and toxic conditions (eg, renal failure,
hyponatremia, hypocalcemia, hypoglycemia, pesticides), brain tumor, drug /
alcohol withdrawal, and allergies.
Cerebrovascular disease is the leading cause of seizures in the elderly.
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Nursing Management During a
Seizure
 A major responsibility of the nurse is to observe and record the
sequence of symptoms.
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The Epilepsies
 Epilepsy is a group of syndromes characterized by recurring seizures. Epileptic
syndromes are classified by specific patterns of clinical features, including age of
onset, family history, and seizure type.
Although there is evidence that susceptibility to some types of epilepsy may be
inherited, the cause of seizures in many people is unknown. Epilepsy can follow
birth trauma, head injuries, some infectious diseases (bacterial, viral, parasitic),
toxicity (carbon monoxide and lead poisoning), circulatory problems, fever,
metabolic and nutritional disorders, and drug / alcohol intoxication. It is also
associated with brain tumors, abscesses, and congenital malformations.
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Clinical
Manifestations
Seizures have been classified according to the area of the brain involved and have been identified as
partial, generalized. Partial seizures are focal in origin and affect only part of the brain.
Generalized seizures are nonspecific in origin and affect the entire brain simultaneously.
 In simple partial seizures, only a finger or hand may shake, or the mouth may jerk uncontrollably.
The person may talk unintelligibly, may be dizzy, and may experience unusual or unpleasant
sights, sounds, odors, or tastes, but without loss of consciousness.
 In complex partial seizures, the person either remains motionless or moves automatically but
inappropriately for time and place, or may experience excessive emotions of fear, anger, elation,
or irritability. Whatever the manifestations, the person does not remember the episode when it is
over.
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 In generalized seizures, previously referred to as grand mal seizures, involve both hemispheres of
the brain, causing both sides of the body to react.
There may be intense rigidity of the entire body followed by alternating muscle relaxation and
contraction (generalized tonic – clonic contraction).
The tongue is often chewed, and the patient is incontinent of urine and stool. After 1 or 2 minutes, the
convulsive movements begin to subside; the patient relaxes and lies in deep coma, breathing
noisily. The respirations at this point are chiefly abdominal. After the seizure, the patient is often
confused and hard to arouse and may sleep for hours. Many patients complain of headache, sore
muscles, fatigue, and depression
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Assessment and
Diagnostic Findings
• The patient is questioned about illnesses or head
injuries that may have affected the brain.
• physical and neurologic evaluations.
• biochemical, hematologic, and serologic studies.
• MRI and EEG.
To give a sense of the overall direction of change in the well-being
children and youth
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Medical Management
PHARMACOLOGIC THERAPY
SURGICAL MANAGEMENT
 Medication therapy controls rather than cures seizures.
Medications are selected on the basis of the type of seizure being treated and the effectiveness
and safety of the medications .
Surgery is indicated for patients whose epilepsy results from intracranial tumors, abscess,
cysts, or vascular anomalies.
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Assessment
Assessment
• Seizure history.
• The factors or events
that may precipitate
the seizures.
• If the patient has an
aura before an
epileptic seizure.
• Observation and
assessment during
and after a seizure.
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Diagnosis
Nursing Diagnosis
Risk for injury
related to
seizure activity
Fear related to
the possibility
of seizures
Ineffective
individual
coping related
to stresses
imposed by
epilepsy
Deficient
knowledge
related to
epilepsy and its
control
The major potential complication of patients with epilepsy is:
 Status epilepticus: (acute prolonged seizure activity) is a series of
generalized seizures that occur without full recovery of consciousness
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between attacks.
Planning
and Goals
Planning and Goals
Prevention of injury
Control of seizures
Achievement of a satisfactory psychosocial adjustment
Gaining knowledge and understanding about the condition
Absence of complications.
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Interventions
PREVENTING INJURY
• the patient should be placed on the floor and
any obstructive items should be removed.
• The patient should never be forced into a
position, nor should anyone attempt to insert
anything into the patient’s mouth once a
seizure has begun.
• Patients should have pads applied to side
rails while in bed.
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Interventions
REDUCING FEAR OF
SEIZURES
• Should be emphasized that the prescribed
antiseizure medication must be taken on a
continuing basis without fear of addiction.
• The patient is encouraged to follow a
regular and moderate routine in lifestyle.
• Classes in stress management may be of
value.
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Interventions
IMPROVING COPING
MECHANISMS
• Nurses can improve the quality of life for
patients with epilepsy by educating them
and their families about symptoms and their
management.
• Counseling assists the individual and family
to understand the condition.
• Social and opportunities are necessary for
good mental health.
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Interventions
PROVIDING PATIENT
AND FAMILY
EDUCATION
• Ongoing education and encouragement
should be given to patients.
• The patient with epilepsy should carry an
emergency medical identification card.
• The patient and family need to be educated
about medications as well as care during a
seizure.
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Evaluation
EXPECTED
PATIENT
OUTCOMES
1.
4.
• 1 Sustains no injury during seizure
activity.
• 2 Exhibits decreased fear.
• 3 Displays effective individual
coping.
• 4 Exhibits knowledge and
understanding of epilepsy
a. Complies with treatment regimen and identifies the hazards of stopping
the medication.
b. Patient and family can identify appropriate care during seizure.
a. Identifies the side effects of medications.
b. Follows a healthy lifestyle by getting adequate sleep and eating meals at
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regular times to avoid hypoglycemia
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Summary
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Question..?