Transcript Anns Siezure Disorders N212_RN_F08_website

Seizure Disorders
Seizures
 Abrupt, uncontrolled
electrical discharges of
cerebral neurons that
interrupts normal brain
function
 May result in: alteration
LOC, motor/sensory
ability, and/or behavior
 May be a symptom of an
underlying illness or may
be spontaneous
Causes of Seizures
Over ½ are Idiopathic (unknown)
Other causes:
 Birth injury
 CNS defects or infection
 Head trauma
 Brain tumors
 CVA- cerebral vascular disease
 Chronic disease
 Metabolic disorders
Epilepsy
 A chronic disorder characterized by recurrent
unprovoked seizure activity
 spontaneous reoccurring seizures
 When seizures continue to occur for unknown
reasons or because of an underlying problem
that cannot be corrected, the condition is
known as epilepsy.
PRECIPITATING FACTORS
 Fatigue
 Sleep deprivation
 Decreased physical
 Stimulants
health
 Alcohol ingestion
 Emotional stress
 Flashing lights
 Menstrual cycle
 Hypoglycemia
 Withdrawal
 Substance abuse
 High Fever
 Electrolyte
imbalance
 Hypoxia
Classification of Seizures
Partial Seizures
Generalized Seizures
Generalized Seizure
► Affects entire brain
► No warning
► Loss of
consciousness
General Seizures
 Tonic - Clonic Seizures
Type
Description
Tonic
Clonic
2-5 min; muscle rigidity
Loss of consciousness; rhythmic
jerking of extremities, biting,
salivation, incontinence.
muscle contraction and relaxation
(jerking)
Clonic
Tonic
muscle stiffness
Absence
Brief loss of consciousness
(staring/glaring)
Brief jerking of extremities,
symmetrical/asymmetrical
Sudden loss of muscle tone; client
falls; “drop attack”
Myoclonic
Atonic
Partial Seizures (Simple or Complex)
 Local onset
 May (Complex) or may
not (Simple) loose
consciousness
 Begin in a specific area
of brain (in a part of one
cerebral hemisphere)
 May generalize and turn
into tonic-clonic
seizures
Diagnostic Studies
 MOST USEFUL diagnostic tool is an
accurate and comprehensive
history/description of the seizures and
health history
 Electroencephalogram (EEG)
 Not
completely reliable
 CT/CAT, MRI, PET scans
 Labs (e.g. CBC, chemistry, UA, kidney
and liver studies; electrolytes/drug
screen) to R/O other metabolic/medical
causes
Electroencephalography: EEG
Video with EEG
Clinical Manifestations
 Determined by the
site of the electrical
disturbance
 May involve
Changes in
consciousness
 Motor
 Sensory/senses
 Emotional

Phases of Seizure Activity
 Prodromal- precedes a seizure activity with a
sign or activity ( e.g. epileptic cry)
 Pre-ictal or aura – period right before a
seizure in which a sensory warning may be
present
Deja vu
 Aura- Smells, sights, numbness, tingling,
emotional changes

 Ictal-during seizure
 Postictal-after the seizure
 Usually lethargic, sleepy, memory loss
Complications of Seizure
Greatest risk with loss
of consciousness
 Trauma from fall
 Head injury
 Drowning
 Auto accident
During a Seizure…
Assist client to floor if standing/sitting position
During a Seizure…
During a Seizure…
Loosen restrictive clothing
During a Seizure…
Never restrain the client
During a Seizure…
During a Seizure…
If seizure lasts longer than 5 minutes…
MD
Seizure Precautions
 Acute care settings
 IV access
 Bed in low position
 Side rails up
• Padded side rails controversial
 At
bedside: Oxygen, Suction, Oral Airway
 No padded tongue blades
Seizure Management (Summary)
DURING a Seizure
 Prevent or minimize injury


Ease patient to floor if standing or sitting
Protect head
 Maintain patent airway


Support head or neck
Turn patient on side to prevent aspiration
 Monitor seizure activity and time event

Call MD if lasting > 5 min
 Do not restrain; stay with client
 Loosen restrictive clothing
 Do not place anything in mouth
video
Nursing Interventions: Post seizure
 Assess VS, LOC (GCS), pupils
 May require O2 or suctioning
 Patient will usually sleep
 Reorient pt when arouses
 Allow to rest
 Dextrose if hypoglycemic
 Administer prescribed meds
Status Epilepticus

State of continuous seizure activity

Period of one continuous seizure lasting
longer then 10 minutes or several seizures
occurring during a 30 minute time frame

Neurological emergency

Tonic-clonic Status Epilepticus can lead to a
respiratory or cardiac arrest and death
Emergency Care
 During a Status Epilepticus
 Establish airway
 Administer oxygen (face mask or NC)
 IV antiseizure drugs
• Lorazepam (Ativan) or Diazepam (Valium): a shortacting benzodiazepine
• Phenytoin (Dilantin) long-acting
• Cerebyx

Stat labs
Drug Therapy: Antiepileptic Drugs
 Stabilize nerve cell membranes
 Prevent the spread of epileptic
discharges
 80% of patients controlled with
medication
Common Medications
 Phenytoin (Dilantin)
 Carbamazepine
(Tegretol)
 Valproic acid
(Depakene)
 Barbiturates Phenobarbital
 Succinimides -Zarontin
 Benzodiazepines –
Valium, Ativan
 Clonazepam –Klonopin
Newer Antiseizure Drugs
 Neurontin
 Lamictal
 Felbatol
 Topamax
 Cerebyx
Education
Medication
 Therapeutic drug
levels
 Drug-drug and food-
drug interactions
 Stress compliance
with medications

Do not stop abruptly
Client and Family
Education
 Care of client during a






seizure
When to call 911
Seizure precautions
Keep seizure diary
Rest; Manage stress
Take medications as
prescribed
States laws re: driving
and operating
machineries
Surgical Management
 Remove the epileptic focus
 Prevent spread of epileptic activity
 Involves resection of brain tissue/ lobe
Brain Mapping
Alternative Therapies: Do NOT
REPLACE DRUGS
 Biofeedback
 Ketogenic Diet-high fat low carb
 Body burns fat instead of glucose for
energy
 Vagal nerve stimulation
 Implantation of a device to stimulate the
vagal nerve
 To abort the seizure
Psychosocial
 Social stigma
 Unable to drive
 Fear of embarrassment
 Effects of medications
Referrals and resources
 Refer to community resources
 Resources: Epilepsy Foundation Of
America, National Epilepsy League