care of pt w/seizure disorder

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  1. definition of a seizure
    • a seizure represents an abnormal behavior caused by an electrical discharge from neurons in the cerebral cortex
    • uncontrolled physiological response to abnormal electrical discharges in the CNS
    • usually indicative of neuronal hyperexcitability
    • symptom rather than a disease
    • starts w/one hyper exitable and spreads
  2. seizures
    • are generated/initiated by synchronous high frequency discharge from a group of abnormal hyperexcitable neurons (focus), spread to adjacent tissues
    • - focus can be the result of congenital defect, hypoxia, head trauma, tumor, meds
    • - sometimes unknown (electrical imb)
  3. two different causes
    • two different causes
    • idiopathic causes: genetic, development (febrile)
    • Acquired: from other things happening to the body
  4. outward manifestation of a seizure depends on
    • location of the seizure focus (where)
    • Neuronal connections to the focus and adjacent neurons- where does it spread
    • - rate, extent and direction of the spread of abnormal electrical discharges
    • - think of the parts of the brain and function
    • tonic-clonic- larger one
    • simple- one place r/t one part of the brain
  5. parts of the brain
    • temporal- ears, balance, emotions, panic, fear
    • frontal- confusion, behavioral, speech, movement
    • parietal- sensory, parenthesia
    • occipatal- eyes visual changes
  6. seizure threshold
    • the nervous system normally exhibits a basal level of excitability
    • whenever the degree of excitability exceeds a certain threshold (seizure threshold), abnormal discharges can occur in the CNS
    • in seizure disorders, the threshold is low or multiple areas are stimulated
    • we all have different threshold- normal, abnormal will bypass this, lower threshold (bypass this too)
    • seizure meds- will raise seizure threshold
  7. seizures are classified into two types
    • partial or focal seizure- one part of the brain
    • generalized seizure- both hemispheres
  8. partial seizures
    simple partial
    • simple partial:
    • involves one hemisphere
    • intact consciousness- aware but can't control abnormal action
    • may have prodrome/aura symptom- can feel it before it comes
    • during seizure: movement of one extremity
    • focal
    • last for 1-1 1/2 min
  9. simple partial seizure s/s
    • motor, vision, hearing impaired
    • Autonomic (SNS)- tachycardia, flushing, diaphorectic
    • automastism- grimacing, smacking of the lips- repetitive non purposeful movement
  10. partial seizures
    complex partial
    • also called temporal lobe/psychomotor seizure
    • prodrome/aura
    • initially begins in a localized area
    • can progress to both hemisphere
    • impairment of consciousness- not loss but can follow commands- may not remember
    • cognitive s/s
    • sensory/motor
    • autonomic s/s
    • automatisms
    • fear, feeling of detachment (confusion)
  11. Generalized seizure
    • loss of consciousness
    • involves both hemispheres
    • subdivided into 6 types:
    • - absence seizures
    • - myoclonic
    • - tonic-clonic
    • - clonic
    • - tonic
    • - atonic
  12. Absence seizure
    • petit mal
    • seizure of sudden onset and termination
    • seen in children
    • impairment of conscious, brief staring, automatisms
    • usually labs < 20 secs
    • affects school
    • usually doesn't occur after puberty
  13. generalized seizure
    tonic-clonic **
    • last for 2-5 mins
    • begins with tonic (stiffing of rigidity of mus. mostly of arms/legs f/b LOC)
    • clonic phase- rhythmic jerking of all extremities follows- person may bit tongue, incont of both urine/feces
    • fatigue, acute confusion, lethargy may last for 1 hr following seizure
    • tonic-clonic seizures: occasionally, only clonic or tonic movement may occur
    • tonic- stiffiness
    • clonic- jerky
    • vague, warning or awareness
    • watch airway b/c muscle in airway (constrict)
    • neuro, safety
  14. atonic seizures (akinetic- w/ot movement)
    • sudden loss of muscle ton, lasting seconds
    • f/b postictal confusion- not sure what happen
    • incr risk for falls
    • drop attack- loss muscle time- falls
    • this type is most resistant to the drug therapy
  15. myoclonic (muscle jerk)
    • small % of population
    • sudden. brief involuntary muscle 'jerking'
    • - rapid brief contractions of muscle contractions
    • can involve one body part (mild) or whole body
    • no loss of consciousness
    • (bright lights, strobe lights, fatigue, dehydration)
  16. epilepsy
    • defined as: two or more seizures experienced by a person 3% of pop
    • chronic disorder in which repeated unprovoked seizure activity occurs
    • may be caused by abnormality of electrical neural activity, an imb of neurotransmitters
    • chx of neuro transmission, birth, trauma, sepsis, meds, alchol and drug withdrawl
  17. Status epilepticus
    • seizure lasting longer than 5 mins or
    • repeated seizures over the course of 30 mins
    • potential complication of all seizures
    • medical emergency!!!!!!
    • seizure > 10 mins- death, airway
  18. different phases of seizures
    • pre ictal phase- pressence of an aura before the seizures
    • ictal- seizure activity occurs
    • post- ictal phase-recovery, amnesia
    • drowsy, sleeping, fatigue, confusion-agitation
    • breathing- airway, safety- decision making not good..like getting up to use batheroom
  19. assessment: seizure
    • determine the type of seizures:
    • frequently, length of time- when, where did it start from
    • description, movement, sequence patterns
    • precipating factor- aura
    • after seizure
    • history
    • pre existing injury- head, fam hx, alcohol and drug use, AED, meds (antiseizure
    • seizure diary**
    • - track aura
    • - percipating factors
    • - fam can document what happened
  20. diagnostics for seizure
    • pt hx
    • PE and description of seizures
    • EEG- best within 2 hr of seizure
    • dx tests: to rule out other causes
    • - CT, MRI, chem studies, drug levels
    • - ie brain tumor, mass, lytes imb, infection (sepsis)
  21. nursing management
    • priorities
    • assessments
    • nursing and medical care
  22. Nx care during seizure activity
    • Protect pt from injury:
    • maintain airway:
    • - airway protection
    • - nothing in pt's mouth
    • - positioning- on side
    • - monitor respiratory and cardiac status
    • Maintain safe environment:
    • - protect the head, loosen clothes ie tie
    • - lower the head of bed, pad rails
    • - do not restrain
    • guide movements
    • p 1961
  23. nx care during seizure activity 2
    • assessment and documentation
    • - seizure- movements, time, LOC
    • Support pt/fam
    • - provide privacy
    • Medication administration
    • - IV access- IV meds benzon diazpems
    • - rectal- diastat (diazpams)
    • - nasal spray- benzodiazepine (clinical trials)
  24. nc care of during seizure activity 3
    meds
    • Benzodiazepine- rescue medication:
    • IV lorazepam (ativan), diazepam (valium)
    • - incre GABA, suppresses foci and movement
    • s/e: CNS, hypotension, respiratory chx
    • NI: assess VS, RR
    • check IV push rate and compatiblity
  25. nx care of a pt after seizure
    • airway/breathing
    • assessments: VS, respiratory, cardiac, neuro
    • safety
    • positioning - on side, head slightly elev
    • support/privacy
    • - basic care needs
    • side rails up, help with incontinence
  26. medical manage of seizure meds
    • mainstay of seizure management
    • choice: seizure type, EEG, indivi pt, safety and PMH
    • objective: seizure control w/minimal side effects- balance but helping s/e
    • single drug therapy: initial
    • - monitor s/e
    • - drug level
    • - compliance
    • see pharm notes
  27. how do anticonvulsants work to dec seizure activity
    • decre discharge of neurons within the seizure focus- decr foci
    • suppress propagation of seizure activity from the focus to other areas of the brain - stop movement
    • incre seizure threshold
  28. Four basic mechanisms of action for AED
    • decr NA influx- nerve transmission
    • decr Ca influx- same
    • incr GABA
    • inhibit glutamate- dec neuronal activity
    • *** decr neuronal stim***
  29. medical management w/drugs
    • start with one dryg and if not working try another one
    • Phenytoin (dilantin)- dec Na reflux, raises seizure threshold, 10-20 small theura range, CNS, ginival hyperplasia
    • valproate (depakote)- , CNS, resp
    • lamtrigine (lamictal)-
    • keppra (levetiracetam)
    • ativan-
    • look at sheet
  30. Nx dx and teaching 1
    Knowledge deficient
    • knowledge deficit:
    • - medication therapy
    • - educate pt/fam
    • - seizure diary- aura
    • - driving after a seizure- usually 6m
    • - community resources
    • - ID bracelet
  31. NX dx and teaching 2
    fear
    • emotional support
    • collab w/heathcare team- emotional, occupational, financial
    • education
    • community resources, support groups
  32. nx dx and teaching 3
    risk for injury
    • prevention of seizure:
    • meds as prescribed- same time each day
    • drugs levels
    • reduce risk
    • healthy diet, exercise, and sleep (help prevent- cause poor nutrition, lack of sleep and exercise can make it happen)
    • f/u care
    • Safe environment--
  33. SUDEP
    • sudden unexpected death in epilepsy
    • respiratory arrest..
    • young adults
    • genetic predisposition
  34. Status Epilecticus and nursing management
    • medical emergency!!!!
    • treat promptly and aggressively- airway
    • stop seizure as quickly as possible- ativan- tonic-clonic worry about airway
    • - airway
    • - safety
    • - IV AED to stop seizure
    • - assess airway, breathing, VS, neuro, seizures
    • - blood- Chem (lytes and BS) CBC (infection, bleeding), drug levels (ellicit drugs/alcohol)
    • - positioning- side
    • - support- neuro
    • - f/u with neuro, daily AED

Card Set Information

Author:
Prittyrick
ID:
317054
Filename:
care of pt w/seizure disorder
Updated:
2016-03-12 00:09:24
Tags:
seizure
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how to take care
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