Seizure

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Author:
kalioppi86
ID:
65337
Filename:
Seizure
Updated:
2011-02-09 17:14:11
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Seizure
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Description:
Seizure
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  1. What is a seizure disorder?
    • escessive and abnormal discharge of electrical activity of all or part of the brain
    • - hypersensitive, hyperactive, unstable neuron activity
    • - neurons initiate seizure activity from epileptic focus
    • - localized or entire focus

    affecs motor function, sensation, autonomic function of organs, behavior, consciousness
  2. Epilepsy
    • a chronic seizure activity vs. isolated incidences
    • - idiopathic
    • - secondary to birth injury, hypoxia, trauma, infection, metabolic, endobrine, toxins, tumor

    onset usually occurs before age 20
  3. Partial Seizures
    begin in one area of cerebral cortex; symptoms depend on area involved
  4. Simple Partial Seizure
    • has no loss of consciousness, usually in one hemisphere
    • usually motor portion of cortex-muscle ctx of contralateral part of body confined to one area

    ie. hand, face
  5. Jacksonian Seizure
    simple partial that spreads sequentially to adjacent parts
  6. Complex Partial Seizure
    • consciousness impaired
    • automatisms = repetitive, nonpurposeful activity

    ie. lip smacking, picking, aimless walking; amnesia
  7. Generalized Seizures
    involves both hemispheres, deeper brain structures - thalmus, basal ganglia, upper brain stem

    consciousness is always impaired
  8. Absence Seizures
    (petit mal)
    brief cessation of motor activity with blank stare and unresponsiveness; 5-10 secs
  9. Tonic-Clonic Seizures
    (grand mal)
    begins with loss of consciousness and sharp tonic muscle contractions --> air forced out of lungs -- falls to opisthotonic posture = rigidity, extension, jaw clenched; incontinence; no breathing - cyanosis; pupils fixed and dilated; lasts 15-60secs

    clonic phase follows - alternating contractions and relaxation of muscles in all extremities with hyperventilation; eyes roll back; froths at mouth; 60-90sec
  10. Generalized Seizures
    Postictal Phase
    lasts 60-90 secs

    unconscious, unresponsive to stimuli, relaxes, breathes easily --> slow waking with confusion, disorientation, sleep, amnesia, injuries from fall
  11. Generalized Seizures
    Status Epilepticus
    continuous, with short breaks between intense, persistent seizures

    CALL 911 d/t hypoxia

    administer Diazepam q10"

    May need surgery; vagal nerve stimulator
  12. Assessment for Seizures
    • - Developmental history: pregnancy, childbirth events
    • - Medical history: illness, infection, fever, head injury
    • - Seizure history: alcohol or drug abuse, warning or aura, observational info about seizures
  13. Observations during the seizure
    • - changes in pupil size and eye deviations, fluttering
    • - LOC, time to return to pre-seizure status
    • - presence of apnea, syanosis, salivation
    • - invontinence of bowel, bladder
    • - movement and progression of motor activity
    • - lip smacking or other automatism
    • - tongue or lip biting
  14. Lab and Diagnostic Testing
    • Diagnostics:
    • - EEG, XR, CT, LP, ECG
    • - EEG Video recording
    • - No hairspray, oily products in hair. Light meal within 4hrs *Avoid caffeine, no stimulants 24-48hrs prior
    • - may restrict sleep night before

    • Labs:
    • - CBC, electrolytes, BUN, glucose, syphilis

    Ongoing Research
  15. Nursing Diagnosis for Seizures
    • - Risk for Inefffective airway clearance
    • - Risk for injury
    • - Fear
    • - Ineffective coping
    • - Knowledge deficit
  16. Nursing Interventions
    • - Protect from injury; loosen clothing
    • - Maintain ABC's
    • - Neurologic checks; VS
    • - Keep on side until responsive
    • - Allow to rest

    • DO NOT
    • - force anything into the mouth
    • - restrain
  17. Nursing Interventions
    • Document
    • - date, time, duration
    • - description of activity: tonic, clonic, staring, blinking, automatisms
    • - sequence of seziure progression, aura

    • If status epilepticus
    • - oxygen via mask or nasal
    • - establish IV access and begin 0.9% saline
    • - administer drugs as ordered: Valium IV repeat q10min
    • - monitor VS and cardiac rhythm
    • - have suction ready
  18. Patient Education
    • - correct misconceptions, fears, myths
    • - resources: Epilepsy Foundation of America
    • - encourage expression of feelings, positive
    • - follow up care
    • - laws
    • - employment, voc counseling; safety issues
    • - medic alert band - type of SA and meds
    • - Aura alert
    • - medication compliance-exactly as prescribed
    • - alcohol, caffeine, stress, lack of sleep, upset
    • - triggers for SA
    • - safety-med SE's *Dilantin- oral hygiene*
  19. Medications
    • Anticonvulsants
    • - Dilantin/Phenytoin (gingival hyperplasia)
    • - Depakote/Valproate
    • - Tegretol/Carbamazepine
    • - Klonopin/Clonazepam
    • - Neurontin/Gabapentin
    • - Lamictal/Lamotrigine

    Valium, Ativan, Phenobarbital

    • Nursing responsibilities
    • - VS, LFT's, therapeutic drug levels
    • - CNS side effects: sedation, drowsiness, dizziness, confusion; vision and speech changes
    • - may need diet rich in Vit D if prolonged therapy
    • - IV administration

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