neuro (class 9) seizures

Question 1

seizures

Answer 1

occur when there is abnormal electrical discharge in the neurons in brain. Temporary.
disturbs skeletal muscle function, sensation, autonomic function, behavior and or consciousness.

Question 2

epilepsy

Answer 2

recurring seizures, variable frequency. prevalence & incidence increases in older adults

Question 3

risks/triggers

Answer 3

fatigue, fever, hypoglycemia, acid/base imbalance, IICP, tumors, ETOH, meds, constipation, hyperventilation, meses as well as individual factors like flashing lights, certain odors, music/sounds

Question 4

Prodomal stage

Answer 4

can begin days before for some.

individual: emotional changes, fatigue, GI, urinary symptoms.

Question 5

AURA

Answer 5

immediately prior to onset of seizure for some types of seizures.
individual: smells, vision change, auditory hallucination

Question 6

ICTUS

Answer 6

actual seizure event

Question 7

Post-ICTUS

Answer 7

recoveray after seizure.

variable length of time (can be up to days), initially unconscious, confusion, fatigue, sleepiness.

Question 8

Focal Seizures

PARTIAL

Answer 8

start in and affect one hemisphere

Question 9

Focal seizures

manifestations

Answer 9

dependent on area of brain affected:
may remain conscious but can be altered.
motor: recurrent muscle contraction of the face or contralateral part of the body (often hands)
sensory: abnormal sensation, smells, tastes, numb/tingling, hallucinations
autonomic: tachycardia, flushing, hypo/hypertension, psychic sensation like Deja vu, emotions.

Question 10

generalized seizures

Answer 10

affect both sides of brain and deeper brain structures

lose consciousness.

Question 11

ABSENSCE

Answer 11

more common in children.
brief cessation of motor activity.
blank stare, unresponsive.
automatisms & eyelid fluttering may occur.

Question 12

TONIC-CLONIC

Answer 12

most common type, last 60-90 seconds.

aura is possible & pt will experience sudden loss of consciousness.

Question 13

TONIC

Answer 13

muscles rigid, often cry out, arms & legs extended & back is arched jaw clenched, incontinence of bladder and bowel possible, breathing ceases, become cyanotic.

Question 14

CLONIC

Answer 14

alternating contraction & relaxation of extremities, hyperventilation, eyes roll back, frothing at mouth, subsides gradually.

Question 15

Post-ICTAL

Answer 15

unconscious & unresponsive to stimuli, event amnesia.

Question 16

precautions

Answer 16

think about who might be at risk. ETOH withdrawal, high fever, CNS infection, substance abuse, any history of epilepsy, alzheimers, head trauma, CVA hx.

make sure have functional IV access

suction, oxygen available

padded bed rails

keep bed in low position

ask your pt with seizure history about triggers, prodromal/aura associated

any change to seizure med orders? NPO? DRUG LEVELS?

Question 17

electroencephalogram EEG

Answer 17

helps localize any brain lesions and confirm the diagnosis, assesses brain activity. no caffeine x8 hrs, withhold seizure meds or other meds impacting CNS, clean, dry hair.
may have sleep restrictions

Question 18

lumbar puncture

Answer 18

to assess spinal fluid for CNS infections (increased wbcs) or tumors (increased protein)

Question 19

MRI or CT scan

Answer 19

to determine abnormalities in the brain

Question 20

skull x-ray

Answer 20

to identify any bone abnormalities

Question 21

seizure medication

Answer 21

goal to reduce or prevent seizure activity without impairing cognitive function. lowest effective dose.

not a cure.

Question 22

potentiate GABA

Answer 22

benzodiazepines (–pam,) very effective IV in acute seizures, status epilepticus.

barbituates (phenobarbital, primidone)

gabapeninoinds (gabapentin, pregabalin)

side effects: drowsiness, respiratory depression, ataxia, hypotension.

Question 23

suppress sodium influx into cells

Answer 23

stops NA channel activation, limits action potential of neuron

levetiracetam- attaches to SV2A on surface of neuron and that this attachment reduces the backlog of signals.

phenytoin- restrics sodium entry GUM hyperplasia is a thing, need good oral and dental care.

sodium valproate- not safe for women of childbearing age.

Question 24

surgery

Answer 24

remove foci surgically.

implanted vagus nerve stimulator

deep brain stimulator

Question 25

other treatment options

Answer 25

ketogenic diet.

cannabis.