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NURS 347 EXAM 6 > Seziure Disorders > Flashcards

Seziure Disorders Flashcards

1
Q

What is a seizure ?

A

Sudden abnormal, excessive, electrical discharge of neurons in the brain

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2
Q

What is going on in the brain when a seizure is happening?

A

Paroxysmal; uncontrolled electrical discharge of neurons in brain that interrupts normal function

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3
Q

Seizure may accompany other discords or occur ___ without apparent cause

A

Spontaneously

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4
Q

Are seizures resulting from metabolic disturbances, like

Acidosis
Electrolyte imblanese
Hypoglycemia
Hypoxemia
Alcohol
Dehydration
Water intoxication

Considered epilepsy/seizures ?

And why?

A

No
Because it’s a underlying condition
And usually can be treated when underlying condition is fixed

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5
Q

What are the 4 extracranial diseases associated with seizures?
Heart ->
Lung ->
Liver ->
Kidneys ->

A

Hypertension
Systemic lupus erythematosus
Diabetes mellitus
Septicemia

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6
Q

What does epilepsy mean?

A

A seizure disorder

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7
Q

Since epilepsy is a seizure disorder, what else does that tell us? Define it

Usually caused by?

A

Condition in which a person has a spontaneously recurring seizures

And underlying chronic condition

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8
Q

In the United States, about ___ million people have epilepsy

And incidence increased in ___

A

3 million

Older adults

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9
Q

Etiology and pathophysiology
Many possible causes vary by ___
Mainly found in which race ?
Which type of people ?
Male or female?
High risk of epilepsy are in which disease?

A

Age
African American
Socially disadvantage
Makes
Alzheimer’s & stroke

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10
Q

For patients who don’t know the seizure disorder, it’s known to be called as?

A

Idiopathic generalized epilepsy (IGE)

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11
Q

Common causes during the first 6 months of life are ? (4) for seizures

A

Severe birth injury
Congenial birth deficits (CNS)
Infections
Inborn errors of metabolism

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12
Q

Common causes from ages 2-20
(4)

A

Birth injury
Infection
Trauma
Genetic factors

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13
Q

Common causes between 20-30
(3)

A

Structural lesions
- trauma
- brain tumor
- vascular disease

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14
Q

Common causes after 50?
(2)

A

Stroke
Metastatic brain tumors

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15
Q

In epilepsy, Abnormal neurons undergo spontaneous firing.

Where does firing of these neurons go to? (2)

( if activity involves whole brain, generalized seizure occurs )

What is the cause of this abnormal firing?

A

Adjacent or distant areas of the brain

Unknown

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16
Q

What is normally found in area of brain from which eplieptic activity arises?

A

Gliosis ( scar tissue )

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17
Q

Gliosis (scar tissue) is thought to interfere with normal what?

And this makes it more likely to ?

A

Chemical and structural environment of neurons

Fire abnormal neurons ( or have another seizure )

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18
Q

Notes
Genetic link

Genetic abnormalities may be the most important factor contributing to IGE, but difficult to separate from environmental or acquired influences

Some types of epilepsy run in families
Others type of IGE are related to specific genes

More than 500 genes play a role

A
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19
Q

What are the 3 classification of a seizure?

A

Determined by site of electrical disturbances
Divided into 2 major classes
Generalized and focal

Treatment is driven by type of seizure

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20
Q

Clinical manifestations of seizures may progress through several phases

Which are 4 of them ( name and define )

Notes
- not all patients have every phase

A

Prodromal - signs that precede seizures

Aural - sensory warning

Ictal phase - seizure

Postictal- rest and recovery

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21
Q

What are the 7 generalized onset seizure?

A

Tonic-clonic
Typical absence ( petit-mal )
Atypical absence
Myoclonic
Atonic
Tonic
Clonic

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22
Q

What is the most common seizure?

A

Tonic clonic

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23
Q

Tonic clonic ( also named as grand mal )
Is characterized by?
What is the tonic phase and time?
What is the clonic phase and time?

What are the 3 symptoms that occur?

A

Loss of consciousness and falling

Body stiffens ( 20secs )
Subsequent jerking of extremities
(30-40secs)

Cyanosis
Excessive salivation
Tongue/cheek biting

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24
Q

In the postictal phase ( after seizure, recovery and rest )
Patients are characterized by? (2)

Patient may sleep for ___
May not feel ___ for hours to days
They will no ___ of seizures

A

Muscle soreness and fatigue

Hours
Normal
Memory

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25
Q

What is a typical absence seizure ?

Usually happens only in?

May ceases as the child ?

Can be precipated by ? (2)

A

Usually occurs only in childern and rarely beyond adolescence

May cease as the child matures or develop into another type

Can be precipitated by flashing lights & hyperventilation

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26
Q

What is the typical symptoms of petit mal?
How does it last?
Often goes?
May occur up to how many times a day ?

What machine demonstrated pattern unique to this type of seizure?

A

Staring spell “daydreaming”

Few seconds
Unnoticed
100times

EEG

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27
Q

What is atypical absence seizure characterized by?

They usually have a what?
What type of behavior during seizure?
What behavior after ?

A

Staring spell with other manifestations that last longer than typical absence seizures

Brief warnings
Peculiar
Confusion

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28
Q

What is a myoclonic seizure?

This can be forceful enough that patients will end up ?

It can be brief seizure but also can occur in?

A

Charactered by sudden; excessive jerk of the body and extremities

Falling

Clusters

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29
Q

What’s atonic seizure?

This begins ___ and person falls

When does consciousness usually return?
( patients can resume normal activity immediately )

This has the greatest risk for ?

A

Involved tonic episode or paroxysmal loss of muscle tone

Suddenly

By the time the person hits the ground

Head injury

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30
Q

Tonic seizures are?

Patients often fall!!

A

Sudden onset of maintained increased tone in the extensor muscles

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31
Q

What is clonic seizures?

Followed by?

A

Begin with loss of consciousness and suddenly loss of muscle time

Limb jerking

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32
Q

What is a focal seizure caused by?

Where does it begin?

What does it produce?

A

Focal irritations

Specific region of cortex of brain

Signs and symptoms related to the function of the area if the brain involved

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33
Q

Focal seizures are also called?

A

Partial or partial focal seizures

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34
Q

Focal seizures are divided into 2
Simple and complex
Describe each forms of LOC
(1)(2)

A

Person remained conscious

Person has loss or change of LOC
Produce a dreamlike experience

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35
Q

What is simple focal seizure ?
It’s a sudden and unexplainable??

Patients may??

A

Person experiences unusual feelings or sensation that can take many forms

Feelings of joy, anger, sadness and nausea

Hear,smell, taste, see or feel things

36
Q

What is complex focal seizures
Patient will display what?
They’ll be doing ?
They have automatisms ( means ?)
Do they remember ?
How does it last?

A

Strange behavior

Lip smacking

Repetitive movements that may not be appropriate

Does not remember

Usually last for a few seconds

37
Q

Notes
If there is aura or warning before tonic clonic seizure. The aura or warning is really a partial seizure that generalized secondarily

Postictal ( Todd’s paralysis ) can develop focal weakness that resolves eventually

A
38
Q

Focal
Psychogenic seizures ( pseudo seizures ) or psychogenic nonepilepitic seizures occur how?

They resemble epileptic seizures

And they are accurate diagnosis how?

A

Triggered by Emotional events

Video or EEG

39
Q

NOTES & 1 question
People with seizure disorder have a higher mortality rate than general populations, especially those who suffer from a fall or loss consciousness.

Often death are due to accidents during a seizure
( sudden unexpected death in epilepsy ) SUDEP or otherwise known as???

A

Status epilepticus

40
Q

What is status epilepticus?

A

A state of constant seizure or seizures occurring in rapid succession without return of consciousness between seizures

41
Q

Status epilepticus is the most serious
___

It’s what type of emergency?

Can involve/occur in what?

Subclinical is what?

A

Complication of epilepsy

Neurologic

Any type of seizure

Status epilepticus in sedated patient
( usually easy to miss )

42
Q

Status epilepticus causes the brain to what?
Causes neurons to?

This resulted in?

A

Use more energy than is supplied

Become exhausted and cease to function

Permanent brain damage

43
Q

Tonic clonic status epilepticus
Also known as
Convulsive status epilepticus is the most common and most dangerous
Why/causes? (5)

And usually is fatal.

A

Cause
ventilators insufficient
Hypoxemia
Cardiac arrhythmias
Hyperthermia
Systemic acidosis

44
Q

Notes ; complications

Severe injury and death from trauma during seizure
- patients who lose consciousness are at greatest risk

Persons with epilepsy have a mortality rate 2-3 times the rate of the general population

A
45
Q

What is the most common complication of seizure disorders?

Notes
- social stigma still exists
- discrimination/limitations
- driving sanction

A

Effect on lifestyle

46
Q

What are disgsnostic studies we can use? (6)

A

History
EEG
Magnetoencepharkography
CBC
CT/MEI
MRA/PET

47
Q

NOTES

EEG will help determine the type of seizures and pinpoint the seizure focus
- many patients did not have abnormal findings

Magnetoencephalography
- greater sensitivity for detecting small magnetic field generated by neuronal a gory

CBC, serum chemistries and lice and kidney function to help rule out metabolic disorders

A
48
Q

Most seizures do not require emergency medical care because they are self limited and rarely cause bodily injury?

True or false?

A

True

49
Q

When we should intervene with seizures are when 3 things occur?
Which are

A

Status epilepticus
Significant body harm
First time seizure

50
Q

Seizures disorders are primarily treated with?

Which the goal of therapy is to?

Notes
- medications control seizures about 70% of patients
- 30% of patients who don’t respond are considers to be medically refractory epilepsy
( drug resistant epilepsy )

A

Anti seizure drug

Prevent seizures & toxic side effects

51
Q

How does drugs ( anti seizure meds ) help patients?

Notes
- about 1/3 of patients require a combination regimen for adequate control
- therapeutic drugs ranges are guides
- serum drugs levels are helpful

A

Stabilizing nerve cells membranes and preventing spread of the epileptic discharge

52
Q

True or false
Drugs for seizures disorder must be taken regularly and continuously often for a lifetime?

A

True

53
Q

So we as nurses much teach our patients to make sure of what? (2)

A

Follow the drug regimen
What to do when dose is missed

54
Q

Notes
Primarily drug for treatment of generalized tonic clonic and focal seizures

Phenytoin ( Dilantin )
carbamazepine ( Tegretol )
Phenobarbital ( Luminal )
Divalproex ( Depakote )
Primidone ( Mysoline )

A
55
Q

Notes
Primary drugs used to treated absence and myoclonic seizures

Ethosuzimide ( Zarontin )
Divalproex ( Depakote )
Clonazapam ( Klonopin )

A
56
Q

Notes
Broad spectrum drugs can be effective for multiple seizure types

Gabapentin ( Neurontin )
Lamotrigine ( lamictal )
Topiramate ( Topamax )
Tiagabine ( Gabitril )
Levetiracetam ( Keppra )
Zonisamide ( Zonegran )

A
57
Q

What is pregabqlin (Lyrica) used for ?

A

Add ones for control of focal seizures that are not successfully managed with a single med

58
Q

What do we use for status epilepticus medications?

Examples included? (2)

Which is followed by?

A

Benzodiazepines

IV Lorazepam( Ativan )
Diazapam (Valium)

Long acting drugs - phenytoin or phenobarbital

59
Q

Because of many anti seizure drugs they have a long half life
Which means it can be given ?
And patients will have an easier time ?

A

1-2X a day

Following medication compliance

60
Q

Anti seizure drugs should not be discontinued abruptly why?

A

Because it can precipate seizures

61
Q

What are common side effects of discontinued antiseziure drugs? (5)

A

CNS
diplopia
Drowsiness
Ataxia
Mental slowing

62
Q

When patients are having medications for there seizures, it’s important that nurses will assess for toxicity or side effects.
Doing what type of assessment? (5)

NONCOMPLIANCE IS A CONCERN!!

A

Nystagmus
Hand and gait coordination
Cognitive functioning
General alertness
Gingival hyperplasia with phenytoin

63
Q

Gerontologic considerations
The incidence is ??
You have to have caution with anti seizure drugs because?

Phenytoin may be an issue for older adults why?

Notes
Phenobarbital, Tegretol, Mysoline negatively affect cognitive function

Drug interactions with carbamazepine, phenytoin, phenobarbital

A

Higher !!

Changes and metabolism

Compromised liver function

64
Q

Notes
Newer anti seizure meds may be safer for older adults
And have fewer effects on cognitive function and less drug interactions

Gabapentin
Lamotrigine
Oxcarbazepine
Levetiracetam

A
65
Q

There are surgical interventions to remove the epileptic focus or prevent spread of epileptic activity in the brain

What are the 2 benefits of surgery?

A

Cessation or seizures
Reduction in frequent of seziured

66
Q

What is the most common surgical intervention?

Most patients (70%) of patients usually are what?

JUST TO NOTE, NOT ALL TYPES OF EPILEPSY BENEFIT FROM SURGERY!

A

Anterior temporal lobe resection

Seizure free after this procedure

67
Q

What are the 3 requirements of surgery?

A

Diagnosis
Adequate trial with drug therapy without satisfactory results

Electroclinical syndrome define

68
Q

There are other forms of therapy’s such as (3)

A

Vagal nerve stimulation
Ketogenic diet
Biofeedback

69
Q

How does vagal nerve stimulation help? (2)

Only used to adjunct to medications when surgery is not feasible

A

Electrode implanted in neck patient activated with magnet when seizure is sense

Interrupts synchronization of epileptic brain wave activity and stop excessive discharge of neurons

70
Q

What is the ketogenic diet?(2)
How does it work

A

High fat
Low carb

Ketones pass into the brain and replace glucose as an energy source

71
Q

Biofeedback is what?

A

To help patients maintain a certain brain wave frequency

72
Q

Notes
What is the nursing assessment ?
What do we want to ask?

A

Brith defects
Anoxic episodes
CNS trauma
Stroke
Metabolic disorders
Alcoholism
Exposure to metals
Hepatic or renal failure

Compliance with anti seizures medications, barbiturate or alcohol withdrawal cocaine

Family history
Headaches
Depression
Anxiety
Decreased sexual drive

73
Q

What are the 5 precipitating factors for a seizure?

M HK HG DE WI

A

Metabolic acidosis or alkalosis
Hyperkalemia
Hypoglycemia
Dehydration
Water intoxication

74
Q

When a patient is having a seizure what will we do for our assessment? (6)

AAAABC

A

Airway occlusion
Absent breathe sounds
Abnormal repository’s rate
Apnea ( itcal )
Bitten tongue
Cyanosis

75
Q

We’ll notice that a patient will be? (8)

A

Hypertensive
Tachy/Brady
Bowel/urinary Incontience
Excessive salivation
Weakness
Paralysis
Ataxia
Abnormal CT, MRI, EEG

76
Q

For tonic clonic we will notice? (7)

A

Loss of consciousness
Muscule tightening
Jerking
Dilated pupils
Hyperventilation
Apnea
Postictal somnolence

77
Q

For absence we will notice? (2)

A

Altered consciousness
Monitor facial motor activity

78
Q

Nursing assessment
Focal seizures
Simple(4)

A

Aura
Focal sensory, motor, cognitive or emotional phenomena

Motor seizure- unilateral marching

Starts in a small area with a tingling sensation and marches across the body

79
Q

Nursing assessment
Focal seizures
Complex (2)

A

Altered consciousness with inappropriate behaviors ( automatisms)

Amenisa if event
( can’t remember )

80
Q

What are the 3 nursing diagnosis?

A

Ineffective breathing
Ineffective self health management
Risk of injury

81
Q

Notes
Planning
- patient be free from injury
- have optimal mental/physical functions while taking anti seizure meds
- have satisfactory psychosocial functioning

A
82
Q

Health promotion
We want to tell patients to wear?
To follow what?
Assist to identify ?
Avoid what?

A

Helmets
Diet/exercise
Events or situations that trigger
Alcohol, fatigue and loss of sleep

83
Q

Notes
Acute intervention
Observe, treated and document!

A

Maintain patent airway
Support head
Turn to side
Loosen constrictive clothing
Ease to floor

Do not restrain patient or place anything in mouth

May require positioning and suctioning or oxygen after seizure

84
Q

Notes
Ambulatory and home care
Emotional support and identifications of coping mechanism to adjust to personal limits imposed by the disease

  • medical alert brackets
  • referrals to agencies and organization
A
85
Q

Evaluation is ? (5)

A

Good breathing pattern
No injury
Acceptance of disorder
Compliance
Therapy

NURS 347 EXAM 6 (17 decks)

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