T3 - Seizures in Children (Josh)

Question 1

Most seizures happen when?

Answer 1

first years of life

Question 2

Seizure results from what/

Answer 2

overly active and hypersensitive neurons in brain that trigger electrical discharges

Question 3

Categories of seizures:

Answer 3

General

Partial

Unclassified (ex: neonatal)

Question 4

Examples of General Seizures:

Answer 4

Tonic-Clonic (Grand Mal)

Abseence (Petite Mal)

Question 5

What is the Tonic and the Clonic in Tonic-Clonic?

Answer 5

Tonic = stiffening of body

Clonic = clonic muscle actiivty

Question 6

– involves recurrent and continuous generalized seizure activity with dangers of cardiac arrest and brain damage.

Answer 6

Status epilepticus

Question 7

– refers to rare disorder seen in the first few months of life that is characterized by flexion of the neck ,trunk or legs.

Answer 7

Infantile spasm

Question 8

Examples of Partial Seizures

Answer 8

Simple Partial

Complex

Question 9

– characterized by maintenance of consciousness . They may also include a focal motor compartment- abnormal movement of leg, sensory component- smell , sound, taste and autonomic component- sweating, or psychic component -deja vu or anger.

Answer 9

Simple partial seizures-

Question 10

– begin as simple and progress to unconsciousness. The child may stop whatever she’s doing and engage in purposeless movement- lip smacking or wandering.

Answer 10

Complex seizures

Question 11

Name the seizure:

Staring, eyes roll upward, change in LOC

Teacher may think student isn’t paying attention in class

Answer 11

Absence (petit mal)

Question 12

Name the seizure:

alteration of consciousness and may include lip smacking, or repetitive motion (picking, pulling)

Answer 12

Complex Partial Seizure

Question 13

Phases of a Grand Mal

Answer 13

Aura Phase

Tonic Phase

Clonic Phase

Postictal Phase

Question 14

First phase of Grand Mal

Answer 14

Aura Phase (Early Seizure Phase)

the child may see, hear, smell or taste something unusual.

This phase may not occur in some children.

Question 15

Second phase of Grand Mal

Answer 15

Tonic Phase (Stiffening Phase)

In this phase the child may experience a change in color, lose consciousness or become very stiff and rigid.

you may notice arching of the back, and extending of arms and legs. the child may fall if standing. the child may give a high pitched, shrill cry or snap his/her jaw shut, sometimes biting the tongue.

(Do not put anything in the child’s mouth).

Question 16

Third phase of Grand Mal

Answer 16

Clonic Phase (Jerking phase)

Child may have rapid jerking movements on both sides of his/her body, tightening (flexing).

Breathing may be fast and loud with increased or decreased heart rate. The child may clench fists and teeth, and drip his/her head backwards. You may notice sweating and drooling.

This phase may last 2-5 minutes.

Question 17

Fourth phase of Grand Mal

Answer 17

Postictal Phase (After Seizure Phase)

In this phase the child will slowly regain consciousness after several minutes, relaxing his/her muscles.

The child may complain of tiredness, muscle aching, or headache. He/she may seem confused, or may sleep.

(you should be able to arouse the child.)

Question 18

What typically happens w/ a tonic-clonic?

Answer 18

incontinence

Question 19

How many phases are there w/ Grand Mal (Tonic Clonic)?

Answer 19

Four

• Aura Phase
• Tonic Phase
• Clonic Phase
• Postictal Phase

Question 20

Videos

Answer 20

watch the vids in the ppt

Question 21

Types of labs for seizures

Answer 21

EEG will document abnormal activity

CBC Blood chemistry to identify underlying disorder such as metabolic disturbances.

Serum medication levels to monitor therapeutic levels of meds

Question 22

Nursing management of Seizure Disorders:

Answer 22

Assess the child and obtain a thorough history

Administer prescribed meds

Document all seizure activity

Help prevent seizures

Promote optimal growth and development and minimize child’s anxiety

Prepare the family for alternatives treatments when necessary such as surgery and vagus nerve stimulator.

Assess for safety and provide interventions as needed per patient seizure plan such as meds , oxygen and suction

Provide emergency interventions such as CPR

Question 23

What should we do while we’re holding the patient during seizure?

Answer 23

time it (look at watch)

protect child from hurting self

begin O2

Call for help

Objective facts (deviation of eyes, what portion of body, types of mvmt)

Question 24

Should we restrain child?

Answer 24

Don’t try and restrain a seizing child, just keep him safe and away from harm.

Question 25

Should we put a tongue blade to protect from biting tongue?

Answer 25

no

Don’t put anything in his or her mouth, this is unnecessary and can cut the mouth, injure a tooth, cause vomiting, or result in a serious bite of your finger.

Question 26

Can they actually swallow tongue in seizure?

Answer 26

no

Question 27

T/F: Most seizures are dangerous.

Answer 27

False

most are harmless

Question 28

T/F: we should hold tightly and hinder patient during seizure.

Answer 28

False

don’t hinder patient movement during seizure

Question 29

Should we let the child sleep after the seizure.

Answer 29

Yes, if they want to

• the brain is temporarily exhausted and there is no point in trying to keep the child awake

Question 30

What should we teach parents of children w/ frequent seizures?

Answer 30

activity restriction may be necessary

wear helmets

Question 31

Seizure Meds

Answer 31

see slide 23 about page #s

Question 32

Ketogenic diet

Answer 32

see slide 24 about page #

Question 33

What about ketogenic diet must we teach parents?

Answer 33

The family must make an effort to make the high-fat diet appealing to the child on a ketogenic diet, despite their personal feelings about eating large amounts of food such as mayonnaise

Question 34

VNS is designed to prevent seizures by –

Answer 34

sending regular mild pulses of electrical energy to the brain via the vagus nerve

Question 35

VNS is –

Answer 35

Vagus Nerve Stimulation

Question 36

– is sometimes called the “pace maker for the brain”. It is placed under the skin on the chest wall and a wire runs from it to the vagus nerve in the neck.

Answer 36

Vagus Nerve Stimulation (VNS)

Question 37

How is VNS used?

Answer 37

The neurologist programs the strength and timing of the impulses according to each patient’s individual needs.

The settings can be programmed and changed without entering the body just by using a programming wand connected to a laptop computer.

The devise is programmed to go on for a certain period and then to go off for another period. The devise runs continuously, usually the patient is not even aware.

Question 38

A/E of VNS.

Answer 38

• don’t hold magnet close to it (activates it outside programed interval)
• sleep apnea
• voice alteration
• coughing
• pharyngitis
• throat pain