Chapter 28: Seizure Disorders and Epilepsy (Children) Flashcards
(41 cards)
Seizure
an electrical disturbance within the brain, resulting in changes of motor function, sensation, or cognitive ability
-classified according to the area of the brain experiencing the abnormal electrical activity and the neuromuscular sensory and psychogenic alteration from the electrical conduction disturbance
Seizures can result from?
a traumatic brain injury, an infection in the central nervous system, toxic ingestion, endocrine dysfunction, atrial-venous malformation, or an anoxic episodes
-neonates may develop seizures b/c of intrapartum or postpartum anoxic episodes, maternal ingestions or exposure to teratogens, and prenatal infections; hypoglycemia and congenital malformations can also cause neonatal seizures in the first month of life
Febrile Seizures
-common form of first-time seizure in childhood
-usually seen in children younger than 3
>Simple febrile seizure: a brief (less than 15 minutes), generalized episode that occurs only once during a 24-hour period in a febrile child without any evidence of metabolic imbalance, history of prior febrile seizure, or intracranial infection
>Complex febrile seizure: lasts longer than 15 minutes and recurs within 24 hours
-antipyretics and anticonvulsant therapy may be administered
Diagnosis
-neurological testing; used to determine the etiological epileptic focal center in the brain causing the abnormal electrical activity
-in-depth testing of the neurological system helps to classify the type of seizure and determine appropriate anticonvulsant therapy
-neurological exam: consists of a cranial nerve assessment, deep tendon reflex, sensory and motor response, LOC, and hearing and pupil checks
>CT scan or MRI performed to look for CNS malformation, lesions, neoplasms, hemorrhage, trauma, foreign body, or edema
>angiography: to assess for arteriovenous malformations that may be hereditary
>Electroencephalogram (EEG) is the accepted standards for diagnosing a seizure disorder
>Positron emission tomography (PET) scans are performed if brain structures require outlining or mapping before a surgical procedure, but not indicated for seizure evaluations
New on-set seizures may suggest what?
malignant neoplasms and warrant emergent neuroimaging
What test is the accepted standards for diagnosing a seizure disorder?
Electroencephalogram (EEG)
>evaluates the electrical activity of the brain while the brain is in a sleepy or drowsy state and also when stimulated
-loud noises, bright lights, and rapid flashing images are presented during the procedure, and the resulting electrical brain wave response is graphed
>Video EEG can also be done if the EEG is inconclusive or if the child experiences sleep and walking onset seizures
Pseudoseizures
false seizures
-evaluated as neurological episodes until determined to be psychological or not pathological in nature and etiology
Partial (Focal) Seizure
localized to one area
- one area is affected: hands, lips, wrist, arms, or face
- impaired loss of consciousness at onset
Partial Complex (psychomotor) Seizure
- location: temporal lobe
- loss of consciousness and loss of awareness of surrounding
- changes in behavior (lip smacking, picking, inappropriate mannerisms, confusion) follow the seizure
- evolve to a generalized seizure
Partial Simple Seizure
- lasts 5 minutes
- child only remembers the aura (feeling before the seizure that something bad is going to happen)
- automatisms are noted (brief unconscious behaviors)
- no loss of consciousness or awareness
- motor signs are isolated to one area of the body and then spread to the rest of the body
- may experience senses such as buzzing sounds, tingling, flashing lights, anxiety, fear, or anger
- evolve to generalized seizures
Generalized: Toxic-Clonic Seizure
- Cause: genetic predisposition or brain injury secondary to anoxia
- partial simple and complex seizures evolve to this
- aura is experienced followed by loss of consciousness and tone
- patient falls to the floor with tonic-clonic muscle contractions
- patient is postictal and confused after the seizure is over
- loss of urine may occur
Generalized: Atonic Seizures (Absence/ petit mal)
- loss of muscle tone; drop attacks
- sudden drop to the floor caused by loss of motor muscle tone
- seen in children 2 to 4 years of age
- no loss of consciousness; but loss of awareness
- non-convulsive
- periods of staring or minor movements lasting seconds
- may occur several times a day
- interferes with learning and schoolwork
Generalized: Tonic Seizures
- stiffening of the body that is sustained
- involving all four extremities
Generalized: Myoclonic Seizures
- cause: metabolic etiology
- single or multiple jerks or flexion of limbs
Generalized: Clonic Seizures
-intermittent rhythmic jerking, 1-3 per second; may start in one body location and move to another location
Generalized: Myoclonic and Akinetic Seizure
complete or total lack of movement
Causes of Epilepsy
preventable events such as traumatic and/or anoxic brain injuries, brain infections, or stroke
Nursing Care
- completes a detailed history of the seizure event
- in depth review of child’s prenatal and postnatal history
- review of systems
What must be included in the seizure event history?
- antecedent events that may have precipitated the seizure (e.g. dehydration, videogaming, exercise, or any ingestion of substances that may cause seizures)
- type of activity during the seizure
- any loss of consciousness
- loss of urine
- noises made
- cyanosis
- history of present illness
- a family history and type of seizure activity
Seizure Management
- collaborative effort
- determined by the type of seizure
- if pathological (disease) in origin, managed medically until cause can be resolved
- if cause is a brain tumor, the mass is excised
- if caused by endocrine dysfunction, it is resolved
- if infection, antibiotic therapy
- if unknown and no structural abnormality, placed on anti-convulsant therapy for the type of seizure being experienced
What is The Priority Nursing Intervention for Child Experiencing Seizure?
Airway Management
- continuous monitoring of respiratory status b/c seizure medications can cause a decreased LOC, apnea, and hypotension
- also, after the postictal phase, the child may need to be reoriented
- maintain airway patency; ensure nothing is placed in the child’s mouth during a seizure; a loose tooth may be aspirated or knocked out; suctioning may be necessary after the seizure is over
The Hospitalized Child
-receives continuous cardiac, respiratory, and oxygen monitoring
Seizure Precautions
- maintain airway patency; ensure nothing is placed in the child’s mouth during a seizure; a loose tooth may be aspirated or knocked out; suctioning may be necessary after the seizure is over
- monitor oxygen saturation; the child’s color should remain pink; pulse oximeter should read 95% or greater and the heart rate normal or slightly raised
- administer IV medications; give the medication slowly to reduce risk of side effects such as respiratory or circulatory failure
- raise and pad the side rails when in bed or crib; needs to be protected from injury
- have child war a medical alert bracelet
- provide emotional support to child and family; allow the child and family to express their feelings, offer a support group, and remind the family to treat the child as normally as possible
Emergency Care for the Child Having a Seizure
- In community setting, call 911
- In a hospital, use the designated emergency number
- Maintain a patent airway; if the airway is occluded, open the airway with a jaw thrust maneuver; administer oxygen if needed and available; do not put anything in the mouth; if the situation warrants emergency medical care, qualified health-care personnel can insert an appropriate-sized oral airway
- loosen restrictive clothing to ensure adequate circulation to essential body organs
- administer medications such as diazepam (Valium), lorazepam (Ativan), or fosphenytoin (Cerebyx) as ordered; not administered to a neonate b/c they are toxic as a result of immature liver function
- monitor respiratory status and circulatory status throughout the seizure
- position the child in a lateral position to prevent aspiration
- inform the child that he/she has just had a seizure; tell the family that the child may still be confused and disoriented for a short time
- stay with the child; support is essential b/c a seizure is frightening to both child and family
- document all important details about the seizure, the care provided, and the condition of the child after the seizure and give notification to the physician
