Seizures Flashcards
(90 cards)
1
Q
Seizures are a
A
Transient, uncontrolled electrical discharge of neurons in brain, interrupting normal function
- sudden
2
Q
Causes of seizures
A
other disorders
febrile = mostly in kids
3
Q
Metabolic disturbances associated with seizures
A
acidosis
electrolyte imbalance (NA)
HYPOGLYCEMIA
hypoxia
alcohol or barbiturate withdraw
Dehydration or water intoxication
4
Q
The chronic version of seizures
A
epilepsy (NO CURE)
5
Q
Extracranial disorders associated with seizures
A
HTN
Heart, lung, liver, and kidney disease
Systemic Lupus Erythematosus
DM
Septicemia (all spetic ptsbc of meds)
6
Q
Seizure Disorders Causes
A
Genetic
Idiopathic
structural lesions
brian trauma
tumor in brain
vascular disease
Hx of metastatic brain seizures
7
Q
Do you hold meals for seizure pts on EEG?
A
No, causes hypoglycemia
8
Q
Seizures are not considered epilepsy if they occur bc of
A
metabolic disturbances
treat underlying cause
9
Q
Epilepsy
A
Chronic disease with a continuing predisposition to seizures with consequences
unprovoked and unpredictable
- neuro bio
psychosocial
social (2.2 million Americans
10
Q
Epilepsy higher in
age
ethnicity
gender
A
Young children and older adults
AA and socially disadvantaged populations
more in males
11
Q
Epilepsy is detected by
A
EEG
brain activity
12
Q
Epilepsy Patho
A
abnormal neurons
spontaneous firing
scar tissue (gliosis)
13
Q
Locating seizure focus is critical for
A
successful surgical interventions
14
Q
How do you determine where the seizure originated from?
A
at least 3 seizures during monitoring in the same spot
to determine the pattern of spread and extent of involvement
15
Q
If they separate locations, then they will give
A
medication back and intervention is not surgery
16
Q
If the seizure is only in one location, then
A
surgery could work better in the local term
17
Q
S/S of Epilsepsy
A
seizures
determined by site of electrical disturbances
2 classes (general and focal)
18
Q
Focal Seizures are located in
A
1 area
19
Q
Generalized seizures are located in
A
multiple parts of the brain
20
Q
Focal Seizures types
A
simple
complex
21
Q
Generalized Seizures types
A
Tonic-Clonic
Absence
Myoclonic
Atonic
Tonic
Clonic
22
Q
Which generalized seizures have probably altered consciousness?
A
tonic-clonic
absence
23
Q
Which generalized seizures have brief or possibly altered consciousness?
A
myoclonic
tonic
clonic
atonic
24
Q
Prodromal phase
A
only pt knows about it
behavior changes
25
Triggers of seizures
anything **extreme/excessive** (drinking and drug use, bright flashing lights, happiness, enjoyment, anger, staying up all night, stress, extreme **exercising** (cross-fit, weight-lifting competitions
**sepsis**
Induce seizures – by **stopping meds slowly, sleep deprivation**
26
Aural phase
sensory warning similar each time different between patients
27
Ictal phase
don't know when the phase hits unless pt is on an EEG
28
Postictal phase
already happened and recovery
29
Tonic-Clonic Phase
LOC and falling
(Tonic)the body stiffens with subsequent jerking of extremities (clonic)
cyanosis, excessive salvation, biting down,a nd incontience
30
Management of Tonic Clonic seizures
seizure pads,
fall risk,
never leave them alone (regardless of privacy),
SUCTION and to the
SIDE-LAYING(aspiration),
O2,
working IV (not when seizing) check patency
31
The postictal phase for tonic-clonic is characterized as
muscle soreness
fatigue
sleep for hours
not feel normal for hours to days
**no memory of seizures**
32
Tonic and Clonic phases last how long
10-20 sec
30-40 sec
33
Typical absence seizures
occurs in children
**precipitated by flashing lights and hyperventilation**
**staring spells "daydreaming**
- no response or s/s
34
typical absence seizure can occur how many times a day
100-1000s a day
each less than 10 secs
35
The longer the seizure =
more brain death
36
Atypical absence seizures are characterized by
staring spell with **eye blinking and chewing**
slight responsive
jerking lip mvmt
more than 10 secs
continue into adulthood
37
Myoclonic seizures
sudden, excessive jerk or twitch of body and extremities
- forceful enough to cause fall
- brief few seconds
-occur in clusters
- altered LOC, **CAUSES FALLS**
38
Atonic seizures aka
drop attack
39
Atonic seizure
involves tonic or paroxysmal loss of muscle tone
Suddenly and person falls
lasts less than 15 secs
remain conscious **resume activity immediately**
**risk for major head injury**
40
Tonic seizure
sudden onset of maintained increased tone in the extensor muscles
- in sleep only few seconds
affect both sides of the body
consciousness is usually preserved
41
Clonic seizures
begin with LOC and loss of tone suddenly
Rhythmic limb jerking may or may not by symmetric
rare
42
Focal seizures begin in
a specific region of cortex in one hemisphere and manifests in s/s of brian involved
43
Simple focal seizures
remains **conscious and alert**
unusual feelings or sensations
- joy, sad, nausea, anger suddenly
- new senses of things not real
44
Complex focal seizures
**loss of consciousness or alteration in awareness**
eyes remain open but no interaction
-strange behaviors
-automatisms: repetitive, purposeless actions
**Do not remember an activity started before or continued during seizure**
30 secs to 2 mins
tired and confused after
45
Psychogenic seizures
**misdx as epilepsy** not false
Hx of abuse or traumatic event
**Accurate diagnosis usually requires use of video-EEG monitoring**
46
Psychogenic seizures hx
Hx of abuse or traumatic event
47
Psychogenic seizures need
counseling
48
Status epilepticus (SE)
State of **continuous** seizure activity or condition when seizures recur in **rapid succession without return** to consciousness between seizures
**neurologic emergency**
49
How long does Status epilepticus (SE) last
longer than 2-5 minutes
50
Status epilepticus (SE) can occur with what type of seizures
any and all types
51
Status epilepticus (SE) is an emergency. why?
The brain needs more energy due to the prolonged time of the seizure (2-5 mins) and stops functioning = leading to death or permanent brain damage
52
Why is Status epilepticus (SE) more frequent in infants and the elderly?
comorbidities
53
Dx assessments for seizures
Hx and Physical (birth to present)
seizure hx
EEG
54
Drugs for Seizure Disorders
Focal
Carbamazepine
Fosphenytoin
Phenytoin
Valproic acid
Primidone
Phenobarbital
55
Drugs for Seizure Disorders
Generalized
Carbamazepine
Phenytoin
Phenobarbital
Valproic acid
Levetiracetam
56
Complications of seizure meds
sedation
mental dull
impaired memory and concentration
reason for fall risk and in beds
57
Goal of seizure tx
suppress neurons or control with acceptable effects
Reduce seizures to a level that allows the patient to live as normal a life as possible
Balance the desire for complete seizure control with acceptable side effects
58
How do AED drugs work?
suppress discharge of neurons with a seizure focus
suppress propagation of activity from the focus to the other areas of then brain
59
AED does what to the body on a chemical level?
suppress of Na, Ca influx
promote K
Block glutamate receptors
Potentiate GABA
60
What needs to be monitored on Antiepileptic drugs?
plasma drug levels
guide dosage adjustment
adherence
cause loss of seizure control
causes of toxicity
61
Education of Rx AEDs
importance of adherence (50%)
plasma levels
maintain frequency chart
*stop one med at a time if undesired*
62
New AED meds are
less complication
more expensive
63
Phenytoin (Dilantin)
**most widely used traditional**
**active against partial and generalized tonic-clonic**
suppress seizures w/o depressing CNS entirely
**selective inhibit of Na channels**
64
Phenytoin (Dilantin) Adverse Effects
**Gingival hyperplasia**
nystagmus (invol. eye mvmt) sedation, atatxia, diplopia, cog impaired
Measle like rash
Teratogen (need contraceptives)
**cardiac dysrhythmias and hypotension**
65
Gingival Hyperplasia
growth of gum tissue
- severe cases of removal of gum tissue
66
Phenytoin (Dilantin) decreases the effects of
contraceptives (need multiple forms)
warfarin
glucocorticoids
67
What meds increase Phenytoin (Dilantin) levels?
diazepam
isoniazid
cimetidine
acute alcohols
68
What meds decrease Phenytoin (Dilantin) levels?
Carbamazepine
phenobarbital
chronic alcohol
69
Phenytoin needs to be administered with
food
after oral hygiene care
70
Carbamazepine (Tegretol)
MOA: same as phenytoin but minimal effects on cognitive function
Used for bipolar disorder & trigeminal neuralgia
**suppresses sodium influx**
71
Carbamazepine (Tegretol) Adverse effects
bone marrow suppression
attention for infections
72
Valproic acid (Depakene, Depakote)
1st line drug for all partial & generalized seizures
used for bipolar disorder & migraine prevention
73
Valproic acid (Depakene, Depakote)
adverse effects
hepatotoxicity
pancreatitis
teratogenic
74
Phenobarbital
**Reduce seizures without causing sedation**
75
Phenobarbital causes
physical dependence
low effect of warfarin and birth control
drowsiness with the metabolism of Vitamin D and K
nystagmus
ataxia
76
Acute withdraw from Phenobarbital can cause
Status epilepticus
77
Oxcarbazepine (Trileptal)
newer AED
block voltage-sensitive Na channels
**Manage partial seizures**
children and adults
78
Oxcarbazepine (Trileptal)
adverse effects
dizzy
drowsy
**avoid driving and other activities**
79
Lamotrigine (lamictal)
blocks Na and Ca channels
**-life-threatening rash
-risk for suicide**
- risk of seizures
80
Gabapentin (Neurontin)
usually used for neuropathy, prophylaxis migraine, fibromyalgia, post-men hot flash
**very well tolerated**
primary or secondary therapy
81
Gabapentin (Neurontin)
common side effects
somnolence
dizzy
ataxia
faigue
nystagmus
peripheral edema
82
Pregabalin (Lyrica)
Neuropathic pain and neuralgia
partial seizure combined
83
Pregabalin (Lyrica)
adverse life-threatening
angioedema
84
Levetiracetam (Keppra)*****
not interact with other AEDs
unknown MOA
helps with seizures
not bing with neurotransmitters
85
Topiramate (Topamax)
broad antiseizure
86
What drugs are given for management of acute and Status Epilepticus
**Lorazepam (Ativan)**
given during seizure
effects last up to 72 hours
Diazepam (Valium)
short duration
Phenytoin (Dilantin)
Fosphenytoin (Cerebyx) less irritating
Magnesium Sulfate
87
Epilepsy Therapies
surgical tx (neurosurgery and vagal nerve stimulation)
88
Nursing Management of Seizures
free from injury
optimal functioning
satisfactory psychosocial functions
educate
rest and not extreme exercise
avoid stress
hx of risk factors
89
Pt is prescribed phenytoin for epileptic seizures. Which of the following is the priority for pt teaching?
a -Teach pt to adjust the dose according to the presence of s/s
b -Tell pt to take meds with meals
c - Inform the pt about prevention of gingival hyperplasia
d -Teach pt to avoid the abrupt cessation of tx
d -Teach pt to avoid the abrupt cessation of tx
90
In TX, how long do you need to wait to drive after a seizure?
3 months
