Seizures

Question 1

Seizures

Answer 1

• Abnormal episodes of motor, sensory, autonomic, or psychic activity (or a combination of these) resulting from a sudden, abnormal, uncontrolled electrical discharge from cerebral neurons
• SEIZURES MAY BE ASSOCIATED WITH AN UNDERLYING PATHOLOGICAL CONDITION

Question 2

Classification of seizures:

Answer 2

• Focal: originates in one hemisphere
• Generalized: occur and engage bilaterally
• Unknown: epilepsy spasms
• “Provoked” related to acute, reversible condition such as structural, metabolic, immune, infectious or unknown etiologies

Question 3

Epilepsy

Answer 3

at least two unprovoked seizures occurring more than 24 hours apart.

Question 4

Epilepsy PATHOPHYSIOLOGY:

Answer 4

• The underlying cause is an Abnormal, sudden, excessive, uncontrolled electrical discharge in the nerve cells in one section of the brain; these cells emit electrical discharges that result in change of LOC, motor/sensory ability and behavior.
• Epilepsy: chronic disorder with repeated unprovoked seizures.
• Chronic disorder
• Two or more seizures
• Group of syndrome, classified by specific patterns of clinical features
• Primary
• Secondary
• More common in children and older adults

Question 5

Generalized seizure

Answer 5

• Both hemispheres
• lasts 2-5 minutes

Question 6

Tonic Clonic (grand mal) seizure with LOC

Answer 6

• Aura or “sensation” may precede onset of actual seizure
• Two phases lasting about 2-5 minutes
• First phase (Tonic phase) muscles become rigid or stiff of arms and legs and loss of consciousness
• Second phase (Clonic phase) rhythmic jerking of extremities- may bite the tongue, incontinent
• Followed by fatigue and lethargy (lasts about 1 hour or less )
• TONIC = stiff muscles; CLONIC = jerking of extremities
  —- note time tonic started
  —- guide to floor/ blow by O2

Question 7

Absence (petite mal) Seizure

Answer 7

• Brief loss of consciousness (blank stare), immediate return to baseline
• Zone out and come back;
• Common in children.
• Often accused of daydreaming
• Brief (seconds) loss of consciousness (blank stare)
• Then continue what they were doing before seizure
• Followed by automatisms (or automatic behavior they have no control over)
• Lip smacking, picking at clothes

Question 8

Myoclonic seizure

Answer 8

• Brief jerking or stiffening of extremities/Single or Bilateral
• Jerking of one extremity, may only last a few minutes
• brief; 1 or both sides affected

Question 9

Atonic seizure

Answer 9

• Sudden loss of muscle tone, Falls lead to injury, Followed by postictal confusion
• Loss of muscle tone, falls to floor,
• Loss of consciousness for a few seconds, postictal confusion

Question 10

Partial seizure

Answer 10

one hemisphere

Question 11

Complex partial seizure

Answer 11

loss of consciousness

Question 12

Simple partial seizure

Answer 12

stays conscious; may have aura

Question 13

SECONDARY SEIZURE

Answer 13

CAUSED BY AN UNDERLYING LESION
- TUMOR
- BRAIN TRAUMA
OTHER CAUSES
- METABOLIC DISORDERS
- ACUTE ALCOHOL WITHDRAWALS
- ELECTROLYTE DISTURBANCES (HYPERKALEMIA, HYPOGLYCEMIA)
- HIGH FEVER
- SUBSTANCE ABUSE

Question 14

Epilepsy risk factors/ Causes

Answer 14

• Cerebrovascular disease (stroke)
• Hypoxemia
• Fever (childhood)
• Head injury
• Hypertension
• Central nervous system infections (meningitis/ encephalitis)
• Metabolic and toxic conditions
• Metabolic disorders
• Brain tumor
• Drug and alcohol withdrawal
• Allergies
• electrolyte imbalance
• high fever
• stroke

Question 15

Seizure Triggers:

Answer 15

• Missed medication (#1 reason)
• increased physical activity
• emotional stress/ anxiety
• Hormonal changes
• Dehydration
• Lack of sleep
• excessive/ extreme fatigue
• Photosensitivity
• certain foods and chemicals
• alcohol/caffeine consumption

Question 16

Seizures Nursing Process Assessment:

Answer 16

• Duration
• Frequency
• Triggers
• Check serum drug levels & patient compliance
• Aura?
• Patient knowledge

Question 17

Seizures Nursing Interventions:

Answer 17

• PATIENT SAFETY!
• O2 & suction at Bedside & IV access
• turn patient on side

Question 18

PLAN OF CARE FOR A PATIENT EXPERIENCING A SEIZURE

Answer 18

• observation and documentation of patient signs and symptoms before, during, and after seizure
• Nursing actions during seizure for patient, safety, and protection
• After seizure care to prevent complications

Question 19

POST SEIZURE (POSTICTAL)

Answer 19

• VITAL SIGNS
• NEURO CHECK (if asleep, try again in 15 min)
• KEEP ON SIDE
• ALLOW TO REST
• DOCUMENT

Question 20

Seizures Patient Teaching

Answer 20

• do not stop meds
• do not take OTC meds without MD approval
• keep med alert bracelet on
• check serum drug levels in am before taking drug
• use two forms of contraceptives
• call MD if unable to take medication due to N/V
• Do not take alcohol while on medications

Question 21

Seizures:
Assessment & Diagnostics

Answer 21

• Assessment and history
• CT
• MRI
• EEG

Question 22

Seizure safety

Answer 22

• Don’t force anything into the mouth
• Turn on the side
• Loosen clothing
• Do not restrain
• Prevent injury
• *IV access
• *Suction
• *O2

Question 23

Epilepsy Pharmacological: STOP THE SEIZURE

Answer 23

• Benzodiazepines:
  — Ativan (lorazepam)
  — Valium (diazepam)
• MOA: enhance GABA
• Nursing implications: short term effect, monitor liver
• Adverse effects: sedation (check ABC’s)
• Benzos for acute onset – 4mg loading dose
• Slow IVP over 2 min Monitor (ABC’s)

Question 24

Epilepsy Pharmacological: Anticonvulsant Medications (AED’s)

Answer 24

• Suppress NA influx (prevents neuron firing)
• Suppress CA influx (suppresses current generated by CA
• Increase GABA (inhibits neurotransmitter)

Question 25

Epilepsy Pharmacological: CONTROL/PREVENT SEIZURES

Answer 25

- Levetiracetam (Keppra) — most common - Phenytoin (Dilantin) — Not compatible with other drugs — dont push fast — monitor liver labs - Fosphenytoin - Carbamazepine (Tegretol) - Divalproex (Depakote)

Question 26

Status Epilepticus

Answer 26

- Acute prolonged seizure activity — wont stop seizing - Includes continuous seizures lasting at least 30 minutes - Medical emergency — Respiratory — Irreversible brain damage - Causes — Interruption of anticonvulsant medication, fever, concurrent infection, other illness

Question 27

Epilepsy medical management

Answer 27

- STOP THE SEIZURE AS QUICKLY AS POSSIBLE - ENSURE ADEQUATE CEREBRAL OXYGENATION - AIRWAY MANAGEMENT — noting in mouth — use nasal trumpet

Question 28

A CLIENT WITH A HISTORY OF SEIZURES IS PLACED ON SEIZURE PRECAUTIONS. WHAT EMERGENCY EQUIPMENT WILL THE NURSE PROVIDE AT THE BEDSIDE? SELECT ALL THAT APPLY.

Answer 28

A. OROPHARYNGEAL AIRWAY B. OXYGEN C. NASOGASTRIC TUBE D. SUCTION SETUP E. PADDED TONGUE BLADE A, B, D

Question 29

Losing brain cells during seizures Check CIWA