Seizures and Meningitis

Question 1

seizure

Answer 1

a burst of uncontrolled electrical activity between neurons, results in transient abnormal movements, muscle tone, behavior, sensation and/or altered LOC

Question 2

focal seizure

Answer 2

originate from one specific location in the brain and affect 1 hemisphere (“partial seizures” can be w/ or w/out loss of consciousness

Question 3

focal seizure without loss of consciousness

Answer 3

• previously “simple partial seizure”
• affects one hemisphere of brain
• pt remains alert and able to recall the event
• usually seconds to 2 minutes
• s/s: blank staring, unilateral extremity movement, odd sensation, or autonomic signs
• may forewarn a larger impending seizure

Question 4

focal seizure with loss of consciousness

Answer 4

• previously “complex partial seizures”
• affects one hemisphere of brain
• patient not aware of surroundings
• typical duration 1-2 minutes
• s/s: automatisms = hallmark movements such as lip smacking, swallowing, picking with fingers, verbal sounds

Question 5

generalized seizures

Answer 5

• not isolated to 1 area of the brain, both hemispheres affected
• always result in loss of consciousness

Question 6

tonic-clonic

Answer 6

initial stiffening of muscles followed by rhythmic jerking movements

Question 7

tonic

Answer 7

abrupt loss of consciousness and muscle stiffening without the myoclonic jerking. Often has autonomic changes.

Question 8

atonic

Answer 8

sudden loss of muscle tone, often causing a fall

Question 9

myoclonic

Answer 9

rhythmic muscle jerking which can be symmetric or asymmetric

Question 10

causes of seizures

Answer 10

• infectious state/fever
• sleep deprivation
• illicit drug use
• hyponatremia
• withdrawal from antiepileptic meds, etoh
• stroke
• low blood sugar
• head trauma
• brain tumor
• epilepsy

Question 11

epilepsy

Answer 11

CNS system disorder caused by abnormal electrical impulses in the brain which result in seizures
- diagnosis requires 2 unprovoked seizures (NO other identifiable cause exists)

Question 12

tx of epilepsy - meds and education

Answer 12

antiepileptic drugs (AEDs)

• can cause leukopenia or liver dysfunction - routine labs: CBC, AST, ALT, etc
• dentist: gingival hyperplasia can occur w/ phenytoin
• important to take same time daily
• tolerance can build over time - lab monitoring of drug levels

Question 13

tx of epilepsy - non pharm

Answer 13

• vagal nerve stimulation: implanted device gives bursts of electricity to vagus nerve -reduces seizures 20-40%
• deep brain stimulation: electrodes placed in brain parenchyma, generator in chest. electrical impulses disrupts random bursts which cause seizures
• ketogenic diet
• CBD

Question 14

SEEG

Answer 14

minimally invasive insertion of electrodes into brain to pinpoint where seizures originate

Question 15

bedside care of epileptic pt

Answer 15

gather info: preceding sx (aura), LOC, duration, tonic/clonic movements

precautions: bed in low, padded bed rails, have at least 1 IV, oxygen and suction ready in room

Question 16

what to do during seizure

Answer 16

move everything out of pts way - don’t restrict movement

• O2 and suction ready
• pt on side
• nothing in mouth
• document onset

Question 17

preictal

Answer 17

before the seizure

Question 18

ictal

Answer 18

during the seizure

Question 19

post ictal

Answer 19

time after the seizure - pt may have continue to have decreased LOC, be fatigued, have muscle soreness, difficulty reading/writing/speaking

Question 20

seizure threshold

Answer 20

lowest amount of stimulation required to induce a seizure

- some meds can lower the threshold (some abx, some pysch meds, SSRIs, Propofol, Cyclosporin)

Question 21

status epilepticus

Answer 21

medical emergency - seizure lasting >5 min or more than one seizure in 30 min timeframe without return to neurologic baseline

tx: 1st choice Benzos (Lorazepam or Midazolam)

Question 22

psychogenic non-epileptic seizures

Answer 22

episodes appear like seizures, but are caused by psychological factors (somatoform disorder)

• 20-30% of intractable seizures
• often caused by trauma, EEG doesn’t show epileptic activity
  tx: work with psychiatrist, EMDR

Question 23

meningitis types

Answer 23

inflammation of meninges

• bacterial: strep, N. meningitidis (have vaccines) avg age 20
• viral: most common (usually <5 yrs old)
• fungal: uncommon, usually seen in immunocompromised pts

Question 24

s/s meningits

Answer 24

• altered mental status
• HA maybe with N/V
• malaise
• fever
• Nuchal rigidity (neck) - Kernig’s sign, Brudzinski’s sign
• nystagmus
• photophobia
• seizures
• red macular skin rash

Question 25

Kernig’s sign

Answer 25

resistance to extension of leg while hip is flexed

Question 26

Brudzinski’s sign

Answer 26

flexion of hips and knees in response to neck flexion

Question 27

diagnosing mengingitis

Answer 27

• CBC: elevated WBC
• blood cultures: to determine if infx spread as result of sepsis
• brain MRI: shows meningeal inflammation

Question 28

lumbar puncture

Answer 28

looks at CSF and its cellular components
- bacterial: low glucose, high protein, high WBC. CSF appears cloudy/turbid. Opening pressure high

• viral: normal glucose, somewhat elevated protein and WBC. CSF appears clear/yellow like normal. Opening pressure normal.

Question 29

tx meningitis

Answer 29

bacterial: abx
viral: resolves on its own, can take OTC meds for fever or body aches (acetaminophen)

Question 30

nursing actions meningitis

Answer 30

• if have altered mental status - ensure airway protected, ABCs maintained
• VS and neuro checks q 4 to check for ICP
• droplet precautions w. bacterial
• strict I&O
• HOB >=30 degrees
• decrease environmental stimuli

Question 31

meningitis vaccines

Answer 31

• Hib: children >2 mos old and others immunocompromised
• PCV13: infants <2 yr old
• PPSV23: everyone >65 and >2 if immunocompromised
• meningococcal conjugate: 1st dose 11/12 and booster at 16