Seizures - Exam 6 Flashcards Preview

SEMESTER FOUR!! Nursing 214 > Seizures - Exam 6 > Flashcards

Flashcards in Seizures - Exam 6 Deck (40):
1

What is status epilepticus?

A state of continous seizure activity or when seizures occur in rapid succession without return to consciousness between seizures

2

What are the types of generalized seizures?

  1. Generalized tonic-clonic
  2. Absence

3

What are the types of focal/partial seizures?

  1. Simple partial seizures (no impairment of consciousness)
  2. Complex partial seizures (impariment of consciousness)

4

What are characteristics of generalized seizures?

  • Sudden onset
  • Bilateral, symmetrical movements
  • Excessive neuronal electrical discahrges that are synchronous throughout entire brain

5

What are characteristics of focal/partial seizures?

  • Come on gradually
  • Abnormal electrical discharges begin in a focal area of the brain that is dysfunctional (chemically or structurally)
  • Focal/partial seizures can secondarily generalize

6

What is aura?

A simple partial seizure that is usually a sensation or sensory phenomenon that reflects the complicated connections and integrative functions of that area of the brain. The most common sensation is a strange feeling at the bottom of the stomach that rises toward the throat. This feeling may be accompanied by odd or unpleasant odors or taste, complex auditory or visual hallucinations, or ill-defined feelings of elation or strangeness (eg deja vu, a feeling a familiarity in a strange environment). Many patients have an aura before a complex partial or generalized seizure. This is call prodromal in some patients

7

What is ictal?

Seizure activity: The physical manifestations of abnormal electrical brain activity. Nursing interventions should include: maintaining patient safety, positioning patient on side, observation and documentation of body, facial and eye movement, respiratory effort, and urination/defecation. The ictal phase is usually less than 5 minutes in duration and is self-limiting

8

What is postictal?

The period of recovery following a seizure. The patient may be drowsy, be uncoordinated and have transient aphasia or confusion and display some sensory or motor impairment. This phase can last a few minutes to a few hours

9

What is included in seizure precautions?

  • Side rails up X 4
  • Side rails and other hard objects in room padded
  • Can place mats on floor
  • Suction set up available
  • Oxygen available
  • Waterproof pad on mattress/crib
  • Appropriate supervision and/or video monitoring

10

What are seizure precautions for a patient in the community?

  • Swim with a companion
  • use of protective helmet and padding for cycling, skateboarding, etc
  • Supervision with use of heavy machinery/equipment
  • Medical identification
  • Avoidance of seizure triggers

11

How does the nurse document seizure activity?

  1. What happened before the seizure?
  2. How did it start?
  3. What do abnormal behaviors/movements look like?
  4. How long did it last?
  5. How does it end?
  6. What happens after the event?
  7. Is awareness of the environment/level of consciousness altered?
  8. Document specific information related to each seizure

12

dilantin (Phenytoin)

Classification: anticonvulsant, antidysrhythmic

Mechanism of action: Inhibits spread of seizure activity in motor cortex by altering ion transport. Increases AV conduction

Use: Generalized tonic-clonic seizures, status epilepticus

Side/Adverse effects: drowsy, dizzy, slurred speech, nystagmus, diplopia, blurred vision (s/sx of toxicity), hypotension, VF, N/V, hepatitis, gingival hyperplasia, hirsutism, Stevens-Johnson's syndrome

Routes: PO/IV/NG

Nursing Implications:

  1. Take same time each day
  2. Monitor for toxicity
  3. Monitor therapeutic drug levels
  4. Given in own IV line with filter

13

diazepam (Valium) (Diastat)

Diastat is the rectal version

Classification: centrally acting antianxiety, anticonvulsant, skeletal muscle relaxant

Mechanism of aciton: potentiates action of GABA

Use: after a seizure, prolonged seizure, anxiety, ETOH withdrawal, rectally for acute repetitive seizure, usually for ped/home use

Side/adverse effects: neutropenia, resp. depression, orthostatic hypotension, N/V/D, CNS depression

Nursing Implications:

  1. VS
  2. Cehck for hypotension by checking BP
  3. Mental status changes
  4. Rectal administration not more than 5 times per month

14

Lorazepam (Ativan)

Classification: antianxiety, benzodiazepine

Mechanism of action: potentiates action of GABA, absorbed and eliminated faster than other benzodiazepines

Use: seizures, status elipticus, alcohol withdrawl, sedation, usual IVP med of choice for patient in adult acute care setting

Side/adverse effects: dizzy, drowsy, orthostatic hypotension, tachycardia, hypotension, apnea, blurred vision, confusion

Nursing Implications:

  1. BP
  2. HR
  3. Mental status
  4. IVP given slowly
  5. Instruct patient to change positions slowly
  6. Caution in hepatic or renal disease

15

Are there any driving license restrictions in NYS for an individual who has a seizure and/or epilepsy?

Can not have had seizure in last 12 months

16

What should the patient know about medicaitons?

  • Take consistently
  • Do not stop abruptly
  • Report side effects
  • blood level checks as ordered by dr
  • gerontologic considerations

17

What should the patient know about non-medication therapies?

  • Avoid triggers
  • Relaxation therapy
  • Vagal nerve stimulator
  • Biofeedback
  • Surgical therapy (resect)

18

What should the patient know about community resources?

  • epilepsy association
  • Social work

19

What should the patient know about identification?

  • Medic alert bracelet essential
  • Be aware of own triggers

20

What should the patient know about lifestyle considerations?

  • Reduce fatigue
  • Reduce alcohol
  • Reduce Stress
  • Reduce loss of sleep

21

What should the patient know about diet/nutrition?

  • Nutritionally sound diet
  • Ketogenic diet (high fat, adequate protein, low carb) for difficult to control (refractory) epilepsy in children

22

What should the family and/or significant others know about seizure first aid?

Do not call 911 unless prolonged seizure activity greater than 5 minutes, patient has injured themself, or is having a second seizure

23

What should the family and/or significant others know about acute seizure management?

  • Keep safe
  • Protect airway
  • Loosen constrictive clothing
  • Do not restrain patient

24

What are risk of seizures?

  1. Genetics
  2. Hypoglycemia
  3. Tumors
  4. Infection

25

What are some seizure triggers?

  1. Alcohol use/abuse
  2. A sudden startle
  3. Flashing lights
  4. Sleep deprivation

26

What are some seizure symptoms?

  1. Deja vu
  2. Loss of consciousness
  3. Lip smacking/chewing
  4. Tremors
  5. Urinary incontinence
  6. Apnea

27

What does a simple partial seizure look like?

  • Jerking may begin in one area of the body, arm, leg, or face. Can't be stopped but patient stays awake and aware.
  • Jerking may proceed from one area of the body to another and sometimes spreads to become a convulsive seizure.
  • Partial sensory seizures may not be obvious to an onlooker.
  • Patient experiences distorted environment. May see or hear things that aren't there. May feel unexplained fear, sadness, anger, or joy.
  • May have nausea, experience off smells and have a generally funny feeling in the stomach. This type of seizure may be the aura and can progress to other types
  • Rarely lasts greater than 1 minute

28

What is a simple partial seizure not?

  • Acting out, bizarre behavior
  • Hysteria
  • Mental illness
  • Psychosomatic illness
  • Parapsychological or mystical experience

29

What to do for a simple partial seizure?

  • No first aid necessary unless seizure becomes generalized
  • No immediate action needed other than reassurance and emotional support
  • Medical evaluation should be recommended

30

What does a complex partial seizure look like?

  • Usually starts with blank stare followed by chewing followed by random activity
  • Person appears unaware of surroundings. May seem dazed and mumble.
  • Unresponsive
  • Actions clumsy, not directed.
  • May pick at clothing, pick up objects, try to take clothes off.
  • May run, appear afraid
  • May struggle or flail at restraint
  • Once pattern established, same set of actions usually occur with each seizure
  • Last a few minutes but post seizure confusion can last substantially longer
  • No memory of what happened during the seizure period

31

What is a complex partial seizure not?

  • Drunkenness
  • Intoxication due to drugs or alcohol
  • Mental illness
  • Disorderly conduct

32

What to do for a complex partial seizure?

  1. Speak calmly and reassuringly to patient and other
  2. Guide gently away from obvious hazards
  3. Stay with person until completely aware of environment
  4. Offer to help getting home

33

What should you not do for a complex partial seizure?

  • Do not restrain unless sudden danger (such as a cliff edge or an approaching care) threatens
  • Don't shout
  • Don't expect verbal instructions to be obeyed

34

What does a generalized tonic-clonic seizure look like?

  • Usually beings with a sudden cry, flail, rigidity, followed by muscle jerks, shallow breahting or temporarily syspended breathing, bluish skin, possible loss of bladder or bowel control
  • Usually lasts a couple of minutes
  • Normal breathing restarts after seizure
  • May be some confusion and/or fatigue followed by return to full consciousness

35

What is a generalized tonic clonic seizure not?

  1. Heart attack
  2. Stroke

36

What to do for patient who is having a generalized tonic-clonic seizure?

  • Look for medic alert identification
  • Protect from nearby hazards
  • Loosen ties or shirt collars
  • Protect head from injury
  • Turn on side to keep airway clear
  • Reassure when consciousness returns
  • In single seizure lasted less than 5 minutes, ask if hopsital evaluation wanted
  • If multiple seizures, or if one seizure lasts longers than 5 minutes, call 911
  • If person is pregnant, injured, or diabetic, call for aid at once

37

What should you not do with a patient who is having a generalized tonic clonic seizure?

  • Do not put any hard implements in the mouth
  • Do not try to hold tongue. It can't be swallowed
  • Do not try to give liquids during or just after seizure
  • Do not use artifical respiration unless breathing is absent after muscle jerks subside, or unless water had been inhaled
  • Do not restrain

38

What does an absence seizure look like?

  • Blank stare beginning and ending abruptly lasting only a few seconds
  • Most common in children
  • May be accompanied by rapid blinking, some chewing movements of the mouth
  • Unaware of what is going on during the seizures but quickly returns to full awareness once it has stopped
  • May result in learning difficulties if not recognized and treated

39

What is an absence seizure not?

  • Daydreaming
  • Lack of attention
  • Deliberate ignoring of adult instructors

40

What should be done if someone is having an absence seizure?

  • No first aid necessary but if this is the first observation of the seizures, medical evaluation should be recommended

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