What is status epilepticus?
A state of continous seizure activity or when seizures occur in rapid succession without return to consciousness between seizures
What are the types of generalized seizures?
- Generalized tonic-clonic
What are the types of focal/partial seizures?
- Simple partial seizures (no impairment of consciousness)
- Complex partial seizures (impariment of consciousness)
What are characteristics of generalized seizures?
- Sudden onset
- Bilateral, symmetrical movements
- Excessive neuronal electrical discahrges that are synchronous throughout entire brain
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
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
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
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
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
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
How does the nurse document seizure activity?
- What happened before the seizure?
- How did it start?
- What do abnormal behaviors/movements look like?
- How long did it last?
- How does it end?
- What happens after the event?
- Is awareness of the environment/level of consciousness altered?
- Document specific information related to each seizure
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
- Take same time each day
- Monitor for toxicity
- Monitor therapeutic drug levels
- Given in own IV line with filter
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
- Cehck for hypotension by checking BP
- Mental status changes
- Rectal administration not more than 5 times per month
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
- Mental status
- IVP given slowly
- Instruct patient to change positions slowly
- Caution in hepatic or renal disease
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
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
What should the patient know about non-medication therapies?
- Avoid triggers
- Relaxation therapy
- Vagal nerve stimulator
- Surgical therapy (resect)
What should the patient know about community resources?
- epilepsy association
- Social work
What should the patient know about identification?
- Medic alert bracelet essential
- Be aware of own triggers
What should the patient know about lifestyle considerations?
- Reduce fatigue
- Reduce alcohol
- Reduce Stress
- Reduce loss of sleep
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
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
What should the family and/or significant others know about acute seizure management?
- Keep safe
- Protect airway
- Loosen constrictive clothing
- Do not restrain patient
What are risk of seizures?
What are some seizure triggers?
- Alcohol use/abuse
- A sudden startle
- Flashing lights
- Sleep deprivation
What are some seizure symptoms?
- Deja vu
- Loss of consciousness
- Lip smacking/chewing
- Urinary incontinence
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
What is a simple partial seizure not?
- Acting out, bizarre behavior
- Mental illness
- Psychosomatic illness
- Parapsychological or mystical experience
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
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.
- 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
What is a complex partial seizure not?
- Intoxication due to drugs or alcohol
- Mental illness
- Disorderly conduct
What to do for a complex partial seizure?
- Speak calmly and reassuringly to patient and other
- Guide gently away from obvious hazards
- Stay with person until completely aware of environment
- Offer to help getting home
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
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
What is a generalized tonic clonic seizure not?
- Heart attack
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
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
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
What is an absence seizure not?
- Lack of attention
- Deliberate ignoring of adult instructors
What should be done if someone is having an absence seizure?