Seizures (Final exam)

Question 1

What is a seizure?

Answer 1

transient, uncontrolled electrical discharge of neurons in the brain that interrupt normal function

Question 2

What is a tonic-clonic seizure (grand mal)? (4)

Answer 2

• most common generalized-onset motor seizure
• patient loses consciousness and falls to the ground if standing up
• body stiffens (tonic) for 10-20 seconds and extremities jerk (clonic) for another 30-40 seconds
• manifestations that can occur during the seizure: cyanosis, excessive salivation, tongue/cheek biting, incontinence

Question 3

4 phases of seizure

Answer 3

1) prodromal: sensations or behavior that precede a seizure by hours or days (ie: anxiety or not feeling well)
2) aural: sensory warning that is similar each time a seizure occurs, considered part of seizure (ie: patient knows that seizure is about to happen)
3) ictal: first symptoms to the end of the seizure
4) post-ictal: recovery period after the seizure

Question 4

Assessment findings for the post-ictal phase of a seizure (3)

Answer 4

• muscle soreness, feels tired, may sleep for several hours
• some patients feel normal for several hours or days after a seizure
• no memory of the episode

Question 5

What diagnostic finding should a new-onset patient have?

Answer 5

Normal CT and EEG findings are common in seizure disorder, especially the first time that testing occurs

Question 6

Possible underlying triggers that a first-time patient may have? (6)

Answer 6

• excess alcohol intake
• fatigue
• loss of sleep
• trauma
• disease
• high fever

Question 7

Complications of seizures (2)

Answer 7

1) status epilepticus

2) psychosocial effects

Question 8

Status epilepticus (4)

Answer 8

state of continuous seizure activity that recur in rapid succession without return to consciousness between the seizures

neurologic emergency

any seizure lasting longer than 5 mins (monitor length of seizure)

treatment: IV lorazepam/Ativan or diazepam/Valium (then long-acting anticonvulsant like phenytoin) neurologic assessment involves testing for toxicity

Question 9

Psychosocial effects of seizure disorder (4)

Answer 9

• depression
• social stigma
• discrimination in employment and education opportunities
• driving sanctions

Question 10

What tasks can be delegated to a UAP in seizure management? (5)

Answer 10

• apply intermittent pneumatic compression devices
• assist with repositioning
• vitals, seizure precautions
• daily hygiene and bathing
• emotional support/encouragement

Question 11

Emergency seizure precautions

Answer 11

1) place on flat ground, support head, turn to side to prevent aspiration
2) ensure safety during seizure
3) record location, duration, details of the event
4) assess vitals and gag reflex, if none then intubate and maintain patent airway

Question 12

patient teaching for EEG (4)

Answer 12

• painless
• can wash hair
• avoid caffeine 6-8 hrs before
• hold medications and give after

Question 13

Why do patients who had a seizure get their glucose level checked?

Answer 13

can be hypoglycemic = IV dextrose if hypoglycemic

Question 14

For patients who seizures cannot be controlled with drug therapy, which intervention is needed?

Answer 14

surgery to resect the focal area (patient must be awake)

Question 15

Nutritional needs for patients after a seizure

Answer 15

high fat, low carb = ketogenic diet

Question 16

medication that should be taken regularly and continuously for patients with seizures, patient teaching for medication (6)

Answer 16

phenytoin (anticonvulsant)

• normal dose: 10-20 mg
• loading dose: 15-20 mg
• s/e: gingival hyperplasia
• avoid grapefruit, milk, antacids
• report visual changes to HCP (ie: blurred vision)
• seizure free 2-5 years and normal EEG findings to discontinue anticonvulsants

Question 17

What medications can be used for patients with migraines and epilepsy? (3)

Answer 17

1) divalproex sodium
2) gabapentin
3) topiramate