Seziure Disorders Flashcards by Brina Quintanilla Reyes

What is a seizure ?

Sudden abnormal, excessive, electrical discharge of neurons in the brain

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What is going on in the brain when a seizure is happening?

Paroxysmal; uncontrolled electrical discharge of neurons in brain that interrupts normal function

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Seizure may accompany other discords or occur ___ without apparent cause

Spontaneously

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Are seizures resulting from metabolic disturbances, like

Acidosis
Electrolyte imblanese
Hypoglycemia
Hypoxemia
Alcohol
Dehydration
Water intoxication

Considered epilepsy/seizures ?

And why?

No
Because it’s a underlying condition
And usually can be treated when underlying condition is fixed

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What are the 4 extracranial diseases associated with seizures?
Heart ->
Lung ->
Liver ->
Kidneys ->

Hypertension
Systemic lupus erythematosus
Diabetes mellitus
Septicemia

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What does epilepsy mean?

A seizure disorder

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Since epilepsy is a seizure disorder, what else does that tell us? Define it

Usually caused by?

Condition in which a person has a spontaneously recurring seizures

And underlying chronic condition

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In the United States, about ___ million people have epilepsy

And incidence increased in ___

3 million

Older adults

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Etiology and pathophysiology
Many possible causes vary by ___
Mainly found in which race ?
Which type of people ?
Male or female?
High risk of epilepsy are in which disease?

Age
African American
Socially disadvantage
Makes
Alzheimer’s & stroke

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For patients who don’t know the seizure disorder, it’s known to be called as?

Idiopathic generalized epilepsy (IGE)

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Common causes during the first 6 months of life are ? (4) for seizures

Severe birth injury
Congenial birth deficits (CNS)
Infections
Inborn errors of metabolism

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Common causes from ages 2-20
(4)

Birth injury
Infection
Trauma
Genetic factors

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Common causes between 20-30
(3)

Structural lesions
- trauma
- brain tumor
- vascular disease

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Common causes after 50?
(2)

Stroke
Metastatic brain tumors

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In epilepsy, Abnormal neurons undergo spontaneous firing.

Where does firing of these neurons go to? (2)

( if activity involves whole brain, generalized seizure occurs )

What is the cause of this abnormal firing?

Adjacent or distant areas of the brain

Unknown

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What is normally found in area of brain from which eplieptic activity arises?

Gliosis ( scar tissue )

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Gliosis (scar tissue) is thought to interfere with normal what?

And this makes it more likely to ?

Chemical and structural environment of neurons

Fire abnormal neurons ( or have another seizure )

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Notes
Genetic link

Genetic abnormalities may be the most important factor contributing to IGE, but difficult to separate from environmental or acquired influences

Some types of epilepsy run in families
Others type of IGE are related to specific genes

More than 500 genes play a role

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What are the 3 classification of a seizure?

Determined by site of electrical disturbances
Divided into 2 major classes
Generalized and focal

Treatment is driven by type of seizure

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Clinical manifestations of seizures may progress through several phases

Which are 4 of them ( name and define )

Notes
- not all patients have every phase

Prodromal - signs that precede seizures

Aural - sensory warning

Ictal phase - seizure

Postictal- rest and recovery

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What are the 7 generalized onset seizure?

Tonic-clonic
Typical absence ( petit-mal )
Atypical absence
Myoclonic
Atonic
Tonic
Clonic

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What is the most common seizure?

Tonic clonic

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Tonic clonic ( also named as grand mal )
Is characterized by?
What is the tonic phase and time?
What is the clonic phase and time?

What are the 3 symptoms that occur?

Loss of consciousness and falling

Body stiffens ( 20secs )
Subsequent jerking of extremities
(30-40secs)

Cyanosis
Excessive salivation
Tongue/cheek biting

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In the postictal phase ( after seizure, recovery and rest )
Patients are characterized by? (2)

Patient may sleep for ___
May not feel ___ for hours to days
They will no ___ of seizures

Muscle soreness and fatigue

Hours
Normal
Memory

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What is a typical absence seizure ? Usually happens only in? May ceases as the child ? Can be precipated by ? (2)

Usually occurs only in childern and rarely beyond adolescence May cease as the child matures or develop into another type Can be precipitated by flashing lights & hyperventilation

What is the typical symptoms of petit mal? How does it last? Often goes? May occur up to how many times a day ? What machine demonstrated pattern unique to this type of seizure?

Staring spell “daydreaming” Few seconds Unnoticed 100times EEG

What is atypical absence seizure characterized by? They usually have a what? What type of behavior during seizure? What behavior after ?

Staring spell with other manifestations that last longer than typical absence seizures Brief warnings Peculiar Confusion

What is a myoclonic seizure? This can be forceful enough that patients will end up ? It can be brief seizure but also can occur in?

Charactered by sudden; excessive jerk of the body and extremities Falling Clusters

What’s atonic seizure? This begins ___ and person falls When does consciousness usually return? ( patients can resume normal activity immediately ) This has the greatest risk for ?

Involved tonic episode or paroxysmal loss of muscle tone Suddenly By the time the person hits the ground Head injury

Tonic seizures are? Patients often fall!!

Sudden onset of maintained increased tone in the extensor muscles

What is clonic seizures? Followed by?

Begin with loss of consciousness and suddenly loss of muscle time Limb jerking

What is a focal seizure caused by? Where does it begin? What does it produce?

Focal irritations Specific region of cortex of brain Signs and symptoms related to the function of the area if the brain involved

Focal seizures are also called?

Partial or partial focal seizures

Focal seizures are divided into 2 Simple and complex Describe each forms of LOC (1)(2)

Person remained conscious Person has loss or change of LOC Produce a dreamlike experience

What is simple focal seizure ? It’s a sudden and unexplainable?? Patients may??

Person experiences unusual feelings or sensation that can take many forms Feelings of joy, anger, sadness and nausea Hear,smell, taste, see or feel things

What is complex focal seizures Patient will display what? They’ll be doing ? They have automatisms ( means ?) Do they remember ? How does it last?

Strange behavior Lip smacking Repetitive movements that may not be appropriate Does not remember Usually last for a few seconds

Notes If there is aura or warning before tonic clonic seizure. The aura or warning is really a partial seizure that generalized secondarily Postictal ( Todd’s paralysis ) can develop focal weakness that resolves eventually

Focal Psychogenic seizures ( pseudo seizures ) or psychogenic nonepilepitic seizures occur how? They resemble epileptic seizures And they are accurate diagnosis how?

Triggered by Emotional events Video or EEG

NOTES & 1 question People with seizure disorder have a higher mortality rate than general populations, especially those who suffer from a fall or loss consciousness. Often death are due to accidents during a seizure ( sudden unexpected death in epilepsy ) SUDEP or otherwise known as???

Status epilepticus

What is status epilepticus?

A state of constant seizure or seizures occurring in rapid succession without return of consciousness between seizures

Status epilepticus is the most serious ___ It’s what type of emergency? Can involve/occur in what? Subclinical is what?

Complication of epilepsy Neurologic Any type of seizure Status epilepticus in sedated patient ( usually easy to miss )

Status epilepticus causes the brain to what? Causes neurons to? This resulted in?

Use more energy than is supplied Become exhausted and cease to function Permanent brain damage

Tonic clonic status epilepticus Also known as Convulsive status epilepticus is the most common and most dangerous Why/causes? (5) And usually is fatal.

Cause ventilators insufficient Hypoxemia Cardiac arrhythmias Hyperthermia Systemic acidosis

Notes ; complications Severe injury and death from trauma during seizure - patients who lose consciousness are at greatest risk Persons with epilepsy have a mortality rate 2-3 times the rate of the general population

What is the most common complication of seizure disorders? Notes - social stigma still exists - discrimination/limitations - driving sanction

Effect on lifestyle

What are disgsnostic studies we can use? (6)

History EEG Magnetoencepharkography CBC CT/MEI MRA/PET

NOTES EEG will help determine the type of seizures and pinpoint the seizure focus - many patients did not have abnormal findings Magnetoencephalography - greater sensitivity for detecting small magnetic field generated by neuronal a gory CBC, serum chemistries and lice and kidney function to help rule out metabolic disorders

Most seizures do not require emergency medical care because they are self limited and rarely cause bodily injury? True or false?

True

When we should intervene with seizures are when 3 things occur? Which are

Status epilepticus Significant body harm First time seizure

Seizures disorders are primarily treated with? Which the goal of therapy is to? Notes - medications control seizures about 70% of patients - 30% of patients who don’t respond are considers to be medically refractory epilepsy ( drug resistant epilepsy )

Anti seizure drug Prevent seizures & toxic side effects

How does drugs ( anti seizure meds ) help patients? Notes - about 1/3 of patients require a combination regimen for adequate control - therapeutic drugs ranges are guides - serum drugs levels are helpful

Stabilizing nerve cells membranes and preventing spread of the epileptic discharge

True or false Drugs for seizures disorder must be taken regularly and continuously often for a lifetime?

True

So we as nurses much teach our patients to make sure of what? (2)

Follow the drug regimen What to do when dose is missed

Notes Primarily drug for treatment of generalized tonic clonic and focal seizures Phenytoin ( Dilantin ) carbamazepine ( Tegretol ) Phenobarbital ( Luminal ) Divalproex ( Depakote ) Primidone ( Mysoline )

Notes Primary drugs used to treated absence and myoclonic seizures Ethosuzimide ( Zarontin ) Divalproex ( Depakote ) Clonazapam ( Klonopin )

Notes Broad spectrum drugs can be effective for multiple seizure types Gabapentin ( Neurontin ) Lamotrigine ( lamictal ) Topiramate ( Topamax ) Tiagabine ( Gabitril ) Levetiracetam ( Keppra ) Zonisamide ( Zonegran )

What is pregabqlin (Lyrica) used for ?

Add ones for control of focal seizures that are not successfully managed with a single med

What do we use for status epilepticus medications? Examples included? (2) Which is followed by?

Benzodiazepines IV Lorazepam( Ativan ) Diazapam (Valium) Long acting drugs - phenytoin or phenobarbital

Because of many anti seizure drugs they have a long half life Which means it can be given ? And patients will have an easier time ?

1-2X a day Following medication compliance

Anti seizure drugs should not be discontinued abruptly why?

Because it can precipate seizures

What are common side effects of discontinued antiseziure drugs? (5)

CNS diplopia Drowsiness Ataxia Mental slowing

When patients are having medications for there seizures, it’s important that nurses will assess for toxicity or side effects. Doing what type of assessment? (5) NONCOMPLIANCE IS A CONCERN!!

Nystagmus Hand and gait coordination Cognitive functioning General alertness Gingival hyperplasia with phenytoin

Gerontologic considerations The incidence is ?? You have to have caution with anti seizure drugs because? Phenytoin may be an issue for older adults why? Notes Phenobarbital, Tegretol, Mysoline negatively affect cognitive function Drug interactions with carbamazepine, phenytoin, phenobarbital

Higher !! Changes and metabolism Compromised liver function

Notes Newer anti seizure meds may be safer for older adults And have fewer effects on cognitive function and less drug interactions Gabapentin Lamotrigine Oxcarbazepine Levetiracetam

There are surgical interventions to remove the epileptic focus or prevent spread of epileptic activity in the brain What are the 2 benefits of surgery?

Cessation or seizures Reduction in frequent of seziured

What is the most common surgical intervention? Most patients (70%) of patients usually are what? JUST TO NOTE, NOT ALL TYPES OF EPILEPSY BENEFIT FROM SURGERY!

Anterior temporal lobe resection Seizure free after this procedure

What are the 3 requirements of surgery?

Diagnosis Adequate trial with drug therapy without satisfactory results Electroclinical syndrome define

There are other forms of therapy’s such as (3)

Vagal nerve stimulation Ketogenic diet Biofeedback

How does vagal nerve stimulation help? (2) Only used to adjunct to medications when surgery is not feasible

Electrode implanted in neck patient activated with magnet when seizure is sense Interrupts synchronization of epileptic brain wave activity and stop excessive discharge of neurons

What is the ketogenic diet?(2) How does it work

High fat Low carb Ketones pass into the brain and replace glucose as an energy source

Biofeedback is what?

To help patients maintain a certain brain wave frequency

Notes What is the nursing assessment ? What do we want to ask?

Brith defects Anoxic episodes CNS trauma Stroke Metabolic disorders Alcoholism Exposure to metals Hepatic or renal failure Compliance with anti seizures medications, barbiturate or alcohol withdrawal cocaine Family history Headaches Depression Anxiety Decreased sexual drive

What are the 5 precipitating factors for a seizure? M HK HG DE WI

Metabolic acidosis or alkalosis Hyperkalemia Hypoglycemia Dehydration Water intoxication

When a patient is having a seizure what will we do for our assessment? (6) AAAABC

Airway occlusion Absent breathe sounds Abnormal repository’s rate Apnea ( itcal ) Bitten tongue Cyanosis

We’ll notice that a patient will be? (8)

Hypertensive Tachy/Brady Bowel/urinary Incontience Excessive salivation Weakness Paralysis Ataxia Abnormal CT, MRI, EEG

For tonic clonic we will notice? (7)

Loss of consciousness Muscule tightening Jerking Dilated pupils Hyperventilation Apnea Postictal somnolence

For absence we will notice? (2)

Altered consciousness Monitor facial motor activity

Nursing assessment Focal seizures Simple(4)

Aura Focal sensory, motor, cognitive or emotional phenomena Motor seizure- unilateral marching Starts in a small area with a tingling sensation and marches across the body

Nursing assessment Focal seizures Complex (2)

Altered consciousness with inappropriate behaviors ( automatisms) Amenisa if event ( can’t remember )

What are the 3 nursing diagnosis?

Ineffective breathing Ineffective self health management Risk of injury

Notes Planning - patient be free from injury - have optimal mental/physical functions while taking anti seizure meds - have satisfactory psychosocial functioning

Health promotion We want to tell patients to wear? To follow what? Assist to identify ? Avoid what?

Helmets Diet/exercise Events or situations that trigger Alcohol, fatigue and loss of sleep

Notes Acute intervention Observe, treated and document!

Maintain patent airway Support head Turn to side Loosen constrictive clothing Ease to floor Do not restrain patient or place anything in mouth May require positioning and suctioning or oxygen after seizure

Notes Ambulatory and home care Emotional support and identifications of coping mechanism to adjust to personal limits imposed by the disease - medical alert brackets - referrals to agencies and organization

Evaluation is ? (5)

Good breathing pattern No injury Acceptance of disorder Compliance Therapy

Seziure Disorders Flashcards

(85 cards)