Topic 12: Epilepsy & Seizure Disorders Flashcards
(33 cards)
Seizure
transient, uncontrolled electrical discharge of neurons in the brain that interrupts normal function
Seizure disorder (epilepsy)
a group of neurogenic diseases marked by recurring seizures
Metabolic disturbances associated with seizures include
acidosis, electrolyte imbalances, hypoglycemia, hypoxemia, alcohol or barbiturate withdrawal, dehydration or water intoxication
Status epilepticus
a state of constant seizure or condition when seizures recur in rapid succession without return to consciousness between seizures (neurologic emergency), a seizure lasting longer than 5 minutes
4 phases of stroke
prodromal
sural
ictal
postictal
Prodromal phase
sensations or behavioral changes that precede seizure by hours or days
Aural phase
with sensory warning that is similar each time a seizure occurs and is considered a part of the seizure
Ictal phase
from first symptom to the end of seizure activity
Postictal phase
the recovery period after the seizure
Tonic-clonic seizure
stiffening-jerking; a major motor seizure involving all muscle groups; previously termed grand mal (big bad) seizure
tonic-clonic aural phase manifestations
o Bowel and bladder incontinence
o Diaphoresis
o LOC
o Pallor, flushing, cyanosis
o Peculiar sensations that precede seizure
o Tachycardia
o Warm skin
Tonic phase of tonic-clonic seizure manifestations
o Continuous muscle contractions
o Body stiffens for 10 to 20 seconds
· Hypertonic phase of tonic-clonic seizure manifestations
o Extreme muscular rigidity lasting 5-15 seconds
· Clonic phase of tonic-clonic seizure manifestations
o Extremities jerk for another 30 to 40 seconds
o Rigidity and relaxation alternating in rapid succession
In post-ictal phase of tonic-clonic seizure manifestations
· muscle soreness, feels tired, may sleep for several hours, confusion, HA
Absence seizure manifestations
· Usually occurs only in children
· Characterized by brief staring spell that resembles daydreaming
Focal-onset seizure manifestations
· Begin in 1 hemisphere of the brain in a specific region in the cortex
· Causes sensory, motor, cognitive, or emotional manifestations based on the function of the involved area of the brain
· Level of awareness
· May be conscious and alert, but have unusual feelings or sensations
· Sudden unexplainable feelings of joy, anger, sadness, or nausea
Status epilepticus manifestations
· Lasting longer than 5 minutes
· Goal is to end clinical and electrical seizure activity
· Decorticate posturing
characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. occurs when the brainstem is not inhibited by the motor function of the cerebral cortex.
Decerebrate posturing
-“extensor posturing”;
-abduction of arms, elbow, and wrist extension
diagnostic assessment
Drug testing
EEG
MRI, CT, PET Scan, X-Ray
CSF
nursing interventions
· Ensure patient airway
· Protect patient from injury. DO NOT RESTRAIN. Pad side rails
· Remove or loosen tight clothing
· Establish IV access
· Stay with patient until the seizure has passed
· Anticipate giving, phenobarbital, phenytoin, and benzodiazepines (diazepam, lorazepam) to try and stop seizure
· Suction as needed
· Assist ventilation if patient does not breathe spontaneously after seizure
· Anticipate need for intubation if gag reflex is absent
Ongoing Monitoring
· Monitor VS, LOC, O2 saturation, Glasgow coma scale results, pupil size and reactivity
· Reassure and orient patient after seizure
· Never force an airway between patients clenched teeth
· Give IV dextrose for hypoglycemia
Health Promotion
· Wear helmet if risk for head injury
· General health habits (diet, exercise)
· Assist in identifying events or situations precipitating seizures and avoid if possible.
· Instruct to avoid excessive alcohol, fatigue, and loss of sleep.
· Help the patient to handle stress constructively.
