TOPIC 12 - stroke and seizures

Question 1

primary seizure (generalized-both hemispheres) examples

Answer 1

Tonic-Clonic
Absence
Myoclonic
Tonic – stiffing
Atonic (Akinetic) – loss of muscle tone
Clonic – jerking movements

Question 2

epilepsy examples

Answer 2

can be primary or idiopathic

Question 3

focal seizures (one hemisphere) example

Answer 3

simple, complex, evolve into secondary

Question 4

metabolic disturbances associated with seizures

Answer 4

Acidosis
Electrolyte imbalances
Hypoglycemia
Hypoxemia
Alcohol or barbiturate withdrawal
Dehydration or water intoxication

Question 5

extra cranial diseases associated with seizures

Answer 5

Heart
Lung
Liver
Kidneys
Hypertension
Systemic lupus erythematosus
Diabetes mellitus
Septicemia

Question 6

complications of seizures

Answer 6

status epilepticus
severe injury and death
effect on lifestyle

Question 7

status epilepticus

Answer 7

A state of constant seizure or condition when seizures recur in rapid succession without return to consciousness between seizures

Status epilepticus causes the brain to use more energy than is supplied.

Question 8

risk factors for seizures

Answer 8

Metabolic Disorders
Acute alcohol withdraw or substance abuse
Electrolyte disturbances
High fever
Stroke or head injury
Heart Disease
Genetics (absence seizures)

Question 9

precipitating factors of seizures

Answer 9

Metabolic acidosis or alkalosis
Hyperkalemia
Hypoglycemia
Dehydration
Water intoxication

Question 10

nursing assessment of seizures

Answer 10

Bitten tongue, soft tissue damage, cyanosis
Abnormal respiratory rate
Apnea (ictal)
Absent or abnormal breath sounds
Airway occlusion
Hypertension, tachy/bradycardia
Bowel/urinary incontinence, excessive salivation
Weakness, paralysis, ataxia (postictal)
Abnormal CT, MRI, EEG

Question 11

phases of seizures

Answer 11

Prodromal phase precedes seizure with signs or activity.
Aural phase with sensory warning.
Ictal phase with full seizure.
Postictal phase with rest and recovery.

Question 12

acute interventions for seizures

Answer 12

Observe, treat, and document seizure.
Maintain patent airway, support head, turn to side, loosen constrictive clothing, ease to floor.
Do not restrain patient or place any objects in their mouth.
May require positioning, suctioning, or oxygen after seizure.

Question 13

seizure precautions

Answer 13

Oxygen
Suction equipment
Airway
IV access
Side rails up and padded

Question 14

ambulatory and home care for seizures

Answer 14

Instruct on importance of adherence to medication, not to adjust dose without physician.
Keep regular appointments.
Teach family members emergency management.
Medical alert bracelets
Referrals to agencies and organizations
Emotional support

Question 15

medications for tonic clonic seizures

Answer 15

Lorazepam (Ativan)
Diazepam (Valium)
Diastat
IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)

Question 16

immediate medical care is needed if …

Answer 16

Status epilepticus occurs.
Significant bodily harm occurs.
The event is a first-time seizure.

Question 17

drug adherance

Answer 17

Drugs for seizure disorder must be taken regularly and continuously, often for a lifetime.
primarily treated with antiseizure drugs
Antiseizure drugs should not be discontinued abruptly as this can precipitate seizures.

Question 18

common side effects of antiseizure drugs

Answer 18

Common side effects involve the CNS and include diplopia, drowsiness, ataxia, and mental slowing.

Question 19

geriatric considerations for seizures

Answer 19

The incidence of new-onset seizure disorders is high among older adults.

Question 20

surgical therapy for seizures

Answer 20

Anterior temporal lobe resection is the most common surgical intervention.
Surgical intervention to remove the epileptic focus or prevent spread of epileptic activity in brain

Question 21

three requirements for surgery

Answer 21

Diagnosis of epilepsy confirmed
Adequate trial with drug therapy without satisfactory results
Electroclinical syndrome defined

Question 22

vagal nerve stimulation

Answer 22

Adjunct to medications when surgery is not feasible
Exact mechanism not known
Thought to interrupt synchronization of epileptic brain-wave activity and stop excessive discharge of neurons

Question 23

what diet is effective in controlling seizures

Answer 23

ketogenic
high fat, low carb
ketones replace glucose as energy source

Question 24

how long does a seizure need to be to be a medical emergency

Answer 24

last more than 5 min or repeated seizures over course of 30 min – medical emergency!

Question 25

status epilepticus interventions

Answer 25

Establish airway ABGs IV push lorazepam, diazepam Rectal diazepam Loading dose IV phenytoin

Question 26

two types of cerebral vascular accidents

Answer 26

ischemic or hemorrhagic

Question 27

ischemic cerebral vascular accidents

Answer 27

Blood vessel is blocked off Lack of oxygen & nutrients Thrombotic or embolic

Question 28

hemorrhagic cerebral vascular accidents

Answer 28

Bleeding into the brain tissue Causes pressure increases (ICP) Lack of oxygen & nutrients

Question 29

two types of hemorrhagic strokes

Answer 29

Intracerebral – bleeding in the brain, usually a ruptured vessel Subarachnoid – bleeding in the CSF space between the pia matter and arachnoid space, usually an aneurysm

Question 30

risk factors for cerebral vascular accidents

Answer 30

Hypertension Heart disease, diabetes Smoking Obesity Sleep apnea Metabolic syndrome Lack of activity/exercise Poor diet Drug & ETOH abuse Genetics Age Gender Ethnicity of African Americans, Hispanics, Native Americans, Asian Americans

Question 31

major types of strokes

Answer 31

thrombotic embolic hemorrhagic

Question 32

differences in strokes based on artery involvement

Answer 32

Anterior Cerebral – motor and/or sensory deficit (contralateral), sucking/rooting reflex, rigidity, gait problems, loss of proprioception & fine touch Middle Cerebral – Dominant side: aphasia, motor and sensory deficit, hemianopsia - Non Dominant side: Neglect, motor and sensory deficit, hemianopsia Posterior Cerebral – hemianopsia, visual hallucination, spontaneous pain, motor deficit Vertebral – Cranial nerve deficits, diplopia, dizziness, nausea, vomiting, dysarthria, dysphagia, coma

Question 33

transient ischemic attack

Answer 33

TIA is a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, but without acute infarction of brain Symptoms typically last < 1 hour

Question 34

right brain damage manifestations

Answer 34

paralyzed left side left sided neglect spatial perceptual deficit tend to deny or minimize problems impulsive, safety problems impaired judgment impaired time concepts rapid performance, short attention span

Question 35

left brain damage manifestations

Answer 35

paralyzed right side impaired speech/language aphasia impaired right/left discrimination slow performance aware of deficits : depression, anxiety impaired comprehension related to language, math

Question 36

when does aphasia occur with strokes

Answer 36

Aphasia occurs when stroke damages dominant hemisphere of brain and affects language

Question 37

types of aphasia

Answer 37

Receptive – loss of comprehension Expressive – loss of production of language Global – total inability to communicate

Question 38

diagnostics for strokes

Answer 38

CT/MRI/MRI Angiography Cerebral angiography Carotid angiography Digital subtraction angiography Transcutaneous doppler ultrasonography Carotid duplex scanning

Question 39

labs for strokes

Answer 39

CBC Coagulation (PT/INR, aPTT) Electrolytes, blood sugar Renal & hepatic labs Lipid profile CSF

Question 40

planning goals for stroke patients

Answer 40

Stable/Improved LOC Attain max physical functioning Attain max self-care abilities Maintain stable body functions Attain max communication ability Maintain adequate nutrition Avoid complications Maintain effective personal/family coping

Question 41

signs of stroke

Answer 41

Face droop Arm numbness Speech difficulty Time - act fast !

Question 42

surgical interventions for strokes

Answer 42

Carotid endarterectomy Transluminal angioplasty Stenting

Question 43

what med is never used for hemmorhagic strokes

Answer 43

tPA