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Glossary of Seizure Questions

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During which phase does a person known for seizure experience the epileptic cry, is conscious or unconscious and falls
Ictal
What type of seizure does this patient have when they epxerience sudden collapse and falls, loss of muscle tone, drop attacks, and regain consciousness in 10 to 60 seconds
Gerneralized: Atonic
A patient is experiencing a seizure during your shift what would not be an appropriate intervention
Hold them firmly so they do not hurt themselves
What would be appropriate nursing interventions for pt experiencing a seizure
Turn client to side of bed
Maintain airway
Loosen client's clothing
When discharging a patient who experiences seizures what should you inform them about their new dilantin medication
Make surethey maintain good oral care because medication can cause gingival hyperplasia
What would be a priority nursing diagnosis for a patient who experiences seizures
Risk for injury related to seizure disorder
You are caring for a client who has had a recent onset of seizures. The client asks "what type of tests will they do to figure out why I am having seizures all of a sudden?" As the nurse, your explanation should incllude
Basic Metaboli Panel
Neurological Assessments
EEG
Nursing interventions when caring for a client with an onset of seizures should include
Making sure there is suction equipment available in the patient's room
What are potential risk factors for developing a seizure disorder
Aging
ETOH
History of dementia
As a nurse, you know that seizure activity most often occurs
during sleep
A example of someone who is at greatest risk for onset of seizures
An elderly woman who has suffered a stroke
A person taking AED demonstrates understanding of medications if they respond to patient teaching with
I should be weaned off gradually
A pt is presented to you in the ED, his symptoms started with a blank stare, followed by chewing or smaking of mouth, then followed by random activity. You as the nuse would recognize this type of seizure as
Complex partial
A pt in your care has seizure activity, what would be aprimary intervention
Have suction readily available to maintain airway clearance
A NI that is not part of post-ictal care
Protecting from injury
Post-ictal NI of pt
Allow client to rest
Document seizure
Keep client on their side
A pt's EEG reveals that neural discharges are involving both hemispheres. This would be known as
A generalized seizure
Status epilepticus occurs
For at least 5 minutes and the patient may not recover fully from one seizure before having another
Teh nurse should advise a patient who is scheduled to have an EEG to avoid
Caffeine
How should tegretol be given
by mouth
Klonopin (Clonazepam) would be contraindicated in what type of patient
67 year old female with respiratory dysfunction
What inreased risks to women with epilepsy have
Fetal malformations due to multiple antiseizure meds
Decreased contraceptive effectiveness due to antiseizure meds
Increased bone loss
Increased seizure activity during menses
What is priority one NI for a seizure patient
Prevention of injury
During the seizure the nurse needs to document
occurances before the seizure
type of movements involved and with what part of the body
Size of pupils
Duration of each phase of the seizure
Primary epilepsy
Not associated with an identifiable brain lesion, probably inherited condition, usually starts in childhood
Secondary epilepsy
Related to underlying brain disease or lesion
Epilepsy
recurrent sterotypical seizures. A recurrent seizure disorder. One seizure does not equal epilepsy
Seizure
Suddent, involuntary motion, change in behavior, muscle control, consciousness. Accompanied by abnormal electrical discharge from the brain
Phases of seizures
Pre-ictal (pre-seizure)
Ictal (seizure)
Post-Ictal (post seizure)
Pre-Ictal Phase
1/2 of all seizures have an aura or sensation before seizure
An aura is a sensation such as numbness, flashing lights, dizziness, odors, or spots
Sign of warning that seizure is going to occur
Ictal Phase
may have epileptic cry (cat)
may have loss of consciousness and fall
may be unconscious, or awake but unaware
Post-ictal Phase
May or may not remember seizure
Types of seizures
Generalized or global - involves neural discharge in both brain hemispheres, always loss of consciousness, abrupt onset
Partial or focal - does not affect consciousness, usuallya ffects one hemisphere, can be interrupted
Types of Generalized Seizures
Tonic-Clonic (Grand Mal)
Absence Seizures (petite mal)
Myoclonic
Atonic
Tonic-Clonic (Grand Mal)
Lasts about 2 minutes
Cry, fall, LOC, stifffening, contractions, shallow greathing, cyanosis, incontinence, tongue biting
Post-ictal state
Confusion, fatigue, dorwsiness & exhaustion after seizure is over
Absence seizures (petite mal)
staring, rapid eye blinking or mouth chewing, less than 1 minute, unaware, no post-ictal state, may or may not remember seizure, may occur frequently through the day
Myoclonic
sudden brief massive muscle jerks (few seconds), may spill what they are holding or cause client to fall, no post-ictal state
Atonic (drop attacks)
Sudden collapse & fall, brief loss of muscle tone, no post-ictal state, 10-50 seconds
Partial Seizures
Simple Partial (focal)
Complex Partial (involuntary)
Simple Partial
Jerking of one area of the body
Starts in one part of body and may move to adjacent areas
Focal twitching of extremity or face, speach arrest, special visual sensations, feeling of foom
Have less motor, sensory, & consciousness involvement due to smaller area of the brain involved
Complex Partial
Start with blank stare, followed by chewing, followed by random activity. Consciousness impaired and unaware of surroundigns, dazed , unresponsive, may run and appear afraid, automatic behavior (lip smacking, chewing, rubbing, or picking at clothes) which are involuntary, lasts a few minutes, post-ictal period of confusion, may spread to larger area of the brain and become generalized.
Status epilepticus
Episode of seizure activity taht lasts at least 5 minutes, or repeated seizures without full recovery between seizures.
Can cause increase in metabolic activity such that the bond cannot keep up with the O2 and nutrition demands leading to cellular exhaustion and death if not effectively treated.
Emergency Criteria
Head trauma
1st seizure
diabetes
pregnant
occurs in water
prolonged (>5 min)
Repeated seizures
No med id
DX a seizure
monitor brain waves while seizure is occuring. Many DX are basedon description of s/s, PE, and other tests
Tests for Seizures
PE and MRI
Blood test for metabolic abnormalities
Neurologic assessment
Memory, language, perception, thinging and emotional functioning
EEG
records electrical activity of the brain and is the best way to DX, but is often noraml between seizures
Prep for EEG
Mean before test because low gblood sugar can alter brain pattern waves
MRI
identifies abnormalities in teh brain structure
CT
Checks for tumors, strokes and otehr abnormalities
NI pre-ictal
type of aura
NI Ictal Phase
Assessment - movement of head, eyes, muscle rigidity will give clues about location of the trigger focus int eh brain
Seizure Assessment
Progession and duration of the seizure, respiratory status, loss of consciousness, pupil size, incontiennce
NI for seizures
protect from injury
nothing into mouth
Turn pt on side
loosen clothing
maintain airway and suction may be needed
no not retrain client, guide movements if necessary
no oral thermometers
NI of Post-ictal Phase
Assess breathing pattern for rate, rhythm, and depth.
Establish the airway is priority intervention
NI Post-Ictal phase
Re-orient client X3 level of sleeplessness, make pt comfortable, VS, neurologic chekc, keep on side, allow to rest, document seizure
NDX
Risk for injury related to seizure disorder
Fluid volume deficit r/t mental status and sudden loss
NI for risk of injury
Seizure precautions (pad side rails, keep rails up and bed in low position), monitor frequently, rapid access to O2, suction, emergency equipment, administer AED as ordered, monitor pt response, insert NC as ordered
NI for Fluid volume
NPO until fully awake, IV as ordered, VS, monitor I/O
Antiepileptic Drugs (AED)
Goal is to control seizures without impairing normal function, often use e2 or more durgs in combination, selective depression of hyperactive areas of the brain
How to test AED levels
Blood test, drug serum levels
Should AED be stopped suddenly
No, wean gradually so that life threatening status epilepticus is avoided
Hazardous activity for pts that taking AED's
driving, other activities that require mental alertness
Adverse SE that may require an adjustment in med dosage
Serum blood levels not routinely done
Somnolence, fatigue, ataxia, dizziness, confusion, diplopa
Topamax
Partial seizures, toxic effect nephrolithiasis. Drink 6-8 water to flush kidney
Neurontin
Partial seizure. Don't take with antacid, decreases absorption, routine blood levels not done.
Lamictal
Partial seizures
Ativan
Partial seizures, respiratory depression
Phenobarbital
Partial, clonic-tonic, status epilepticus
Dilantin
Partial, clonic-tonic, status epilepticus
Good oral care important
Klonopin
Absence, myoclonig, atonic
high degree of toxicity, caution with respiratory disease
Valium
Status epilepticus
Depakote
All types, contra in pg, thrombocytopenia, liver disease
Zarontin
All types, drug of choice for absence seizures
Tegretol
Partial, clonic-tonic, status epilepticus, SE leukopenia, diplopia
Treatment available
Seizure precautions
Surgery
Vagus nerve stimulation
Ketogenic diet
Activity
Client education
General Seizure Precuations
Oxygen, suction equipment, airway, IV access, padded side rails, lossen clothes, no pillows, no restraint, no padded tongue blade, occur most ofent during sleep or shortly after awakening
Surgical option
Lobectomy - removal of one lobe of the brain
Hemishpherectomy - removal of 1/2 the brain hemisphere
Corpus Callostomy - cutting the nerve fibers between the brain hemispheres
Vagus Nerve Stimulation
Not a surgical candidate, unacceptable sE from meds, pacemake-like device, vagus nerve stimulated, use magnet to manually turn stimulator on or off
Ketogenic Diet
Children, high fat/low protein diet/low carbs
keep pt in a state of ketosis
Controls seizures
Activity
Avoid hazardous activity until meds are stabilized, maintain normal activity aafter stabilized, can perform personal care and wear own clothes, OOB
Client education
Diet, no ETOH, check OTC drugs, med alter braclet, regular sleep, low stress, good oral care and dental visits, control fevers, avoid bright flashing lights, swim with buddy, avoid noisy environments
Speical population - Women
contraceptives may be decreased because of AED, seizure pattern often changes when pg, may have first seizure during peri-menopausal time, considered high risk pg, may have birth defects with AED use
Special population - Elderly
High incidence fo new onset seizures > 65, risk factors include: stroke, head trauma, dementia, infection, ETOH, aging
Stroke is greatest risk

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