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Seizures
is a single event of abnormal electriccal discharge in the brain resulting in an abrupt and teporary altered state of cerebral function
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Epilepsy
a chronic disorder of abnormal, recurring, ecessive and self-terminating electrical discharge from neurons
more than one seizure without a cause
time range of seizures can range from mins to years
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Seizures and Epilepsy
Are they the same?
not all seizures are considered epilepsy
but epilepsy people have seizures
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Seizures
Cased by:* primary and secondary
P- Idiopathic: don't know why
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Seizures Cased by:
primary and *secondary
S- Acquired: Head injuries, CNS Infections, Brain tumors, Birth Trauma, Metabolic disorders (renal failure), Alcohol withdrawal, Electrolyte problems – inc or dec sodium, Heart disease, Medications – some meds can cause seizures, High fevers in kids (especially under the age of five years old)
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Seizures
Goal
Control seizures activity
EEG technology
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Seizure
Prevention
- monitor high risk pregnancies
- control lead poisoning
- prevent childhood diseases – get immunized; measles and mumps can cause high temperatures which can lead to seizures
- prevent head injuries – wear seatbelts and helmets
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Generalized
Two kind
*tonic-clonic
absence
Tonic-clonic (grand mall)- are the most common type of seizure in adults, a warning aura may precede, sudden loss of consiousness and sharp tonic muscle contractions
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Tonic-clonic
Tonic phase
sudden loss of consciousness and sharp tonic muscle contrations
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Tonic-clonic
Clonic phase
- follows the tonic phase
- alternating contractions and relaxation of the muscles in all the extremities along with hypervenilation
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Post icatal phase:
is altered state of consciousness that a person enters after experiencing a seizure usually lasts between 5-30mins to hours
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Generalized
Two kind
tonic-clonic
*absence
- Petit mal- a sudden brief cessation of all motor activity accompanied by a black stare and unrresponsiceness
- more common in children, but adults get them too
- typically last only about 5-10 sec, but some last 30sec
- movements such as eyelid fluttering or automatisms such as lip smacking may occur during an absent seizure
- vary from occasional episods to several hundred per day
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Parital Seizures
*Complex
Simple
- Complex partial seizures- memory, awarness, or consciousness impaired
- may engage in repetivitive, nonpurposeful activity, such as lipsmacking, aimless walking, or picking at clothing
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Parital Seizures
Complex
*Simple
- memory, awareness and consciousness preserved
- the motor portion of the cortex is affected, causing recurrent muscle contractions of the face or a contralateral part of the body, such as a hand or finger
- (Deja Vu)
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Status epilepticus
- can develop during seizue activity
- the seizure activity becomes continuous, with only very short periods of calm between intense and persistent seizures
- can be any type of seizure, but usually are tonic-clonic
- A. airway B. assessment C. prevent injury D. emergency meds (Versed, Valium, Ativan)
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Occurrence of seizures –
Vary in frequency
- Absence – can happen 100 X daily
- Tonic-Clonic – can happen every few weeks or once in a lifetime
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Seizure
Attacks precipitated by:
- Excitement – wedding, prom
- Anger
- Menstruation
- Fatigue
- Some meds (e.g., Demerol) can lower pt seizure threshold (liver has problem metabolizing the med either due to lack of an enzyme or a build-up of the med in the system); the seizure may be secondary to taking the med
- Brain tumors/scar tissue in brain
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Document history
- Journal
- how often, frequency, how long the seizure lasts, what was going on around the pt at the time it happened
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Treatment during a Seiure attack
Prevent from
- Injury
- don't restrain, can cause harm
- assure safety, what's around the pt
- loosen tight clothing especially around the neck
- call 911
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Seizure
Observe and record
- Look at watch to time seizure
- Notice what part of body the seizure started/involved (e.g., arm or just hand, leg, whole body [tonic-clonic], top half, right side, etc)
- did pt appear to lose consciousness?; did pt make eye contact?
- note skin color – does it look like pt is suffering O2 deprivation?
- respiration – is pt breathing?
- Did pt go thru stages (e.g., stiff to jerking or just jerking with no stiffness)?
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Seizure
Maintain Privacy
- people tend to gather around someone who is having a seizure
- do crowd control; pull curtain; keep pt covered when possible
- pt doesn’t want everyone seeing their wet pants from incontinence
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Seiures
Nursing diagnoses
- risk for airway clearance/risk for aspiration
- risk for injury
- anxiety/depression
- social isolation
- disturbed sensory preceptural: visual
- low self-esteem
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Pt might need life-style adjustments
- if pt can pinpoint seizure triggers he/she can try to avoid them (e.g. flashing lights from video games)
- Pt does better with regular routine
- Get adequate sleep
- Don’t drink alcohol
- Eat a nutritional diet
- Wear Medic Alert jewelry if hx of seizures
- driving and employment
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Seizures
Drugs
- control 50-60% if properly prescribed and taken, may need combination
- Usually continue for life
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Seizures
Drug
Side effects
suicidal thoughts and behavior
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Seizure
Drug side effects:
Dilantin
rash, skin darker (females)
gingival hyperplasia
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Peripheral Nervous system disorders
Trigeminal neuralgia
description
- also called tic douloureux, is a chronic disease of the trigeminal cranial nerve (v) that causes unilateral excruciating facial pain
- more common in women than in men
- occuring most often in middle or late adult life
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Peripheral Nervous system disorders
Trigeminal neuralgia
Cause
- Unknown
- unilateral excuciating facial pain
- the nerve has 3 division: the ophthalmic, the maxillary, and mandibular
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Peripheral Nervous system disorders
Trigeminal neuralgia
S/S
- severe facial pain occurring from brief seconds to several minutes long hundreds of times a day
- Recurring several times a year
- Usually unilateral (one-sided)
- Pain can be set off by sensory contact (e.g., touching, talking, eating, change in temperature, cold rain hitting face, brushing teeth, etc)
- Can go into spontaneous remission for several years and pt is free of pain
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Peripheral Nervous system disorders
Trigeminal neuralgia
meds
- the drug most useful in controlling the pain is the tricylic anticonvulsant carbamazepine (Tegretol)
- if ineffective there is other meds
- Dilantin, Neurontin, Lioresal
- side effects: dizziness, nausea, and drowsiness
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Peripheral Nervous system disorders
Trigeminal neuralgia
Surgery
- if meds do not control the pain, surgical procedures may be performed, including various types of rhizotomy, the surgical severing of a nerve root.
- blood vessel may be putting pressure on or irritates the nerve, so the surgeon puts fat (subQ tissue) between nerve and vessel
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Peripheral Nervous system disorders
Trigeminal neuralgia
Nursing Diagnosis
- Acute Pain
- Risk for altered Nurition: less than body requirments
- knowledge Deficit
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Peripheral Nervous system disorders
Bell's Palsy
Description
- also called facial paralysis
- a disorder of the cranial nerve VII (7) which is a MOTOR nerve
- most commonly effects pt ages 20-60 years
- effects men and women equally
- causes one-sided facial paralysis (effects only FACE not body)
- cause unknown, some MD’s think it may be related to a branch of the Herpes Simplex Virus
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Peripheral Nervous system disorders
Bell's Palsy
S/S
- sudden onset and almost always involves one side of the face
- pain behind the ear or along the jaw may precede the paralysis
- pt initially notices numbness or stiffness of one side of the face that distorts the appearance
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Peripheral Nervous system disorders
Bell's Palsy
Prognosis
- majority of pt will fully recover but it might take several weeks to several months
- some pts have residual paralysis for life
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Peripheral Nervous system disorders
Bell's Palsy
Meds
- there are no meds for this
- some MDs use steroids (short-term) to reduce inflammation and swelling
- antiviral (acyclovir) w/an anti-inflammitory (prednisone) limiting nerve damage
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Peripheral Nervous system disorders
Bell's Palsy
Nursing Care
- Usually not admitted to hospital
- Prevent injury-wear patch at night to keep eye clean r/t not being able to blink, wear sunglasses during the day r/t un-reactive pupil, may need artifical tears r/t can’t blink
- Maintain nutrition, Easy to bite tongue/cheek, Pt isn’t aware food is caught in effected cheek, Eat soft food
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Peripheral Nervous system disorders
Neuropathies
most common
Diabetic Neuropathies- is a disease of the kidneys characterized by the presence of albumin in the urine
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Peripheral Nervous system disorders
Neuropathies
types
Polyneuropathy
mononeuropathy
Visceral (autonomic)
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Peripheral Nervous system disorders
Neuropathies
Polyneuropathy
- effecting more than one nerve
- Distal paresthesias - (numbness and tingling)
- odd feelings; sensations is just not “normal”
- Pain - including aching, burning (yet feels frozen), feelings of cold – most of the time
- Altered or impaired sensation – pt doesn’t have normal feeling in those extremities anymore
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Peripheral Nervous system disorders
Neuropathies
Mononureopathy
are isolated peripheral neuropathy that affect a single nerve (carpal tunnel, shingles, eye nerve, diabetic femoral neuropathy)
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Peripheral Nervous system disorders
Neuropathies
Visceral (autonomic)
- lack of blood flow to some of the autonomic nervous system
- Sweating – excessive or unable to
- Gastrointestinal - eat food, but it sits in stomach r/t to slowed peristalsis
- Sexual dysfunction – can’t get or keep erections r/t decrease blood flow; Viagra won’t help
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Peripheral Nervous system disorders
Neuropathies
Collaborative managment of peripheral disorders
- Always wear properly fitting shoes when walking everywhere (including in home) to avoid stepping on things (i.e., pin, nail, splinter);
- don’t want impaired skin integrity – IV antibiotics won’t get to the affected area r/t poor circulation
- Have shoes fitted properly; don’t want blisters; wear for short periods of time while breaking them in
- Assess skin on feet daily for sores, etc.; have a mirror on the floor so can inspect easily § Have toenails professionally trimmed (podiatrist)
- Avoid use of corn plaster (acid to burn off corn can damage skin)
- Check temperature of water with hand or thermometer before stepping into it
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