1. What are the 4 phases of seizures?
    • Prodormoal: emotional signals
    • Aura: premonition via senses
    • Ictal: seizure (partial and generalized)
    • Postictal: drowsiness and confusion common
  2. Match: Most common generalized seizure with a loss of consciousness (falling to the ground)

    C. Has tonic phase of muscle contraction, and intermittent relaxing phase (clonic)
  3. Match: this type of seizure occurs in childhood and is rare after adolescence.

    How is it characterized? 
    List Triggers

    • Characterized as brief staring spells with possible loss of consciousness. 
    • Triggers include: hyperventilation and/or flashing lights
  4. Match: This type of seizure is characterized by staring spell with subtle motor movements. It can begin at childhood and usually continues to adulthood. 

    List other characteristics

    Others: Peculiar behavior warning, with confusion after seizure
  5. Myoclonic seizures can be described as _____. 
    It will respond to this drug ____.
    • Jerking, brief seizures, leading to a fall.
    • It can respond with valproic acid (Depakote)
  6. This type of seizure is known as a "drop attack." What is its biggest concern?
    • Atonic Seizure: sudden fall to the ground, with consciousness returning immediately.
    • Head injury is a big concern.
  7. What is Todd's paralysis and how long can it last up to?
    • Weakness in part of all of the body after a seizure.
    • Usually subsides completely within 48 hours.
  8. Fill in:
    Simple focal seizures (partial) lasts up to __a__. They will __b__ (lose / remain) consciousness.

    They may also have sudden __c__.
    • a. 1 minute or less
    • b. remain conscious
    • c. sudden and unusual feelings (joy, anger, sadness)
  9. This type of seizure may cause a person to display strange behavior (automatism), or do dangerous things, like walk into traffic.

  10. What is magneto - encephalography? 
    What do you repeat if assessment diagnostics show no explanation for seizure?
    • (MEG): neuroimaging technique for brain activity
    • Repeat: CT or MRI should be repeated at periodic intervals to rule out tumor
  11. How is a electro - encephalogram performed?
    Electrodes are placed on the scalp, and the person is exposed to stimuli to provoke a seizure.
  12. Why is a status epilepticus the most dangerous type of seizure?
    This seizure is continuous or multiple seizures without full recovery of consciousness and can occur with any type.

    The brain uses more energy than can be supplied, leading to possible brain damage.

    • Can lead to:
    •  - Hypoxemia
    •  - Arrhythmias
    •  - Hyperthermia
    •  - acidosis
  13. Status epilepticus is the most dangerous type of seizure. List treatment measures

    List emergent interventions

    List things you will monitor

    List meds for status epilepticus
    • Stop seizure and identify cause.
    • Aggressive anticonvulsant if indicated.

    • Emergency measures:
    •  - CPR if needed
    •  - Airway
    •  - IV w/ NS

    Monitor: VS, labs, EKG

    Meds: Lorazapam, Phenobarbital, Phenytoin
  14. Valproic acid can be used for this type of seizure:

  15. List indication for the med, Diazepam:

  16. Select all that apply for meds that are for generalized simple or complex partial seizures:

    a. Valproic acid
    b. Carbamazepine
    c. Clonazepam
    d. Phenytoin
    e. Phenobarbital
    f. Ethosuximide
    g. Primidone
    • a. Valproic acid
    • b. Carbamazepine
    • c. Clonazepam
    • d. Phenytoin
    • e. Phenobarbital
    • f. Ethosuximide
    • g. Primidone
  17. Select all that apply for meds indicated for Absence seizures:

    a. Valproic acid
    b. Carbamazepine
    c. Clonazepam
    d. Phenytoin
    e. Phenobarbital
    f. Ethosuximide
    g. Primidone
    • a. Valproic acid
    • b. Carbamazepine
    • c. Clonazepam
    • d. Phenytoin
    • e. Phenobarbital
    • f. Ethosuximide
    • g. Primidone
  18. List nursing consideration, how many days to wait between dosing changes, and patient education about Phenytoin.

    What are its side effects?
    What are toxic effects?
    • Nursing: 
    •  - d/c the drug if liver enzymes >2x normal value
    • Days: allow 7-10 days between dose changes
    • Teaching: warn patient to never abruptly stop taking med
    •  - Encourage flossing
    • Side Effects: dulling of cognition, Nystagmus, Gingival Hypertrophy (lack of flossing)
    • Hepatic granulomas
    • Toxicity: slurred speech
    •  - problems w/ coordination
    •  - shakiness
    •  - dizziness
  19. T or F: Carbamazepine is indicated for absence seizures
    False: simple or complex partial seizures
  20. List serious side effects of valproic acids. 
    Can pregnant women take this?
    • serious s/e: pancreatitis and liver failure
    • It is a teratogenic in pregnancy
  21. This drug is an alternative for generalized tonic-clonic and simple/complex partial seizures. 

    Is it more or less effective as phenytoin?
    Phenobarbital: it is as effective as phenytoin
  22. This drug is indicated as an adjunctive therapy in seizures

  23. Fill in: ETOH withdrawals can be seen within __a__ hours of cessation of alcohol ingestion.
    The 2 drugs that can be administered are __b__ or __c__
    • a. 7-30 hours
    • b. Chloriazepoxide
    • c. Lorazapam
  24. This type of seizure resembles epileptic seizures, but are different as diagnosis occurs from people with a history of emotional abuse, physical neglect, or other specific traumatic episode.

    What is its name and how is it different than other seizures?
    Psychogenic seizure: there is usually no incontinence, tongue biting, or postictal phase
  25. List management during postop
    • HOB up
    • Neuro assessment
    • LOC alterations
    • Check for bleeding or infection
    • Evidence of seizure activity
  26. List patient teaching of what to do during a seizure

    How will they protect from injury?
    When to call 911?
    • Protect from injury:
    •  - Protect head w/out restraining movements
    •  - Turn on side
    •  - Loosen constrictive clothing
    •  - Ease person to floor if sitting
    • When to call 911: during status epilepticus. This is when seizure is prolonged without full recovery (brain damage and hypoxia)
  27. List patient teaching of phenytoin
    • Take same time each day
    • May cause drowsiness or dizziness
    • Avoid use with alcohol
    • Maintain good dental hygiene (see denist frequently)
    • If diabetic, monitor BG carefully
    • Do not take within 2-3 hours of antacids
    • Notify healthcare provider for thoughts of suicide
  28. A patient comes in the ER who is experiencing seizures. List the initial steps that you will take to ensure patient safety, meds to anticipate, and other interventions that you will need to do during a seizure event.
    • Maintain patent airway with suctioning and/or turning on side.
    • Ensure safety by padding side rails, DO NOT RESTRAIN, and remove or loosen tight clothing.
    • Establish IV access, and anticipate administration of phenobarbital, phenytoin (Dilantin), benzos to control seizures.
    • Assist with ventilation if needed after seizure or intubation if gag reflex is absent.
  29. What are the 2 most commonly used antiseizure drugs during a status epilepticus seizure? What is it usually followed up with?
    • Lorazepam and diazepam are commonly given as a rapid-acting IV.
    • They are short-acting drugs, so it is followed up with a long-acting drug such as phenytoin or phenobarbital.
  30. How can these 3 therapies help with seizures?

    Vagal nerve stimulation
    Ketogenic diet
    • Vagal nerve stimulation: surgically implanted electrode in the neck delivers impulses to the vagus nerve is activated with a magnet when a seizure is imminent.
    • Keto diet: may be effective for patients with drug-resistant epilepsy.
    • Biofeedback: aimed to teach patient to maintain certain brain wave frequency that is refrACTORY TO seizure activity
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