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What is a seizure disorder?
- escessive and abnormal discharge of electrical activity of all or part of the brain
- - hypersensitive, hyperactive, unstable neuron activity
- - neurons initiate seizure activity from epileptic focus
- - localized or entire focus
affecs motor function, sensation, autonomic function of organs, behavior, consciousness
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Epilepsy
- a chronic seizure activity vs. isolated incidences
- - idiopathic
- - secondary to birth injury, hypoxia, trauma, infection, metabolic, endobrine, toxins, tumor
onset usually occurs before age 20
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Partial Seizures
begin in one area of cerebral cortex; symptoms depend on area involved
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Simple Partial Seizure
- has no loss of consciousness, usually in one hemisphere
- usually motor portion of cortex-muscle ctx of contralateral part of body confined to one area
ie. hand, face
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Jacksonian Seizure
simple partial that spreads sequentially to adjacent parts
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Complex Partial Seizure
- consciousness impaired
- automatisms = repetitive, nonpurposeful activity
ie. lip smacking, picking, aimless walking; amnesia
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Generalized Seizures
involves both hemispheres, deeper brain structures - thalmus, basal ganglia, upper brain stem
consciousness is always impaired
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Absence Seizures
(petit mal)
brief cessation of motor activity with blank stare and unresponsiveness; 5-10 secs
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Tonic-Clonic Seizures
(grand mal)
begins with loss of consciousness and sharp tonic muscle contractions --> air forced out of lungs -- falls to opisthotonic posture = rigidity, extension, jaw clenched; incontinence; no breathing - cyanosis; pupils fixed and dilated; lasts 15-60secs
clonic phase follows - alternating contractions and relaxation of muscles in all extremities with hyperventilation; eyes roll back; froths at mouth; 60-90sec
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Generalized Seizures
Postictal Phase
lasts 60-90 secs
unconscious, unresponsive to stimuli, relaxes, breathes easily --> slow waking with confusion, disorientation, sleep, amnesia, injuries from fall
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Generalized Seizures
Status Epilepticus
continuous, with short breaks between intense, persistent seizures
CALL 911 d/t hypoxia
administer Diazepam q10"
May need surgery; vagal nerve stimulator
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Assessment for Seizures
- - Developmental history: pregnancy, childbirth events
- - Medical history: illness, infection, fever, head injury
- - Seizure history: alcohol or drug abuse, warning or aura, observational info about seizures
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Observations during the seizure
- - changes in pupil size and eye deviations, fluttering
- - LOC, time to return to pre-seizure status
- - presence of apnea, syanosis, salivation
- - invontinence of bowel, bladder
- - movement and progression of motor activity
- - lip smacking or other automatism
- - tongue or lip biting
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Lab and Diagnostic Testing
- Diagnostics:
- - EEG, XR, CT, LP, ECG
- - EEG Video recording
- - No hairspray, oily products in hair. Light meal within 4hrs *Avoid caffeine, no stimulants 24-48hrs prior
- - may restrict sleep night before
- Labs:
- - CBC, electrolytes, BUN, glucose, syphilis
Ongoing Research
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Nursing Diagnosis for Seizures
- - Risk for Inefffective airway clearance
- - Risk for injury
- - Fear
- - Ineffective coping
- - Knowledge deficit
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Nursing Interventions
- - Protect from injury; loosen clothing
- - Maintain ABC's
- - Neurologic checks; VS
- - Keep on side until responsive
- - Allow to rest
- DO NOT
- - force anything into the mouth
- - restrain
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Nursing Interventions
- Document
- - date, time, duration
- - description of activity: tonic, clonic, staring, blinking, automatisms
- - sequence of seziure progression, aura
- If status epilepticus
- - oxygen via mask or nasal
- - establish IV access and begin 0.9% saline
- - administer drugs as ordered: Valium IV repeat q10min
- - monitor VS and cardiac rhythm
- - have suction ready
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Patient Education
- - correct misconceptions, fears, myths
- - resources: Epilepsy Foundation of America
- - encourage expression of feelings, positive
- - follow up care
- - laws
- - employment, voc counseling; safety issues
- - medic alert band - type of SA and meds
- - Aura alert
- - medication compliance-exactly as prescribed
- - alcohol, caffeine, stress, lack of sleep, upset
- - triggers for SA
- - safety-med SE's *Dilantin- oral hygiene*
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Medications
- Anticonvulsants
- - Dilantin/Phenytoin (gingival hyperplasia)
- - Depakote/Valproate
- - Tegretol/Carbamazepine
- - Klonopin/Clonazepam
- - Neurontin/Gabapentin
- - Lamictal/Lamotrigine
Valium, Ativan, Phenobarbital
- Nursing responsibilities
- - VS, LFT's, therapeutic drug levels
- - CNS side effects: sedation, drowsiness, dizziness, confusion; vision and speech changes
- - may need diet rich in Vit D if prolonged therapy
- - IV administration
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