fuentes seizure
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seizure- are episodes of abnormal motor, sensory, autonomic, or psychicactivity (or a combination of these) that result from sudden excessive
discharge from cerebral neurons.
Partial Seizures- seizures beginning locally
Simple Partial Seizures- seizures with elementary symptoms, generally without impairment of consciousness]
Complex Partial Seizures- with complex symptoms, generally withimpairment of consciousness
Generalized Seizures- convulsive or non convulsive, bilaterally symmetric, without local onset
Epilepsy - a group of syndromes characterized by unprovoked, recurringseizures
Status epilepticus- an acute prolonged seizure activity - is a series of generalized seizures that occurs wthout
full recovery of consciousness between attacks
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Category:Idiopathic:•genetic,•developmental defects
Acquired:
•Cerebrovascular disease•Hypoxemia•Fever (childhood)•
Head injury •CNS infections•Metabolic and toxic conditions•Brain tumor•Drug and alcohol withdrawal• Allergies
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Risk Factors Given
disturbance in cerebral function
Electrical disturbance in the nerve cells in one section of the brain
Diseased tissue in the Cerebrum discharges electrical impulses abnormally
Neurons emits abnormal, recurring, uncontrolled electrical discharges
Erratic Electrical discharge thatbegins in one part of the brain
Partial seizures (Simple and Complex) Generalized seizure
erratic electrical dischargesinvolving the whole brain
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International Classification of Seizures
Seizures are divided first into two categories:•Partial (focal)
1. simple partial seizures (with no alteration of consciousness or memory)
•motor seizures with twitching,•abnormal sensations, abnormal visions,sounds or smells,and
•distortions of perception.•.resulting in flushing,•tingling,•nausea.
2. complex partial seizures (with alteration of
consciousness or memory)•may have an aura (nausea, heat or tingling, or distortionof sensory perceptions)•lip smacking,• walking around aimlessly, or• saying nonsense phrases over and over again.•These purposeless activities are called automatisms.
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•Generalized
Absence Seizures•previously called petit mal seizures.•usually have onset in childhood, but they can persistinto adulthood.•present with staring spells lasting several seconds,
sometimes in conjunction with eyelid fluttering orhead nodding.•These seizures can be difficult to distinguish fromcomplex partial seizures that also may result in
staring.• Absence seizures usually are briefer and permitquicker recovery.
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Generalized Tonic-Clonic Seizures
•previously called grand mal seizures.•These seizures start with sudden loss of consciousnessand tonic activity (stiffening) followed by clonic activity (rhythmic jerking) of the limbs.•
The patient's eyes will roll up at the beginning of theseizure and the patient will typically emit a cry, notbecause of pain, but because of contraction of therespiratory muscles against a closed throat.• Generalized tonic-clonic seizures usually last one to
three minutes.• After the seizure, the patient is "postictal“ (sluggish,sleepy and confused, variably for hours)
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Atonic Seizures
•These are epileptic drop attacks.•
typically occur in children or adults with widespread brain injuries.•People with atonic seizures suddenly become limp and may fall to theground.•helmets are sometimes required to protect against serious injuries.
Myoclonic Seizure
•a brief un-sustained jerk or series of jerks,•less organized than the rhythmic jerks seen during a generalized tonic-clonic seizure.
Tonic Seizures
•involve stiffening of muscles as the primary seizure manifestation.• Arms or legs may extend forward.•Consciousness may or may not be lost.•
the clonic (jerking) phase is absent.
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During a seizure:Major responsibility of the nurse is to observe and record the sequence of signs
Before and during a seizure, the patient is assessed and the ff items are documented
the circumstances before the seizure (visual, auditory stimuli, emotiopnalor psychological disturbances, hyperventilation)
the occurrence of an aura (premonitory warning or sensation which may be Visual , Auditory)
the 1st thing the patient does in the seizure– where the movements orstiffness begins, conjugate gaze position,etc.
the type of movements in the part of body involved
size of both pupils whether eyes are are open
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•Presence of automatisms (involuntary motor activity, such as lipsmacking or repeated swallowing)
•
Incontinence of urine or stool
•Duration of each phase of seizure
•Unconsciousness, if presence, and its duration
• Any obvious weakness of arms and legs after the seizure
•Inability to peak after the seizure
• Whether or not the patient sleeps afterward
•Cognitive status (is pt. confused or not confused after theseizure?)
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Nursing care during a seizure: •Provide privacy and protect the pt. from conscious onlookers
•Ease the pt to the floor if possible, protect the head with a pad to prevent injury
•Loosen constrictive clothing
•Push aside any furniture that may injure the pt. during seizure
•If pt. is in bed, remove pillows and raise siderails
•If an aura precedes a seizure, insert an oral airway to reduce the possibility of biting the tongue or cheek
•Do not attempt to pry open jaws that are clenched in a spasm or to insert
anything
•No attempt should be made to restrain the patient during the seizure
•If possible, place the patient on one side with the head flexed forward
•If suction available, use if necessar to clear secretions
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After a seizure:
After a seizure, the nurse’s role is to document the events leading to andoccurring during and after the seizure and to prevent complications
Keep the patient on one side to prevent aspiration
There is usually a confusion after a grand mal seizure
A short apneic period may occur during or immediately after a generalizedseizure
The patient, upon awakening, shoulb be oriented to the environment
If pt. becomes agitated after a seizure, use persuation and gentle restraint toassist him to stay calm.
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Medication Dose related side effects Toxic effects
Carbamazepine Skin rash.Dry mouth, nausea, vomiting, fluid retention,unsteadiness, dizziness,
drowsiness, fatigue,headache, low sodium in theblood, blood disorders,dermatitis, and hives.
Severe skin rash, blooddyscrasias, hepatitis
Ethosuximide Nausea, vomiting, diarrhoea,abdominal pain, anorexia,and weight loss.
Hepatotoxicity, bone marrowdepression
Lamotrigine Drowsiness, tremor, nausea,ataxia, dizziness
Severe rash
Phenobarbital sedation, irritability,diplopia, ataxia
skin rash, anemia
Phenytoin visual problems, hirsutism,
gingival hyperplasia
Peripheral neuropathy,
ataxia, drowsiness, blooddyscrasias
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Risk for Injury Related to seizure activity injury preventionseizure precautions
Fear related to possibility of seizures:adherence to prescribed medication regimen
emphasize need to medication complianceencourage periodic monitoring of condition to assure adequacy of treatmentregimen Avoid factors that may initiate seizure (emotional disturbances, environmentalstressors, fever, etc)encourage pt. to follow a regular and moderate routine in lifestyle, diet,
exercise, and restavoid photic stimulationavoid alcoholic beverages
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Ineffective individual coping
•Counseling of patient and patient’s family •Encourage provision of social and recreational activities within thefamily
Knowledge deficit•Educate them about the condition and the limitation it imposesas well as the symptoms and management•Provide modification on pts efforts and behaviors if necessary •Instruct the pt. to carry a medication card or bracelet
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Seizures occur when the electrical system of the brain malfunctions. The brain cells keepfiring instead of discharging electrical
energy in a controlled manner. The resultcan be a surge of energy through the brain,causing unconsciousness and musclecontractions.
Seizures that begin focally can spread to the entire brain, in whichcase a tonic-clonic seizure ensues. It is important, however, todistinguish those that are true grand mal, generalized from thestart, from those that start focally and secondarily generalize.Secondarily generalized seizures arise from a part of the brain thatis focally abnormal. Drugs used to treat primarily and secondarily
generalized tonic-clonic seizures are different. Patients withsecondarily generalized tonic-clonic seizures may be candidates forcurative epilepsy surgery, whereas, primarily generalized tonic-clonic seizures are not surgical candidates, because there is noseizure origin site (focus) to remove.
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A group of syndromes characterized by unprovoked, recurring seizures
Types:
•
Primary – idiopathic
•Secondary – known cause-birth trauma -metabolic-asphyxia - alcohol intoxication-head injuries - brain tumor-bacterial, viral, parasitic dses. - abscess-toxicity - congenital malformation-fever
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Sensory Stimuli
Brain integration (neurons)
Discharge of electrochemical energy
Action/purposeful activity is carried out(motor output)
Neuronal/electrical system of the brainmalfunctions
Repeated discharges of electrical energy inan uncontrolled manner
the brain cells keep firing even afterbrain integration—motor output is carried
out
Resulting a surge of energy through thebrain,
Parts of the body controlled by the errantbrain cells also performs erratically
Simple to staring episodes, convulsivemoments, muscle contractions, loss of
consciousness, etc.
Depending on the location of the discharging neurons, seizures
may range from a simple stari ng
episode to prolonged convulsive
moments with loss of
consciousness
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•There is an increase in seizure frequency during menses; this has beenlinked to the increase sex hormones that alter the excitability of neurons in
the cerebral cortex
•Effectiveness of contraceptives is decreased by antiseizure medz
• Women of childbearing age who have epilepsy require special care before,
during, and after pregnancy
•Risk of fetal congenital anomaly is 2-3x higher in women with epilepsy
•Maternal seizures, antiseizure medz, and genetic predisposition allcontribute to possible malformation
• Women taking antiseizure medz are at risk and needs careful monitoring,including blood studies to detect the level of antiseizure medz throughoutpregnancy
•Bone loss is associated with long term use of anti seizure medz
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•Cerebrovascular dse is the leading cause of seizures in the elderly
•
The increase incidence is also associated with stroke, head injury,dementia, infection, alcoholism, and aging
•Because of decreased liver and renal fx, elderly pts. Must bemonitored closely for adverse and toxic effects of antiseizure medzand for osteoporosis.
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• society wide efforts are the key to prevention of epilepsy :
--thru highway safety programs and occupational safety precautions
Mgt. of epilepsy is individualized to meet the needs of each pt. and not just to
manage and prevent seizuresPharmacologic therapy:
• objective is to achieve seizure control with minimal Side effects
•
Medication therapy controls rather than cure seizures•Starts with single medication starting dose and rate of increase in dosage depends on
the occurrence of side effects
•Changing to another medication may be necessary if seizure control is not achieved or if
toxicity makes it impossible ti increase the dosage
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Side effects of antiseizure medz may be divided into 3 grps. :
1. Idiosyncratic or allergic disorders - skin reactions2. Acute toxicity- may occur when medz is initially prescribed
3. Chronic toxicity- occurs late in the course of therapy
Various manifestations of antiseizure drug toxicity:
• gingival hyperplasia
• severe skin rash
•
Hepatitis• Blood dyscrasias
• Aplastic anemia
• leukopenia
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Indication:
•Pts whose epilepsy results from :
-intracranial tumors
-brain abscess
-cysts
-vascular anomalies
•
Pts whose seizures originate in a reasonably well-circumscribed area of thebrain that can be excised without producing significant neurologic deficits.
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Neurosurgery and Resection surgery
-aided with microsurgical techniques, EEG with depth electrodes, improved
illumination and hemostasis and introduction of neuroleptic agents & local
anesthetic agents
-Use of special testing devices, electrocortical mapping and pt’s response to
stimulation
Generator implant- when seizures are refractory to medz inadolescent and adults with partial seizures
•Implanted under the clavicle.
•Device is connected to the vagus nerve in the cervical area delivers electrical
signals to the brain to control & reduce seizure activity
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The major potential complications forpatients with epilepsy are:
- status epilepticus
- medication side effects ( toxicity)
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• An acute prolonged seizure activity (includes continuous clinical or electrical seizures
lasting atleast 30 mins., even without impairment of consciousness)
• A series of generalized seizures that occur without full recovery of consciousness
between attacks
Risk factors:
• Withdrawal of antiseizure medication
•Fever
•Concurrent infection
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• A MEDICAL EMERGENCY!Depletion of GABA(a principle inhibitory neurotransmitter)
and the excessive action of glutamate (an proconvulsive neurotransmitter)
state of raised excitability
Vigorous muscular contractions
Creates heavy metabolic demand and interference with respirations
Hypoxia
Cerebral anoxia
Repeated and prolonged cerebral anoxia
Irreversible and fatal brain damage
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Goals of treatment are :
• to stop the seizures as quickly as possible
• to ensure adequate cerebral oxygenation (respiratory support, ET)
• to maintain patient in s seizure-free state
•IV diazepam lorazepam or fosphenytoin is administered in an attempt to
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•IV diazepam,lorazepam,or fosphenytoin is administered in an attempt tohalt seizures immediately
•Other medz- phenytoin, phenobarbital- are administered later to
maintain a seizure free state
•IV line is established and blood samples are obtained to monitor serumelectrolytes, glucose, and phenytoin levels
•EEG monitoring
• VS and neurologic signs monitoring on a continuing basis
•IV infusion of dextrose if the cause of seizure
•If initial treatment is unsuccessful, general anesthesia with short-actingbarbiturate may be used
•Serum concentration of antiseizure medz are measured
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•Ongoing assessment and monitoring of respiratory and cardiacfunction
•Monitoring and documenting the seizure activity and patient’sresponsiveness
•
Turn pt. to a side lying position
•Suction equipments should be readily available
•IV lines must be closely monitored
•Protect patient from injury most esp. during seizure attacks
•Refer accordingly
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