Seizure (types & phases)
What is a partial seizure?
A seizure involving only a specific area of the brain.
What is a seizure?
The malfunction of the brain’s electrical system, which results from cortical neuronal discharge.
Bonus Q: What is epilepsy?
What are at least 3 supportive treatment options we can do for a patient with a confirmed ischemic stroke?
-thrombolytic therapy
-aspirin (antiplatelet)
-benzos for seizure prevention (ativan)
-stool softeners (minimize straining)
-corticosteroids (minimize secondary injury)
-analgesics
What are the two different types of strokes?
Ischemic and hemorrhagic.
Bonus Q: What it s the difference?
A lumbar puncture is done on a patient with a suspected stroke. The CSF is bloody. What type of stroke would this indicate?
A hemorrhagic stroke.
What is a generalized seizure?
A seizure involving both hemispheres of the brain.
Bonus Q (200 pts): What are the 3 types of generalized seizures?
T/F: Research has found that all electrical discharges that produce seizures original from one specific area in the cerebral cortex.
False! Different seizures have different electric discharge characteristics. Some arise in the central area of the brain some start localized in an area of the cerebral cortex and then spread.
What is a normal range for ICP and CPP?
CPP: 65-90 mm Hg
ICP: 5-15 mm Hg
List at least 2 clinical manifestations of a stroke.
-loss of CNS function of that infarcted area (maybe loss off sensation or motor functioning)
-contralateral deficits
-loss of consciousness
-vision disturbances/cuts
What are the two things required for adequate brain function?
-consistent supply of oxygenated blood
-nutrients (primarily glucose)
Bonus Q: Name at least 2 potential reason either of these would be disrupted.
What is the ictal phase?
The actual event of the seizure
Name at least three problems/conditions that will put a patient with epilepsy at a higher risk of having a seizure.
-dehydration
-hypoglycemia
-hyponatremia
-fever
-fatigue
-emotional stress
What is included in Cushing’s triad?
-widening pulse pressure & HTN
-irregular respirations
-bradycardia
What is a hemorrhagic stroke?
The rupture of a cerebral blood vessel, causing intracranial bleeding.
Bonus Q: What are potential causes of this?
What type of scan should be obtained within minutes of the patient’s arrival if we suspect a stroke?
A CT scan.
Bonus Q: Why is it so important to get this scan done?
What is the seizure symptom/phase is more common in both simple and complex partial seizures?
An “aura”. It is a feeling that person gets right before they have a seizure. New research suggests this is actually a part of the seizure. It is different for each person, but it might feel like impending doom, fear, or even deja vu.
List at least 3 safety measures when can take when a patient is actively seizing.
-Padding on side rails
-Protect patient (no restraints!)
-Do not attempt to pry the mouth open or place anything in the mouth
-Loosen restrictive clothing
-Gather equipment for O2
-Clear secretions (Side-lying, Suction if needed)
-Vitals, monitors
-Document events and timing
What are at least 2 nonpharacologic nursing interventions that can help control a patient’s increased ICP?
-HOB at 30 degrees
-Spacing nursing interventions
-Encouraging a quiet environment, decreasing stimuli to the patient
-Prevent neck and hip flexion to promote venous return
-Prevent straining, gagging or combative behavior
What is a transient ischemic attack (TIA)?
Intermittent occlusion of small arteries in the brain. It is a type of stroke that only lasts a few minutes and neurological deficits usually resolve within 24 hours.
What are at least 2 signs of increased intracranial pressure?
-altered level of consciousness (earliest, nostalgic important indicator)
-hemiparesis progressing to hemiplegia (one-sided weakness to paralysis)
-abnormal motor responses (decorticate to decerebrate posturing)
-altered vision (blurry, slow pupil response)
What is status epilepticus?
Either a prolonged, single seizure (> 5 miknutes) or a series of seizures in a row within a 5 minute window without gaining consciousness between them.
Bonus Q: What class of medication (IV) would we administer to a patient experiencing this?
What are at least 2 potential treatment options for an epileptic patient?
-Pharmacotherapy
-Vagal Nerve Stimulation
-Diets (ex: ketogenic has been shown to raise the seizure threshold in kids)
-Seizure-alert dogs
-Surgery (ex: ablating part of the brain to prevent conduction)
List at least 3 components of the general brain attack (stroke) protocol.
-Document when patient last seen normal
-Secure patient safety
-Titrate O2 to maintain SP02 over 95%
-Establish and record VS Q 15 minutes
-Labs: CBC, Chem 14, Coags, Tox Screen, Troponin, LFTs, β Hcg
-Bedside glucose check
-Record patient’s weight
-Stat EKG
-NIHSS exam
What is a lacunar infarct?
A type of stroke where blood supply is occluded in a small artery in the deeper portions of the brain.
What is at least 1 potential reason transmission of nerve impulses across synapses (necessary for brain function) would be disrupted?
-seizures (more common)
-drugs or toxins (ex: heroin, which binds to presynaptic endorphin to block pain)