Etiology
What is a seizure?
A seizure is a sudden uncontrolled electrical discharge in the brain. For short we call them small riots in the brain.
Your patient is diagnosed with Non-Epleptic seizures. What causes these types of seizures and how do we treat them?
Causes:
-Electrolyte imbalances: hypo/hyper-natremia, hypocalcemia, hypomagnesemia
-Metabolic imbalances: Hypoglycemia, nonketotic hypergylcemia
-Parathyroid imbalances: Hypo/hyper- parathyroidism
-Adrenal insufficiency
-Drug intoxication or withdraw
Treatment: We treat the cause of the seizures
Define what an Aura is and give an example?
An aura is what we call a warning signs that a seizure is about to occur.
Ex. "Sick to my stomach", Tasting certain things.
We classify seizures into two groups. What are these two groups?
Partial and generalized
The nurse would ask the patients wife the questions
What do we worry about with a patient experiencing seizure?
Tongue can call back and block the airway
Secretions can pool in the mouth
Muscle contractions can prevent inhalation
What is an EEG
Electroencephalography
EEG results show changes in brain activity that help diagnose seizures.
What does the choice of medications depend on?
Seizure types and all medications are individualized. Just because it works for one pt doesn't mean its going to work for another.
Your patient is on an anti-convulsant. You got into the room to do an assessment and notice a rash upon your patients skin.
1. What are you going to do first?
2. What could this possibly be?
3. What are we most concerned about?
4. How do we treat these pts?
1. BRING TO ATTENTION of the HCP
2. Most likely SJS
3. Were most concerned with the airway because it can cause esophageal erosion which they will get a gt tube
4. We treat these pts like burn patients
This is VERY life threatening
1.Lorazepam or Diazepam are also given to treat what? and in what situation would we give this med to our patient?
2.How can this medication be given? Which route has the fastest affect and we will most often use?
3.What are patients at risk for with this medication?
1. Anxiety prior to a procedure such as a CT scan
2. PO (30 mins), IV (60 secs), IM (Longer)
3. Substance abuse/ dependence
65 year old female goes to her regular HCP to get a check up. This patient has a history of seizures and as she is getting her check up she asked the nurse "Where do seizures originate in the brain?" what would the correct response be from the nurse?
Seizures start in one area of the brain and may be confined to that one area or can spread to other areas.
Your patient is diagnosed with Epilepsy Syndrome.
1.What are these types of seizures?
2. To be diagnosed with this type of syndrome what has to be apparent?
3.What should we teach these patients about these seizures and their treatment?
4. What type of people does these seizures effect?
1.These types of seizures are characterized by recurrent seizures of a non-metabolic cause.
2. Two or more seizures of a non-metabolic cause
3. We should teach these patient that 1/3 of people diagnosed with epilepsy continue to have seizures despite treatment.
4. Epilepsy is the most common serious brain disorder world wide. ANYONE can experience it.
With a patient diagnosed with complex partial seizures what might they experience after a seizure?
What do these patient normally have a history of?
Are these patients going to respond to you during a seizure?
Patient might experience amnesia and lethergy after a seizure
These patient normally have history of febrile seizures or head trauma
With partial seizures does affect one side or both sides of the brain?
One side
The nurse enters her pts room who is diagnosed with tonic-clonic seizues. The pt was speaking to the nurse when suddenly he started to experience an event. What is the first thing the nurse should do?
A. Note the first thing the client does and time the seizure
B. Pull all of the blankets off the patient
C. Turn the patient to his side
D. Use the tongue blade to be sure the pt is not blocking his airway
A. Noticing the first thing the pt does
during a seizure provides information
and clues as to the location of the
seizure in the brain. It is important to
document whether the beginning of
the seizure was observed. Timing the seizure is also very important because long seizures are dangerous.
What are our nursing interventions to prevent the life threatening things that can happen during a seizure?
Loosen clothing around the neck
Turn on side
DO NOT FORCE ANYTHING INTO THE MOUTH
Give O2
Have suctioning available
How long will a patient be in the hospital when undergoing an EEG?
How do we induce seizure activity?
-24-48 hours or until we have recordings of seizure activity
-We take these pts off their meds and do things to induce seizures such as (Flashing lights, loud sounds, sleep deprevation)
Overall how do seizure medications work in the body?
These medications reduce the abnormal electrical activity in the brain that is causing the seizures.
2. What two types of seizures will we used this med for?
3. Can you buy it at the vape shop? If not where can a pt get it?
4. Will these pts likely be on an anti-convulsants?
5. What do we need to monitor?
1. Cannabinol
2. Lennox-Gastuat & Dravet Syndrome THE BIG BAD SIEZURES
3. No you cannot buy it from the vape shop you have to be under the care of those 4 centers
4. Yes more than likely
5. Serum levels of seizure meds
Benzo's
1. If our patient has is intoxicated are we going to give them this medication?
2. What would we teach a mother who is pregnant and taking this medication?
3. What is the antidote?
1. No it cause an additive effect for sedation
2. Can cause birth defects & can be passed through breast milk that can cause CNS depression in the infant
3. Flumazenil
Patients with a head injury may be at a 5% risk for what?
Developing a seizure disorder
1. What are these seizures also called?
2. What causes these seizures?
3. How do we describe these seizures?
4.What are the treatment options for this patient?
1. Pseudoseizures
2. They are emotional or stress related (Conversion disorder)
3. The patients appear to be having a seizures, but there are no abnormal electrical discharges so we CANT see them on the monitor.
4. Neurological workup and CBT
A patient with absence Seizure is just placed on your unit and you are the assigned nurse.
1. How do we describe these seizures?
2. What are the signs and symptoms we will see with this patient?
3. These patients are misdiagnosed with what most of the time and why?
4. Do these patient have an aura?
1. We describe them as SUDDEN, Brief sensation of all motor activity
2. S&S: Blank stare and are unresponsive, 3Hz blinking
3. They are misdiagnosed with ADHD d/t loosing 5-10 seconds every few minutes
4. NO these pts do not have an aura
With Generalized seizures is both or one side of the brain affected?
Both sides
What are some other important things to note about seizure activity?
Did the pt experience any warning sign?
Did the pt lose consciousness?
Did anything unusual happen that could have stimulated the seizure?
Did the client cry out last the beginning of the seizure?
What movements did you notice during the seizure? (turning head to one side)
Did the pt lose bowel or bladder control?
Did the client have increased secretions?
The unlicensed assistive personnel (UAP) is attempting to put an oral airway in the mouth of a client having a tonic-clonic seizure. Which action should the primary
nurse take?
1. Help the UAP to insert the oral airway in the mouth.
2. Tell the UAP to stop trying to insert anything in the mouth.
3. Take no action because the UAP is handling the situation.
4. Notify the charge nurse of the situation immediately.
The nurse should tell the UAP to stop trying to insert anything in the mouth of the client experiencing a
seizure. Broken teeth and injury to the lips and tongue may result from trying to place anything in the clenched jaws of a client having a tonic-clonic seizure.
Why do we do get a CBC on our seizure patients?
Controlling the movement of electrolytes across neural membranes (sodium, chloride, calcium)
or
By affecting the neurotransmitters balance by increasing GABA in the brain.
1. Barbiturates do what in the body?
2. Pts who take barbiturates are at risk for what?
3. Are they long-acting or short-acting
1. Enhance the action of GABA in the brain
2. R/F Dependence/abuse & respiratory depression
3. Long acting and inexpensive meds
Benzo's can worsen_______ and if taken with MAOIS can cause _______.
-Hypertensive crisis. (MAIO: Nardil)
We characterize seizure into two groups. What are these groups and what are their causes?
Primary: (idiopathic)
-There is no known cause
Secondary:
-Metabolic disorders (hypoglycemia), Electrolyte disturbances (hyponatremia), acute ETOH withdraw, CV diseases, anoxia, infection/high fever, exposure to toxins (Pesticides), trauma, tumors of the brain, brainstem or spinal cord, vascular abnormalities (aneurysm)
Your patient is diagnosed with Fibrile seizures.
1. What causes these seizures?
2. What age group do they affect?
3. At what ages do these seizures peak?
1. A result in rapid temperature rise above 102oF/39oC
2. Between 3 months to 5 years of age
3. Between 17-24 months of age
A patient with absence Seizure is just placed on your unit and you are the assigned nurse.
1. How long do these seizures last
2. Is LOC affected?
3. What age group does this affect?
4. Is there any post-ictal confusion with these patients?
4. What is the treatment for these seizures?
1. Very brief (5-30 secs)
2.
3. Children agree 4-10 years of age, normally resolves by age 20
4. There is NO post-octal confusion
True or false
A Tonic-Clonic seizure is considered a partial seizure?
False
It is a generalized seizure
What are the important things we need to assess after a seizure?
-Neuro status
-Signs of hypoxia and LOC
-During the postnatal period you should assess VS, NEURO CHECKS, AND MAINTAIN SAFETY
One of your seizure patient has a history of respiratory issues during seizures. What should the pt have on to be monitored?
Cardiac monitor and pulse OX
What do we rule out when doing a LP?
Pts with hepatic or renal dysfunction because these medications are metabolized
1. How can Barbiturates be given?
2. What are we worried about with our patients taking barbiturates?
3. Can we stop these medications abruptly and if so what time happen?
1. PO, IM, IV
2. These medications can cause agranulocytosis, Respiratory depression, bradycardia, CNS depression, coma
3. No it can cause withdraw and STATUS
1.Hydantoins end in what?
2. These medication can cause 3 things that we need to know. What are they?
3. Due to these three things what supplements might they take?
1. toin example: Phenytoin
May see dilantin used frequently
2. Neuropathic pain, Gingival hyperplasia, demineralize bones
3. Vitamin D and calcium supplements
What may Hide call a seizure on her test?
Event
Your patient is diagnosed with Febrile seizures.
1. When do these patient usually experience their seizures?
2. Will these seizure go away or will they affect them for the rest of their life?
3. What kind of seizures do these patients have?
4. What puts these children at higher risk for this diagnosis?
1. On the first day of fever/illness
2. They typically grow out of them
3.Tonic-clonic
4. Family history of Febrile seizures. If one of your older siblings had Febrile seizures you're likely to have them as well.
A 35 year old male was just admitted to your unit with a diagnosis of Tonic-Clonic seizures.
1. What did these seizures used to be called?
2. What age group do these seizures affect?
3. Do these patients experience an aura?
4. Do these seizures affect LOC?
1. Grand Mal
2. Adults
3. Yes or sense of unsteadiness prior to the seizure
4.Yes SUDDEN LOSS of consciousness
-remember if these patients are standing they're going to fall
True of false
Simple seizure are classified as partial seizures
True
A 7-year-old male patient is being evaluated for seizures. While in the child’s room talking with the child’s parents, you notice that the child appears to be daydreaming. You time this event to be 10 seconds. After 10 seconds, the child appropriately responds and doesn’t recall the event. This is known as what type of seizure?
A. Focal Impaired Awareness (complex partial)
B. Atonic
C. Tonic-clonic
D. Absence
The answer is D. This is an absence seizure and is most common in children. The hallmark of it is staring that appears to be like a daydreaming state. It is very short and the post ictus stage of this type of seizure is immediate.
How do we implement safety for these seizure patients?
ALL 4 bed rails up WITH padding
Keep bed in lowest position
What do our CT/MRI scans rule out for our seizure pts?
Brain tumors, stroke, bleeding
Normally this will be done if its the pts 1st seizure
True or false
If a patient feels like their seizure medications are not working for them anymore they can just stop taking their medications.
FALSE these meds cannot be stopped abruptly.
What do our barbiturates end in?
Barbital
Phenobarbital is the most common
1.How many Mg can push Hydantoins per minutes?
2. If our patient is ordered 2G of Phenytoin to be administered at @900, How many minutes would it take to administer?
1. 50 mg per minute
2. 40 minutes
Your patient is diagnosed with Febrile seizures
1. What should teaching should we implement for these patients?
2. How do we treat these patients?
1. These children have a greater chance of experiencing a future seizure. Most of these children DO NOT develop Epilepsy
2. Antipyretics
The 35 year old male that was just admitted to your unit with a diagnosis of Tonic-Clonic seizures asked you the following questions. How will you answer?
1. Are there phases that present with tonic clonic seizures? If so what are they? How long do they last?
2. How do you know I am having a tonic clonic seizure?
3. Why am I so tired after my seizures?
4. What do we call the postictal phase?
5. In what phase do we apply oxygen by face mask?
1. Tonic phase: Where the muscle contraction takes place and the cry out happens. Usually last 10-15 secs
Clonic phase: Alternating contractions (Jerks). Usually last 1-2 minutes
Postictal Phase: Decrease in LOC and pt wants to sleep
2. I know if you're having a tonic clonic seizure if I see or hear the "cry out" (Where the contractions forces air out of the lungs)
3. You may be tired after the seizure d/t glucose and oxygen depletion.
4. The recovery period
5. During the Clonic phase
True or false
When a patient is experiencing symptoms of jerking on the right side of their body, this means the left side of the brain is affected.
true
You’re developing discharge instructions to the parents of a child who experiences atonic seizures. What information below is important to include in the teaching?
A. “This type of seizure is hard to detect because the child may appear like he or she is daydreaming.”
B. “Be sure your child wears a helmet daily.”
C. “It is common for the child to feel extremely tired after experiencing this type of seizure.”
D. “Avoid high fat and low carbohydrate diets.”
The answer is B. This type of seizure leads to a sudden loss of muscle tone. The patient will go limp and fall, which when this happens the head is usually the first part of the body to hit the floor or an object nearby. It is important the child wears a helmet daily to protect their head from injury.
If your patient is hospitalized d/t seizures what would be a priority for these patients?
Getting IV access
What is the ketogenic diet do for our patients?
Makes the pt go into ketosis due to the diet and it causes an anticonvulsant effect to control seizures.
For anticonvulsant medications
What do we as nurses need to monitor?
What S&S can they cause?
-it is normal for these patients to feel drowsy when first starting these medication but it normally improves in a few days or weeks
S&S: slurred speech/ confusion, incorrdination
1.There are medications that our Barbiturates can interact with, what are these meds?
2. The medications have teratogenic effects as well so what would instruct our women of childbearing age to have?
3. What is the normal serum level for Barbiturates?
4. If your patients dose is increased will this effect the serum levels?
1. Depakote: these can raise the level significantly Digoxin: if taken with barbiturates can decrease dig levels
Coumadin: Can increase or decrease clotting times
2. Reliable birth control
3. 10-40
4. Yes with long term use they range can be up to 50 so they fluctuated based on how they have been taking the medication
Hydantoins can also cause Extravasation of the skin. What do we want to do as nurse to prevent this?
Have a good IV in the ATC or a central line with blood flow return. This med acts like acid and will burn detonate the skin.
2. What type of S&S will we see?
3. Does these seizures affect LOC?
4. How do we describe these seizures?
1. They depend upon Which area of the brain is affected
2. S&S: Aura, tachycardia, hypotension or hypertension, flushing of the face, sense of Deja vu, inappropriate behavior of flushing
3. These seizures DO NOT affect LOC.
4. These seizures may just look like a jerk. These patients have contractions of the face, fingers, or feet, and then these move to other muscle groups on the same side of the body.
A 43 year old female present to the ED for status epileptics.
1. How long do these seizures last?
2. What are these patients at risk for?
3. What are the common causes of these seizures?
4. What is the most common cause of these seizures?
1. These seizures last more than 5 minutes or repeated seizures that can occur over 30 minutes or more
2. The pt is at risk for ANOXIA
3. common causes include, Infections, ETOH withdraw, head trauma, cerebral edema, metabolic disturbances
4. The most common cause of these seizures is ABRUPTLY STOPPING anti-convulsant medications
What types of seizures fall under the partial category?
-Simple
-Complex
You’re assessing a patient who recently experienced a focal type seizure (partial seizure). As the nurse, you know that which statement by the patient indicates the patient may have experienced a focal impaired awareness (complex partial) seizure?
A. “My friend reported that during the seizure I was staring off and rubbing my hands together, but I don’t remember doing this.”
B. “I remember having vision changes, but it didn’t last long.”
C. “I woke up on the floor with my mouth bleeding.”
D. “After the seizure I was very sleepy, and I had a headache for several hours.”
The answer is A. The patient will experience an alternation in consciousness (hence the name focal IMPAIRED awareness) AND will perform an action without knowing they are doing it called automatism like lip-smacking, rubbing the hands together etc. With a focal onset AWARE seizure (also called partial simple seizure) the patient is aware and will remember what happens (like vision changes etc.).
You are walking in the hall with your patient and your patients states "I feel like I'm chewing on aluminum foil". You notice this is an aura. What would you do?
Get this patient flat on the floor
Put their head in your lap to protect the head
What age group do we use the Ketogenic diet for?
Children under the age of 8 WITH SEIZURES
With anticonvulsant what are the general rules/ teaching that we need to implement.
Many cause photosensitivity so wear sunscreen (30 SPF)
Always check with pharmacist before taking any prescribed OTC medications
Do not stop meds abruptly because they do increase the risk for suicidal ideation, depression, and psychosis.
What do our Benzodiazepines end in?
Pams
Diazepam and Lorazepam is the ones she has as the biggest examples
1.We should not give hydantoins with _____,______, and ______.
2. Do not stop these meds abruptly because is can cause _____ _______
2. Status Epilepticus
You patient is diagnosed with Complex partial seizures.
1. What part of the brain is affected?
2. What S&S do these patient experience?
3. Do these pts have an aura?
4. Is the LOC affected?
1. Temporal lobe
2. Automatism: Repetitive movement such as lip smacking, head rolling, swallowing, arm or leg movement) SIMILAR TO TD
3. Yes
4. Yes it is affected for HOURS
Your 43 year old female pt that just came into the ED for status epileptics start experiencing another seizure what are the PRIORITIES?
1. AIRWAY! AIRWAY!!!!
2.O2 (Face mask)
3.IV medications (BENZOS)
-Diazepam or Lorazepam
REMEMBER THIS IS A NEUROLOGICAL EMERGENCY. They require immediate treatment
What types of seizures fall under the Generalized seizure category?
Absence
Myoclonic
Tonic-Clonic
Atonic
A patient with a documented history of seizure disorder experiences a generalized seizure.
What nursing action is most appropriate?
A) Restrain the patient to prevent injury.
B) Open the patients jaws to insert an oral airway.
C) Place patient in high Fowlers position.
D) Loosen the patients restrictive clothing.
Answer is D
The client who just had a three (3)-minute seizure has no apparent injuries and is oriented to name, place, and time but is very lethargic and just wants to sleep. Which intervention should the nurse implement?
1. Perform a complete neurological assessment.
2. Awaken the client every 30 minutes.
3. Turn the client to the side and allow the client to sleep.
4. Interview the client to find out what caused the seizure
During the postictal (after-seizure)
phase, the client is very tired and
should be allowed to rest quietly;
placing the client on the side will help
prevent aspiration and maintain a
patent airway.
1. What does our Ketogenic diet consist of?
2. What are most common complication of this diet?
3. How much water should these pts consume?
4. What food can these pts not eat?
1. It consist of 5% green-leafy veggies, 30% proteins, and 65% fats, 0 sugar
2. Complications: constipation, hyperlipidemia, and kidney stones d/t the break down of protein
3. 2/3 liter of water a day to prevent kidney stones
4. no hot dogs, no Mac and cheese, no chicken nuggets
OVERALL QUESTION ABOUT ANTI-CONVULESENT!
1.What do we need to avoid taking when taking these medications?
2. What may happen to these patients that can impact body image?
3. If you pharmacist switch your brand name med to generic, should you take it>+?
We need to avoid Ginkgo, St, Johns Wart and grapefruit juice
2. Weight gain, anorexia, nausea, acne
3. DO NOT CHANGE BRANDS!! tell the pharmacist that you cannot change brands because they can require different dosages to get same effect
1. What do Lorazepam and Diazepam do in the brain?
2. Do these medication have a fast or slow onset?
3. What is the NUMBER ONE thing these medication can cause that we're most worried about?
1. Enhance GABA
2. They work fast (60 secs)
3. Laryngeal Spasms