NUR 114 Test 2 (Intracranial Regulation)

A patient who is having a tonic-clonic seizure is prescribed Phenobarbital. During administration of this drug, it is important the nurse monitors for: A. Respiratory depression B. Hypertension C. Disseminated intravascular clotting D. Hypotension E. Fever

A ,D R:This medication stimulates the GABA receptors and helps with inhibitory neurotransmission. It can lead to respiratory depression and hypotension, therefore, it is very important the nurse monitors the patient for this.

When preparing to admit a patient who has been treated for status epilepticus in the emergency department, which equipment should the nurse have available in the room? SAP A. Suction tubing B. Oxygen mask C. Nasogastric tube D. Siderail pads E. Tongue blade F. Oral airway

A, B, D R: The patient is at risk for further seizures, and oxygen and suctioning may be needed after any seizures to clear the airway and maximize oxygenation. The bed's side rails should be padded to minimize the risk for patient injury during a seizure. Insertion of a nasogastric (NG) tube is not indicated because the airway problem is not caused by vomiting or abdominal distention. Use of tongue blades or oral airways during a seizure is contraindicated.

The most precipitating factors for seizures in children include: (SAP) A. physical and psychologic stress B. sleep deprivation C.fever and illness D. menstrual cycle E. water

A,B,C

You're assessing your patient load for the patients who are at MOST risk for seizures. Select all the patients below that are at risk: SAP A. A 32-year-old with a blood glucose of 20 mg/dL. B. A 63-year-old whose CT scan shows an ischemic stroke. C. A 72-year-old who is post opt day 5 from open heart surgery. D. A 16-year-old with bacterial meningitis. E. A 58-year-old experiencing ETOH withdrawal.

A,B,D,E R: All the patients are at risk except option C. Remember all the risk factors: illness (especially CNS types like bacterial meningitis), fever, electrolyte/metabolic issues (low blood sugar, acidosis etc), ETOH (alcohol) withdraw, brain injury, STROKE, congenital brain defects, tumors etc.

You have a patient who has a brain tumor and is at risk for seizures. In the patient's plan of care you incorporate seizure precautions. Select below all the proper steps to take in initiating seizure precautions: SAP A. Oxygen and suction at bedside B. Bed in highest position C. Remove all pillows from the patient's head D. Have restraints on stand-by E. Padded bed rails F. Remove restrictive objects or clothing from patient's body G. IV access

A,E,F,G R: The bed needs to be in the LOWEST position possible, a pillow should be underneath the patient's head to protect it from injury, AVOID using restraints (this can cause musculoskeletal damage).

A patient is taking Phenytoin for treatment of seizures. Which statement by the patient requires you to re-educate the patient about this medication? A. "Every morning I take this medication with a full glass of milk with my breakfast." B. "I know it is important to have my drug levels checked regularly." C. "I will report a skin rash immediately to my doctor." D. "This medication can lower my body's ability to clot and fight infection."

A. "Every morning I take this medication with a full glass of milk with my breakfast." R: This medication should NOT be taken with milk products or antacids because it affects absorption. All the other options are correct.

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."

A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this R: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.).

The nurse uses the Glasgow Coma Scale to assess a client with head injury. Which Glasgow Coma Scale score indicates that the client is in a coma? A. 6 B. 9 C. 12 D .15

A. 6 R: A score of 8 below indicates coma. The Glasgow Coma Scale is used to assess the extent of neurologic damage; it consist of three assessments: Eye opening, response to auditory stimuli, and motor response. Consciousness exists on a continuum from full consciousness coma. A score can be from 3 to 15; the lower the score the more indicative of coma. To achieve the ratings of 9, 12, or 15 the client must be exhibiting some meaningful response.

CRITICAL RESCUE Convulsive status epilepticus must be treated promptly and aggressively!!! Establish what first priority? and THEN notify the health care provider or Rapid Response Team immediately if this problem occurs! A. an airway B. administer O2 C. Intubation (Anesthesia) D. establish IV access

A. Airway think (ABC,s) R: Establishing an airway is the priority for this patient's care. Intubation by an anesthesia provider or respiratory therapist may be necessary. Administer O2 as indicated by the patient condition. If not already in place, establish IV access with a large bore catheter and start 0.9% Normal Saline (Sodium Chloride. The patient is then usually placed in the intensive care unit for continuous monitoring and management.

a patient experiencing ___________ lasts several minutes and causes muscle contraction and relaxation. A. Clonic seizure B. Tonic seizure C. Myoclonic seizure D. Febrile Seizure

A. Clonic Seizure

Defined as two or more seizures experienced by a person. It may be caused by an abnormality in electrical neuronal activity, an imbalance of neurotransmitters, especially gamma aminobutyric acid (GABA) or a combination of both A. epilepsy B. Seizure C. Stroke D. Heart attack

A. Epilepsy

A nurse finds a victim under the wreckage of a collapsed building. The individual is conscious, supine, breathing satisfactorily, and reports back pain and an inability to move the legs. Which action should the nurse take first? A. leave the individual lying on the back with instructions not to move, and seek additional help. B. Roll the individual onto the abdomen, place a pad under the head, and cover with any material available. c. Gently raise the individual to a sitting position to determine whether the pain either diminishes or increases in intensity D. Gently lift the individual onto a flat piece and, using any available transportation, rush to the closest medical institution.

A. Leave the individual lying on the back with instructions not to move, and seek additional help. R:The individual should be moved only with a backboard to avoid additional spinal cord damage. Moving a person whose spinal cord has been injured may cause irreversible paralysis. A back injury precludes changing the person's position. A back injury is suspected; therefore the person should not be moved. A flat board is indicated; however, one rescuer should not move the person without help.

These seizures are most often seen in adults and they are generally less responsive to medical treatment compared with other types? A. Partial Seizure B. Generalized seizure C. unclassified Seizure D. static epilepticus

A. Partial Seizure R: Partial Seizures are also called focal or local seizures, begin in a part of one cerebral hemisphere. They are further subdivided into two main classes: complex partial seizures and simple partial seizures. In addition, some partial seizures can become generalized tonic-clonic, tonic, or clonic seizures. Partial seizures are most often seen in adults and generally are less responsive to medical treatment when compared with other types.

Brief staring spell that only lasts a few seconds. Appears mostly in kids, affecting more girls than boys. EEG shows a 3H2 spike-wave pattern. triggers are hyperventilation, hyper/hypoglycemia, extreme sleepiness, anxiety and flashing lights. May also go undiagnosed, could be seen as a behavioral problem.

Absence seizure

the nurse knows the Difference between Seizure and Epilepsy consist of?

An epileptic episode is a medical emergency, chronic, recurrent. Present when 2 or more unprovoked seizures. and a Seizure is a single event abnormal discharge that results in a abrupt, altered brain state.

("Drop Attack"): The patient has a sudden LOSS of muscle tone, lasting for seconds, followed by postictal (after the seizure) confusion. Onset is around 2 and 5. This type of seizure is MOST RESISTANT TO DRUG THERAPY. These seizures cause the patient to fall, which may cause injury. Protect the pediatric pt's head (might have to advise wearing a helmet) due to the risk for head injury, pediatric pt head proportionally bigger than rest of body.

Atonic seizure

You're patient is scheduled for an EEG (electroencephalogram). As the nurse you will: A. Keep the patient nothing by mouth. B. Hold seizure medications until after the test. C. Allow the patient to have coffee, milk, and juice only. D. Wash the patient's hair prior to the test. E. Administer a sedative prior to the test.

B, D, R: An EEG is a painless procedure that will assess the patient's brain activity (if a seizure occurs during the test this can allow the physician to determine what type of seizure it is). Therefore, the nurse would hold seizure medications (this can affect the test) and would NOT allow the patient to have caffeine like coffee or stimulant drugs (the patient can eat prior to the test just NO caffeine). The patient's hair should be cleaned prior to the test so the technician can apply the electrodes and get them to stick to the scalp easily. A sedative is not needed before this test.

A client with a history of seizures is placed on seizure precautions. Which emergency equipment will the nurse provide at the bedside? Select all that apply. A. Oropharyngeal airway B. Oxygen C. Nasogastric tube D. Suction setup E. Padded tongue blade F. Siderail pads

B,D,F R: The patient is at risk for further seizures, and oxygen and suctioning may be needed after any seizures to clear the airway and maximize oxygenation. The bed's side rails should be padded to minimize the risk for patient injury during a seizure. Insertion of a nasogastric (NG) tube is not indicated because the airway problem is not caused by vomiting or abdominal distention. Use of tongue blades or oral airways during a seizure is contraindicated.

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."

B. "Be sure your child wears a helmet daily." R: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. Option A is a characteristic of an absence seizure. Option C is a characteristic of a tonic-clonic seizure during the post ictus stage. And option D is wrong because some patients benefit from this type of diet known as the ketogenic diet.

You're educating a 25-year-old female about possible triggers for seizures. Which statement requires you to re-educate the patient about the triggers? A. "I'm at risk for seizure activity during my menstrual cycle." B. "I will limit my alcohol intake to 2 glasses of wine per day." C. "It's important I get plenty of sleep." D. "I will be sure to stay hydrated, especially during hot weather."

B. "I will limit my alcohol intake of 2 glasses of wine per day R: The patient should avoid all alcohol because it can lead to a seizure. Hormone shifts (menstrual cycle, ovulation, pregnancy) sleep deprivation, and dehydration can lead to a seizure.

Which part of the client's brain is primarily associated with life support and basic functions of the body? A. Cerebrum B. Brain Stem C. Cerebellum D. Cerebral Cortex

B. Brain Stem R: The brainstem, which connects the brain to the CNS, is concerned primarily with life support and basic functions, such as breathing and movement. The cerebrum controls intelligence, creativity, and memory. The cerebellum is concerned with coordination of movement. The cerebral cortex is part of the cerebrum, which is involved with almost all of the higher functions of the brain.

The nurse knows that the religion who believes a person experiencing a seizure is possessed by a demons demonstrates which religion? A. Catholic B. Christians C. Laos D. Vietnamese

B. Christians R: Christians believe one undergoing a seizure is possessed by demons, these cultures believe that seizures are a form of madness. (Laos) believe hat saliva from epileptic patients can transmit the disease (social isolation of the patient). Vietnamese culture believes that seizures are triggered by too much brain activity (brain work, thinking) To assess the family for cultural differences the nurse should use the BELIVE tool.

While walking in the hall, a hospitalized client has a tonic-clonic seizure. To protect the client during the seizure, what should the nurse do? A. Hold the clients extremities firmly B. Protect the clients head from injury c. Insert the airway between the clients teeth. D. Have several staff members move the client to a soft surface.

B. Protect the clients head from injury R: Rhythmic contraction and relaxation associated with a tonic-clonic seizure can cause repeated banging of the head. holding extremities firmly is contrindicated ; can cause broken bones. Inserting airway through teeth is contraindicated ; causing damage to teeth b/c of force. moving during a seizure can result in physical injuries; the client should be over after the seizure

A patient experiencing ______________ is an abrupt increase in muscle tone, loss of consciousness, and autonomic changes lasting from 30 seconds to several minutes. s/s : confusion and headaches A. clonic seizure B. tonic seizure C. Myoclonic seizure D. Febrile Seizure

B. Tonic Seizure

A patient with a history of epilepsy is taking Phenytoin. The patient's morning labs are back, and the patient's Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will? A. Assess the patient for a rash B. Initiate seizure precautions C. Hold the next dose of Phenytoin D. Continue to monitor the patient

B. initiate seizure precautions R:A normal Phenytoin level is 10 to 20 mcg/mL. The patient's level is low; therefore, the patient is at risk for seizures. The nurse should initiate seizure precautions. Remember a patient being under medicated is a trigger for developing a seizure

what is an Abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change of consciousness (LOC), motor or sensory ability, and/or behavior. A. epilepsy B. Seizure C. stroke D. Heart attack

B. seizure

This procedure establishes the safety of surgery to preserve language memory. A. Partial corpus callosotomy B. Transiiton managment C. An intracarotid amobarbital test (Wada test) D. Neuropsychological testing

C. An intracarotid amobarbital test (Wada test) R: The Wada test assesses hemispheric lateralization of language and memory after injection of amobarbital, a short-acting anesthetic.

When assessing a patient with a head injury, the nurse recognizes that the earliest indication of increased intracranial pressure (ICP) is a. vomiting. b. headache. c. change in level of consciousness (LOC). d. sluggish pupil response to light.

C. Change in level of consciousness R: LOC is the most sensitive indicator of the patient's neurologic status and possible changes in ICP. Vomiting and sluggish pupil response to light are later signs of increased ICP. A headache can be caused by compression of intracranial structures as the brain swells, but it is not unexpected after a head injury.

A patient found in a tonic-clonic seizure reports afterward that the seizure was preceded by numbness and tingling of the arm. The nurse knows that this finding indicates a(n) _____ seizure. A. absence B. simple partial C. complex partial D. generalized myoclonic

C. Complex partial R: The initial symptoms of a complex partial seizure involve clinical manifestations that are localized to a particular part of the body or brain. In addition, an alteration in consciousness is always manifested. Symptoms of an absence seizure are staring and a brief loss of consciousness. During a simple partial seizure, the patient does not lose consciousness. A generalized myoclonic seizure is characterized by a sudden jerk of the body or extremities.

A patient experienced a seizure that affects both hemispheres of the brain, the nurse knows this seizure is to most likely to be a ? A. Partial seizure B. unclassified seizure C. Generalized seizure D. Classified seizure

C. Generalized Seizure R: The International Classification of Epileptic Seizures recognizes three broad categories of seizure disorders: generalized seizures, partial seizures, and unclassified seizures. Five types of generalized seizures may occur in adults and involve both cerebral hemispheres.

Neurons in the brain are tasked with handling and transmitting information. There are different types of neurons, such as excitatory and inhibitory. Excitatory neurons release the neurotransmitter _____________, while inhibitory neurons release the neurotransmitter ________________. A. GABA, glutamate B. Norepinephrine, GABA C. Glutamate, GABA D. Dopamine, glutamate

C. Glutamate, GABA R:Excitatory neurons release glutamate and inhibitory neurons release GABA.

An 8-year-old child, who is not responding to anti-seizure medications, is prescribed to start a ketogenic diet. This diet will include: A. High carbohydrates and high fat B. Low fat, high salt, and high carbohydrates C. High fat and low carbohydrates D. High glucose, high fat, and low carbohydrates

C. High fat and low carbohydrates R: This is a type of diet used in the pediatric population with epilepsy whose seizures cannot be controlled by medication. It is a high fat and low carb diet.

(story continued) the patient is now experiencing characteristics of a tonic-clonic seizure. The seizure started at 1402 and it is now 1408, and the patient is still experiencing a seizure. The nurse should? A. Continue to monitor the patient B. Suction the patient C. Initiate the emergency response system D. Restrain the patient to prevent further injury

C. Initiate the emergency response team R:Tonic-clonic seizures should last about 1-3 minutes. If the seizure lasts MORE than 5 minutes, the patient needs medical treatment FAST to stop the seizure....this is known as status epilepticus.

Your patient has a history of epilepsy. While helping the patient to the restroom, the patient reports having this feeling of déjà vu and seeing spots in their visual field. Your next nursing action is to? A. Continue assisting the patient to the restroom and let them sit down. B. Initiate the emergency response system. C. Lay the patient down on their side with a pillow underneath the head. D. Assess the patient's medication history.

C. Lay the patient down on their side with a pillow underneath the head R: The patient is reporting signs and symptoms of an aura (this is a warning sign before a seizure event). Lay the patient down on their side with a pillow underneath the head and remove any restrictive clothing. Also, time the seizure. If the seizure lasts more than 5 minutes or if the patient starts to have seizures back-to-back activate the emergency response system.

a patient experiencing _____________ causes a brief jerking or stiffening of the extremities that may occur singly or in groups. Lasting for just a few seconds, the contractions may be symmetric (both sides) or asymmetric (one side). A. Clonic Seizure B. Tonic seizure C. Myoclonic Seizure D. Febrile Seizure

C. Myoclonic Seizure

Your patient has entered the post ictus stage for seizures. The patient's seizure presented with an aura followed by body stiffening and then recurrent jerking. The patient had incontinence and bleeding in the mouth from injury to the tongue. What is an expected finding in this stage based on the type of seizure this patient experienced? A. Crying and anxiety B. Immediate return to baseline behavior C. Sleepy, headache, and soreness D. Unconsciousness

C. Sleepy, headache, and soreness R: Based on the findings during the seizure the patient experienced a tonic-clonic seizure. In the post ictus stage (after the seizure) the patient is expected to be sleepy (very tired), have soreness, and a headache. The nurse should let the patient sleep.

this is a medical emergency and is a prolonged seizure lasting longer than 5 minutes or repeated seizures over the course of 30 minutes. It is a complication of all types of seizures (general, partial, etc.). A. Partial seizure B. Myoclonic seizure C. status epilepticus D. Clonic phase

C. Status epilepticus

The nurse witnesses a patient with a seizure disorder as the patient suddenly jerks the arms and legs, falls to the floor, and regains consciousness immediately. It will be most important for the nurse to

C. assess the patient for a possible head injury.

Complex partial and tonic clonic seizures are treated with?

Carbamazepine ( Tegretol, Tegretol XR, Tegretol-CR )

Most common form of partial seizure -Begins at the age of 3 to adolescent -Unable to respond when given instructions, drooling, constant swallowing -Patient may wander at the start of the seizure

Complex partial seizure R: Complex partial seizures are the most common among older adults. They are difficult to diagnose because symptoms appear similar to those of dementia, psychosis or other neurobehavioral disorders, especially in the postictal stage (after the seizure). (LOSS OF CONSCIOUSNESS/AWARENESS)

What are the reasons for performing a Lumbar puncture on a client? SAP A. Confirming Spinal cord injuries B. Assessing Sensory nerve problems C. Measuring blood flow in many areas D. Reading cerebrospinal fluid pressure E. Injecting contrast medium for diagnostic stud

D,E (Reading & Injecting ONLY***) R: A lumbar puncture is the insertion of a spinal needle into the subarachnoid space between the third and fourth lumbar vertebrae; it can be used to obtain cerebrospinal fluid readings with a manometer. Using a lumbar puncture, contrast medium or air is injected for diagnostic study.

A client has a tonic-clonic seizure at work and is admitted to the emergency department. Which question is most useful when planning nursing care related to the client's seizure? A. "is your job demanding or stressful most of the time?" B. "Do you participate in any strenuous sports activities on a regular basis?" C. "Does anyone in your family have a history of central nervous system problems?" D. "Were you aware of anything different or unusual just before your seizure began?"

D. "Were you aware of anything different or unusual just before your seizure began?" R: Identification of a sensation that occurs before each seizure [1] [2] (aura) is helpful in identifying the cause of the seizure and planning how to identify and avoid a future seizure. Although the response "Is your job demanding or stressful most of the time?" may provide some information, it is not the most inclusive question the nurse can ask; also, it limits the client's reply. Although the response "Do you participate in any strenuous sports activities on a regular basis?" may provide some information, it is not the most inclusive question the nurse can ask; also, it limits the client's reply. Although the response "Does anyone in your family have a history of central nervous system problems?" may provide some information, it is not the most inclusive question the nurse can ask; also, it limits the client's reply.

The Adolescent period may prove to be a trying time for the child with epilepsy. In the time period of increased freedom and independence, all U.S. states have a defined seizure-free period before a driver's license can be obtained ________ symptom free. A. 6 months B. 3 moths C. 2 years D. 1 year

D. 1 year

A patient experiencing _________ may bite his or her tongue and become incontinent of urine or feces. Fatigue, acute confusion, and lethargy may last up to an hour after the seizure. A. Myoclonic Seizure B. Absence seizure C. Febrile seizure D. A tonic - clonic seizure

D. A clonic- tonic seizure R:The tonic-clonic seizure lasting 2 to 5 minutes begins with a tonic phase that causes stiffening or rigidity of the muscles, particularly of the arms and legs, and immediate loss of consciousness. Clonic or rhythmic jerking of all extremities follows. The patient may bite his or her tongue and become incontinent of urine or feces. Fatigue, acute confusion, and lethargy may last up to an hour after the seizure.

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

D. Absence R: 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.

The nurse witnesses a patient with a seizure disorder as the patient suddenly jerks the arms and legs, falls to the floor, and regains consciousness immediately. It will be most important for the nurse to A. document the timing and description of the seizure. B. notify the patient's health care provider about the seizure. C. give the scheduled dose of divalproex (Depakote). D. assess the patient for a possible head injury.

D. Assess the patient for a possible head injury R: The patient who has had a myoclonic seizure and fall is at risk for head injury and should be evaluated and treated for this possible complication first. Documentation of the seizure, notification of the seizure, and administration of antiseizure medications are also appropriate actions, but the initial action should be assessment for injury.

A nurse is caring for an older adult with a history of recent memory loss. Which action should the nurse take? A. Instruct the client to move slowly when changing positions B. Remind the client to look where places feet while walking C. Adjust the daily schedule to accommodate sleep pattern D. Employ electronic devices that provide alerts

D. Employ electronic devices that provide alerts R: Providing electronic devices that give alerts can help an older adult who has developed recent memory loss. Adjusting the daily schedule can aid older adults who have changes in their sleep pattern.

A nurse is caring for a client who is admitted to the hospital with a severe head injury. Which action is priority? A. Place the client in a supine position B. Prevent contractures and deformities C. Monitor the blood pressure frequently D. Maintain respiratory exchange and ventilation.

D. Maintain respiratory exchange and ventilation R: The brain requires continuous, large quantities of oxygen to function; maintaining the airway and ensuring respiratory exchange and ventilation are the priorities. Although avoiding contractures and deformities is a concern, preventing contractures and deformities is not the priority at this time. Although monitoring the blood pressure is done because a widening pulse pressure may indicate increasing intracranial pressure, it is not the priority.

A client with a brain attack (cerebrovascular accident) is admitted to the hospital. what is the Priority nursing intervention for this client? A. Changing position every 2 hours B. Keeping a serial record of the pulse C. Performing range -of-motion exercises D. Monitoring for increased intracranial Pressure

D. Monitoring for increased intracranial Pressure R: Cerebral edema may occur with a brain attack, resulting in increased intracranial pressure. Although preventing pressure ulcers is important, it is not the priority. All vital signs are important, not just the pulse. Performing Range of motion may increase intracranial pressure and should be instituted in collaboration with the healthcare provider.

this testing evaluates memory, visuospatial function, language function, and intelligence quotient (IQ) to identify regions of the brain that is believed to the epileptic region. It is also used to compare preoperative and postoperative COGNITION. A. Partial corpus callosotomy B. Transiiton managment C. An intracarotid amobarbital test (Wada test) D. Neuropsychological testing

D. Neuropsychological testing

A patient has a tonic-clonic seizure while the nurse is in the patient's room. During the seizure, it is important for the nurse to a. insert an oral airway during the seizure to maintain a patent airway. b. restrain the patient's arms and legs to prevent injury during the seizure. c. avoid touching the patient to prevent further nervous system stimulation. d. time and observe and record the details of the seizure and postictal state.

D. Time and observe and record the details of the seizure and postictal state R:Because diagnosis and treatment of seizures frequently are based on the description of the seizure, recording the length and details of the seizure is important. Insertion of an oral airway and restraining the patient during the seizure are contraindicated. The nurse may need to move the patient to decrease the risk of injury during the seizure.

These seizures account for about half of all seizure activity. They occur for no known reason and do not fit into the generalized or partial classifications. A. Myoclonic seizure B. Febrile seizure C. tonic phase D. Unclassified or idiopathic seizures

D. Unclassified or Idiopathic seizures

A client with a head injury is admitted to the hospital. Which assessment finding alerts the nurse to increasing intracranial pressure? A. Hyper-vigilance B. Constricted pupils C. Increased heart rate D. Widening pulse pressure

D. Widening Pulse Pressure R:Pressure on the vital centers in the brain causes an increase in the systolic blood pressure, widening the difference between the systolic and diastolic pressures. The client will be lethargic and have a lowered level of consciousness. The pupils will be unequal or dilated, not constricted. Pressure on the vital centers in the brain results in a decreased, not increased, heart rate.

Seizure associated with a febrile illness in the absence of a CNS infection. By definition, children who have a febrile seizure cannot have a history of afebrile seizures (seizures that have nothing to do with temperature), must have a temperature of at least 38 degrees C (100.4 F) and must be between the age of age 6 and 60 months (6 months-5 years old). Most common type of seizure, affecting 2-4% of children.

Febrile seizure

Partial, tonic-clonic, Lennox-Gastaut syndrome. are treated with?

Lamotrigine (Lamictal)

The surgeon sections the anterior two thirds of the corpus callosum, preventing neuronal discharges from passing between the two hemispheres of the brain. This surgery usually reduces the number and severity of the seizures, making them more likely to respond to conventional drug therapy. This is not as common as other surgeries, but it is very successful in some patients.?

Partial corpus callosotomy R: Partial corpus callosotomy may be used to treat tonic-clonic or atonic seizures in patients who aren't candidates for other procedures.

Neonatal, febrile, partial, tonic-clonic

Phenobarbital

Partial, tonic-clonic; status epilepticus; neonatal seizures are treated with?

Phenytoin (Dilantin, Phenytek) R: most widely used

A patient experiencing this type of seizure is Conscious throughout the entire episode, Often reports an aura (unusual sensation like "smelling thunder or electricity"). This may consist of the "deja' vu" phenomenon, perception of an offensive smell, or sudden onset of pain. they Lasts 30 seconds, Rhythmic movement alteration, contractions,Visual flashing lights, flashing, can't speak Starts at any age, Autonomic changes include a change in heart rate, skin flushing, and epigastric discomfort.

Simple partial seizure R: (NO LOSS OF CONSCIOUSNESS/AWARENESS)

Series of seizures at intervals too brief to allow the child to regain consciousness between the time one event ends and the next begins

Status epilepticus

Lasts 2-5 minutes beginning with tonic phase (stiffening or rigidity of the muscles, PARTICULARLY OF THE ARMS AND LEGS, and immediate loss of consciousness). Clonic phase (rhythmic jerking of all extremities) follows afterwards. They can become cyanotic. After the seizure they can have visual impairment.

Tonic clonic seizure

(the nurse is performing these steps during which seizure?) 1.Remain calm. 2. Time seizure episode. 3. If child is standing or seated, ease child down to the floor. 4. Place pillow or folded blanket under child's head. 5. Loosen restrictive clothing. 6. Remove eyeglasses. 7. Clear area of any hazards or hard objects. 8. Allow seizure to end without interference. 9. If vomiting occurs, turn child to one side. Do not • Attempt to restrain child or use force. • Put anything in child's mouth. • Give any food or liquids

Tonic-Clonic seizure After seizure : Time postictal period. Check for breathing. Check position of head and tongue. Reposition if head is hyperextended. If breathing is not present, give rescue breathing and call emergency medical services (EMS). Keep child on side. Remain with child. Do not give food or liquids until child is fully alert and swallowing reflex has returned. Look for medical identification, and determine what factors occurred before onset of seizure that may have been triggering factors. Check head and body for possible injuries. Check the inside of mouth to see if tongue or lips have been bitten.

Primary generalized, absence, myoclonic, febrile, complex partial, Lennox-Gastaut syndrome; not recommended for children less than 2 years of age are treated with?

Valproic Acid (Depakote, Depakote ER, Epival)

In the period after the seizure, the patient will have what is called __________ due to the fact that the area of the brain most involved with this kind of seizure is the temporal lobe, complex partial seizures are often called psychomotor or temporal lobe seizures.

amnesia ("loss of memory")