Seizures

Absence

- Blank stare - Brief upward deviation of eyes - Unresponsive when spoken to

Tonic-clonic

- Generalized - Rhythmic jerking of all extrem. - Loss of conciousness

Atonic

- Loss of muscle tone - w/o apparent myoclonic or tonic event - Lasts ~2 min

Automatism

- More/less motor activ. - Impaired cognition. - Resembles voluntary movement

- Hypo/hypernatremia - Hypo/hyperglycemia - Hypocalcemia - Hypomagnesemia - Underactive thyroid

Metabolic causes

Myoclonic

Quick repetitive contraction of muscle (arm twitch or face)

Airway

#1 nursing priority

- Left lateral (if not already) - NPO - Safety - Antiepileptics

Actions during postictical phase

- Vascular (stroke, TIA, etc.) - Structural (TBI) - Infection - Hypoxia - Metabolic - Substance abuse/withdrawl - Toxins - Non-compliance w/meds (status epilepticus) - Acute fever - Stress

Causes of provoked, non-epileptic seizures

- Time/date/duration - Preceding event - Description/type

Documentation

- Phenytoin - Carbamazepine - Phenobarbital - Dival proex - Clonazepam - Gabapentin - Lamotragine - Levetiracetam - Pregablin (lyrica) - Ativan - Valium

Drugs

- Divalproex - Clonazepam

Drugs for myoclonic seizures

- Valium - Ativan

Drugs for status epilepticus

- Phenytoin - Carbamazepine - Phenobarbital - Divalproex

Drugs for tonic-clonic & focal

- EEG - Blood work - CT - MRI

Dx

- NO alcohol - Check before taking OTCs - Avoid activities that require alertness - Med alert - Oral hygiene

Education: status epilepticus

All of the above

James's seizure stops after 7 minutes. He is not intubated but is placed on a ventilator and transferred to the intensive care unit. Which medications may the nurse request from the provider in case he has additional seizures? Select all that apply. Lorazepam (Ativan) Midazolam (Versed) Phenytoin (Dilantin) Levetiracetam (Keppra) Propofol (Diprivan)

Clonic

Jerking muscle contractions

- Confusion/disorientation - Drowsiness - Agitation - N/V - Hypoxia - Headache

Postictal phase manifestations

- Bed lowest position, locked - Padded side rails - Loosen restrictive clothing - Suction, O2, artif. airway ready and set up - PRN ativan

Seizure precautions

- Decr. BP - Hypoxia - Cardiac arrythmias High risk for brain damage/death

Status epilepticus manifestations

Aura

Subjective ictal phenomenon preceding observable seizure

Tonic

Sustained incr. in muscle tone

"You will need to notify the Department of Motor Vehicles about your condition. Each state has different rules and regulations."

The adult who has had his first complex partial seizure is asking the nurse when he can drive again. What is the best response to the client regarding this question? "The doctor usually lets clients drive upon discharge." "You will need to notify the Department of Motor Vehicles about your condition. Each state has different rules and regulations." "You will need to notify the national Department of Motor Vehicles about your condition. The rules are the same for every state." "I doubt you will ever drive again, but there are public transportation options that you can explore."

"A ketogenic diet is high in fat and low in carbohydrates and protein."

The client's mother has heard a certain type of diet can improve seizure control. Although usually used with children, the doctor believes a ketogenic diet may be effective for James. When asked by the mother to explain a ketogenic diet, what information would you provide? "A ketogenic diet is high in protein, but low in carbohydrates and fats." "A ketogenic diet is high in carbohydrates and fats, but low in protein." "A ketogenic diet is high in fat and low in carbohydrates and protein." "A ketogenic diet is a balanced diet with equal values of fat, carbohydrates, and protein."

Maintain the airway and prepare for intubation.

The nurse enters the room and finds James is having a seizure. The episode has lasted more than 5 minutes. What is the nurse's priority action? Observe the length and sequence of the seizure. Maintain the airway and prepare for intubation. Deliver the evening dose of oral phenytoin early. Confirm that the wall suction is functioning properly.

Left-lying (lateral)

The nurse would expect to place the client who just had a seizure in which position? Right-lying (lateral) Left-lying (lateral) Supine Supine with head elevated 15 degrees

The generator is implanted into a small pouch in the left chest below the clavicle.

The provider plans to implant a vagal nerve stimulator (VNS) to better control James's seizures. The family asks for more information. Which statement by the nurse is correct? The generator continuously stimulates the vague nerve, providing electrical shock. The generator is activated and programmed immediately in the operating room. The generator is implanted into a small pouch in the left chest below the clavicle. Access to the vagal nerve is then established via an incision in the armpit.

Phases of rhythmic jerking of extremities and loss of consciousness

Which characteristic should the nurse monitor for in case James has another tonic-clonic seizure? Twitching with a brief loss of consciousness Twitching with no loss of consciousness Phases of rhythmic jerking of extremities and loss of consciousness Twitching where the client may or may not lose consciousness

The postictal phase occurs after the seizure. The client may exhibit confusion and disorientation during the postictal phase. The postictal phase can last from 5-30 minutes.

Which statements would the nurse include in the client and family teaching about the postictal phase of seizures? Select all that apply. The postictal phase occurs after the seizure. The client in the postictal phase may exhibit automatisms such as lip smacking, rhythmic muscle movements, or chewing. The client may exhibit confusion and disorientation during the postictal phase. The postictal phase can last from 5-30 minutes. The postictal phase client may state seeing visualizations, hallucinations, or smell odors that are not present.

If possible, turn the client on the left side during or immediately after a seizure to reduce the risk of aspiration. Do not force any object into the mouth during the seizure. Document specifics of the seizure activity to report to the client's healthcare provider. (incl. date, time, duration, description/type, sequence/precipitating event)

Which teaching points should the nurse include when educating James's parents about caring for a client with seizures? Select all that apply. If possible, turn the client on the left side during or immediately after a seizure to reduce the risk of aspiration. Attempt to restrain the client to reduce the risk of injury during the seizure. Do not force any object into the mouth during the seizure. Offer the client a drink of water immediately following the seizure. Document specifics of the seizure activity to report to the client's healthcare provider.