Peds Exam 4 Seizures

consult dr about medications esp dilantin increase risk of having a CL/CP baby by 10 times

can ppl with seizures have kids?

FEBRILE SEIZURES

caused by rapid rise in temp two types simple febrile ( 6months and 5 years)- usually no preexisting abnormal neurological condition( tonic-clonic type behavior- usually last for about(15 minutes) with a return to metal status after the seizure no further seizure activity for hours complex- occur in any child at any age with a previous neurologic deficits after the seizure prolonged seizure activity more than15 minutes can reoccur within 24 hours can result in neurological deficits after the seizure

EEG

electrocephlagraphy, 20 elctrodes on the scalp to look for the brain activity

medic alert braclet cant drive a car unless free of them for a period of time dont leave alone in the bathtub dont lock bathroom door( older children) encourage showers rather than baths

education

low carbohydrate diet

dietary for seizures

Vitamin D and folic acid

if taking phenytoin and phenobarbitol they will need_____ and ___

true

led levels may need to be checked when dx seizures( true or false)

phenobarbital( luminal)

what seizure medication is given for general tonic clonic, partial seizures, and status epilepticus?

meds type of seizure and common side effect of each drug

what to know for seizure drugs

it happens when the temp rises super fast

when do seizures happen with fever?

2

which is the best action for the nurse to take during the childs seizure? 1. administer the childs rescue dose of oral diazepam(valium) 2. loosen the childs clothing and call for help 3. place a tongue blade in the childs mouth to prevet aspiration 4. carry the child o the infirmary to call 911 and start an IV line

2

which medication should the nurse anticipate administering first to a child in status epilepticus? 1. establish an iv line and administer IV lorazepam 2. administer rectal diazepam 3. administer oral glucose gel to the side of the childs mouth 4. administer oral diazepam

prodromal

just before the seizure occurs. child goes thru mood and behavioral changes and aura may occur. some may even have a funny taste in their mouth this period is known as

partial seizures

localized onset and involves a relatively small area of the brain( electrical discharge is limited to a pecific region of the cerebral coretex, can often be identified on th eeg that is done

myoclonic SEIZURES( GROUP)

usually characterized by a sudden, brief contraction of a muscle or muscle group occur singley or repetitively NO POSTICTAL STATE MAY OR MAY NOT BE SYMMETRIC MAY OR MAY NOT INCLUDE LOSS OF CONSCIOUSNESS

2

A child recently diagnosed with epilepsy is being evaluated for anticonvulsion medication therapy. the child will most likely be placed on which type of regimen? 1. 2-3 oral anticonvulsant medications so that dosing can be low and side effects minimized 2. one oral anticonvulsant med to observe effectiveness and minimize side effects 3. one rectal gel to be administered in the event of a seizure 4. a combination of oral and iv anticonvulsant meds to ensure coimpliance

atonic( drop attack)((((((( generalized))))))

usually occurs between ages 2-5 common to reoccur during the day fall to the ground with sudden loss of postural tone: inability to break fall injuries may occur to HEAD they have no ability to break their fall usually occur first thing in the morning

carbamazepine( tegretol) monitor liver enzymes

vertigo and diplopia are common side effects to this seizure drug what teaching needs to be done?

2

Which activity should an adolescent just diagnosed with epilepsy avoid? 1. swimming, even with a friend 2. being in a car at night 3. participating in any strenous activities 4. returning to school right away

1

a child diagnose with meningitis is having genralized tonic-clonic seizure whihc should the nurse do first? 1.administer blow by oxygen and call fro additional help 2. reassure the parents that seizures are common in children with meningitis 3. call a code and ask the parents to leave the room 4. asses the childs temp and BP

1.

a child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming this is most likely a: 1. absent seizure 2. akinetic seizure 3. non epileptic seizure 4. simple spasm seizure

simple partial

have no impairment of consciousness, last less than 30 seconds may have a aura or may not motor response may involve one extremity, eyes, and head may turn away from the side of the foucs. sensory responses involve parathesias, auditory, olfactory, or sensory sensations such as localized tingling or unplesant odor

1

a preschooler has been having periods during which she suddenly falls and appears to be weak for a short time after the event. the preschool teacher asks what she should do. select the nurses best response: 1. have the parents folow up with his pediatrician as this is likely an atonic seizure 2. find out if there have been nay new stressors in his life as it could be attention seeking behavior 3. have the parents follow up with his pediatrician as this is likely an absent seizure 4. the preschool years are a time of rapid growth and many children appear clumsy, it would be best to watch him to see if it continues

tonic clonic( grand mal)(((( also a genralized seizure))))))

abrupt onset lose consciousness for 1-2 minutes post-ictal state with no aura tonic state( amrs contract and reax) may release piercing cry r/t diaphargn contraction clonic state( alternate contraction and relaxing of the body itslefl)) eyes roll back pupils dilated abdominal rigidity with legs, head and neck extended, amrs flexed urinary and bowel incontinence can also bite tongue

avoid heights, wear helments baseball and track are ok if seizures are controlled

activities

post-ictal

immediately following the seizure act. may be sleepy, confused, or disoriented

seizure free for 2 years, wean slowly, if succesful may come off.. if they have one they will stop weaning process and go back to dose where they had no seizure activity

coming off of seizure meds

complex partial

consciousness is impaired last greater than 60 seconds has a posictal state aura frequently present- may involve visual disturbances, dizziness, unusual smells or sensations. the purpose is to warn of an impending seizure so safety measures canbe taken. automatisms( lip smaking, lip chewing, sucking)

status epilepticus( USUALLY GRAND MAL)

continuous seizure that last more than 30 minutes that or a serial seizure from which the child does not regain consciousness usually tonic-clonic but can be any kind MEDICAL EMERGENCY- CAN RESULT IN PERMANENT BRAIN INJURY AND DEATH BC OF HEART AND BRAIN BECOME OVER TAXED

seizure that recurs over a period of time in a decernible pattern, the disorder is called epilepsy( 2 or more unprovoked seizures)

define epilepsy

health hx( any seizures in the past) try to find out what triggers it did they have an aura are they under alot of stress lights?flashy lights? were they sleep afterwards mimin the behavior for me so i can see( may forget to tell you about the eye rolling) infection can induce seizures hypoglycemia

dx for siezures

phenytoin( dilantin)

what drug is used for complex partial, general tonic clonic, and status epilepticus seizures?

phenobarbital(Luminal)

may cause vit D deficiency and folic acid deficiency, hyperactivity, and itrritability are common side effects of what seizure med?

give meds at the same time everyday( meal time preferably)

med admin education

control seizures and decrease frequency usually start with 1 drug at low dose and titrate as needed

medication for treatment

pheytoin( dilantin)

nervousness, diplopia, folate difeiceny, gingival hyperplasia are common side effects with what seizure medication

threshold on nerve cells are lowered resulting in excessive discharge of electrical impulses

patho of seizures

excitability

purpose of dilantin is to raise the seizure threshold ( _____ theshold) of normal neurons to prevent the spread of abnormal electrical discharges.

FYI

side effects are huge issues for seizure meds and they may not take them so educate them to talk about the problems to find out what works best for them

ictal

starts when the seizure activity begins and lasts until seizure act is over

10-20ug/ml it precipitates when mixed wiht glucose if giving IV, flush tubing with normal saline only

what is the therapeutic blood level of phenytoin( dilantin)?

lobectomy-- or remove tumor or something causing the seizures vagal nerve stimulant over age of 12 can help to keep seizures from happening( care giver can use magnet to activate a device to stop the seixure)

what kind of surgery ca =n help with seizures?

cbc liver function test

what labs are routinely done with seizure drugs?

CAB adminster antiepileptics( ativan or dilantin or phenobarbital) administer oxygen IV access

status epilepticus- last fro 30 minutes

seizure disorder( do not have to have all symptoms)

sudden excesive uncontrolled electrical discharge of a group of neurons in the brain resulting in the transient impairment of consciousness, sensation, or memory

absent( petit mal) (((((( also a generalized seizure)))))

teachers usually notice these before anyone come without warning and include a sudden, brief lapse of consciousness(10-15 secs) abrupt cessation of current activity for a few seconds with prompt recovery no aura staring episodes may be confused with day dreaming or inattentiveness rolling or blinking of eyes usually ceases at puberty LOOKS LIKE DAY DREAMING

epileptogenic focus

the area on the brain where the seizure occurs is known as the

2

the nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure the nurse knows clarification is needed when the mother says: 1. my child will likely have another seizure 2. my childs 7 year old brother is at high risk for a febrile seizure 3. I'll give my child acetaminophen when ill to prevent the fever from rising to high to rapidly 4. most children with febrile seizures do not require seizure medication

partial

these types of seizures are usually secondary to an underlying disorder( tumor, fever, drug use)

generalized

this category involves both hemispheres of the brain without any kind of localized onset

phenobarbital( Luminal)

this drug is sometimes given with dilantin

carbamazepine( tegretol)

this drug is used for partial seizures, and generalzed seizures

valproic acid( depakote/depakene)

this is used for absent seizures

valproic acid( depakote/depakene)

this seizure medication can cause elevate liver enzymes

valproic acid( depakote/depakene)

tremors and sedation are common side effects of this seizure medication

partial seizure( simple and complex)

types of seizures:

ethosuximide(Zarontin)

used for absent seizures, petit mal seizures common side effects: sedation, GI upset

Clonazepam( Klonopin)

used for treatment of myocloic seizures common side effects are: ataxia, drowsiness

Fosphenytoin( Cerebreyx)

used for treatment of status epilepticus can be infused faster IV than dilantin common side effects are: HYPOGLYCEMIA AND HYPOTENSION IF GIVEN TO FAST