seizures and epilepsy

benzodiazepines

-used for status epilepticus (midazolam, lorazepam, diazepam) -common adverse effects (sedation, drowsiness, dizziness, fatigue, lethargy, blurred vision)

3 phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills.

the home health nurse visits a client who is taking phenytoin for control of seizures. during the assessment, the nurse notes that the client is taking birth control pills. which information should the nurse include in the teaching plan? 1) pregnancy must be avoided while taking phenytoin. 2) the client may stop the medication if it is causing severe gastrointestinal effects. 3) there is the potential of decreased effectiveness of birth control pills while taking phenytoin. 4) there is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

seizure disorders

-abnormal, sudden, uncontrolled, excessive discharge of electrical activity within the brain -epilepsy- is a syndrome characterized by chronic recurring abnormal brain electrical activity

idiopathic seizures

-do not fit into other categories -account for half of all seizure activity -occur for no known reason

anticonvulsant therapy

-goals (reduce frequency of seizure activity, minimize adverse effects of the medicine) -selection of drug depends on type of seizure, age and gender of patient, potential adverse effects -anticonvulsants increase seizure threshold -agents either inhibit excitatory processes or enhance inhibitory processes

partial seizures

-involve only one cerebral hemisphere -complex -simple

data collection

-lab test (alcohol, illicit substance levels, HIV, CBC, electrolytes, BUN, blood glucose) -diagnostic test (EEG, MRI, CT scan, PET scan, CSF analysis)

status epilepticus

-medical emergency -a life-threatening condition characterized by a series of generalized seizures w/out full recovery of consciousness between -may be caused by a sudden withdrawal of anticonvulsant medications -may lead to brain damage

common antiseizure medications

-phenytoin -carbamazepine -valproic acid -phenobarbital -levetracetam -topiramate -lamotrigine

nursing care for seizures

-preseizure (history of seizure, implement seizure precautions) -during a seizure (maintain airway, protect from injury, suction) -post seizure (documentation, neurological checks, vital signs)

non-drug therapy for seizures

-surgical intervention can treat refractory seizures -implantable vagus nerve stimulator -ketogenic diet

generalized seizures

-tonic-clonic -absence -myoclonic -atonic or akinetic- partial or complete loss of muscle tone

3 the therapeutic phenytoin level is 10 to 120 mcg/mL. at a level higher than 20 mcg/mL, involuntary movements of the eyeballs occur. at a level higher than 30 mcg/mL, ataxia and slurred speech occur.

a client is taking the prescribed dose of phenytoin to control seizures. results of a phenytoin blood level study reveal a level of 35 mcg/mL. which finding would be expected as a result of this laboratory result? 1) hypotension 2) tachycardia 3) slurred speech 4) no abnormal finding

a, b, c, d, e the nurse should implement privacy to minimize the client's embarrassment. the nurse should ease the client to the floor to prevent falling and injury. the nurse should move the furniture away from the client to prevent injury. the nurse should loosen the client's clothing to minimize restriction of movement. the nurse should protect the client's head from injury by placing the client's head in her lap or using a pillow or blanket under the head during a seizure.

a nurse is assessing a client who has a seizure disorder. the client tells the nurse, "i am about to have a seizure." which of the following actions should the nurse implement? (select all that apply.) a) provide privacy. b) ease the client to the floor if standing. c) move furniture away from the client. d) loosen the client's clothing. e) protect the client's head with padding. f) restrain the client.

a the greatest risk to the client is aspiration during the postical phase. therefore, the priority intervention is to keep the client in a side-lying position so secretions can drain from the mouth keeping the airway patent.

a nurse is caring for a client who has just experienced a generalized seizure. which of the following actions should the nurse perform first? a) keep the client in a side-lying position. b) document the duration of the seizure. c) reorient the client to the environment. d) provide client hygiene.

c the nurse should instruct the client to take phenytoin at the same time every day to enhance effectiveness.

a nurse is providing discharge instructions to a client who has a prescription for phenytoin. which of the following information should the nurse include? a) consider taking an antacid when on this medication. b) watch for receding gums when taking the medication. c) take the medication at the same time every day. d) provide a urine sample to determine therapeutic levels of the medication.

a, b, c the nurse should instruct the client to avoid overwhelming fatigue, which can trigger a seizure by stimulating abnormal electrical neuron activity. the nurse should instruct the client to remove caffeinated products from the diet, which can trigger a seizure by stimulating abnormal electrical neuron activity. the nurse should instruct the client to refrain from looking at flashing lights, which can trigger a seizure by stimulating abnormal electrical neuron activity.

a nurse is reviewing trigger factors that can cause seizures with a client who has a new diagnosis of generalized seizures. which of the following information should the nurse include in this review? (select all that apply.) a) avoid overwhelming fatigue. b) remove caffeinated products from the diet. c) limit looking at flashing lights. d) perform aerobic exercise. e) limit episodes of hypoventilation. f) use of aerosol hairspray is recommended.

1, 3, 4 nursing actions during a seizure include providing for privacy, loosening restrictive clothing, removing the pillow and raising padded side rails in the bed, and placing the client on 1 side with the head flexed forward, if possible, to allow the tongue to fall forward and facilitate drainage. the limbs are never restricted because the strong muscle contractions could cause the client harm. if the client is not in bed when seizure activity begins, the nurse lowers the client to the floor, if possible; protects the head from injury; and moves furniture that may injure the client.

a nurse is caring for a client who begins to experience seizure activity while in bed. which actions should the nurse take? select all that apply. 1) loosening restrictive clothing. 2) restraining the client's limbs. 3) removing the pillow and raising padded side rails. 4) positioning the client to the side, if possible, with the head flexed forward. 5) keeping the curtain around the client and the room door open so when help arrives they can quickly enter to assist.

c the nurse should instruct the client to hold a magnet over the implantable device when an aura occurs so as to decrease seizure activity.

a nurse is completing discharge teaching to a client who has seizures and received a vagal nerve stimulator to decrease seizure activity. which of the following statements should the nurse include in the teaching? a) "it is safe to use microwaves that are 1,200 watts or less." b) "you should avoid the use of CT scans with contrast." c) "you should place a magnet over the implantable device when you feel an aura occurring." d) "it is recommended that you use ultrasound diathermy for pain management."

1, 2, 5, 6 Seizure precautions may vary from agency to agency, but they generally have some common features. Usually, an airway, oxygen, and suctioning equipment are kept available at the bedside. The side rails of the bed are padded, and the bed is kept in the lowest position. The client has an intravenous access in place to have a readily accessible route if antiseizure medications must be administered, and as part of the routine assessment the nurse should be checking the patency of the catheter. The use of padded tongue blades is highly controversial, and they should not be kept at the bedside. Forcing a tongue blade into the mouth during a seizure more likely will harm the client who bites down during seizure activity. Risks include blocking the airway from improper placement, chipping the client's teeth, and subsequent risk of aspirating tooth fragments. If the client has an aura before the seizure, it may give the nurse enough time to place an oral airway before seizure activity begins.

the nurse is instituting seizure precautions for a client who is being admitted from the emergency department. which measures should the nurse include in planning for the client's safety? select all that apply. 1) padding the side rails of the bed. 2) placing and airway at the bedside. 3) placing the bed in the high position. 4) putting a padded tongue blade at the head of the bed. 5) placing oxygen and suction equipment at the bedside. 6) flushing the intravenous catheter to ensure that the site it patent.