Pediatric seizure disorders

3 categories to classify seizures

1. Where the seizure occurs 2. Level of awareness during the seizure 3. Defining characteristics of the seizure

A school-aged child with seizures is prescribed phenytoin sodium, 75 mg four times per day. What instruction would the nurse give the parents regarding this medication? Numbness of the fingers is common while taking this drug Even small doses may cause noticeable dizziness Watching television while taking the drug may cause seizures The child will have to adhere to good tooth brushing

The child will have to adhere to good tooth brushing

The parents of a child with a history of seizures who has been taking phenytoin ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate? "The capacity to metabolize the drug becomes overwhelmed over time." "A drop in the plasma drug level will lead to a toxic state." "Small increments in dosage lead to sharp increases in plasma drug levels." "Large increments in dosage lead to a more rapid stabilizing therapeutic effect."

"Small increments in dosage lead to sharp increases in plasma drug levels."

The nurse has performed discharge teaching for parents of a child diagnosed with epilepsy. The child has been prescribed Zonegran (zonisamide). Which comments by the parents indicate the need for further discharge teaching regarding this medication? Select all that apply. "We need to watch our child's gums for swelling since this commonly happens with this medicine." "We may need to add B-complex vitamin supplementation to our child's medications because this can help mange side effects." "This medication can make our child very sedated so we need to monitor for this side effect." "I hope this medicine doesn't upset our child's stomach when taking it since the medication should be given on an empty stomach." "Since our child also takes Dilantin (phenytoin), the dosages will likely be adjusted since it increases the metabolism of the Zonegran (zonisamide)."

"This medication can make our child very sedated so we need to monitor for this side effect." "We need to watch our child's gums for swelling since this commonly happens with this medicine." "We may need to add B-complex vitamin supplementation to our child's medications because this can help mange side effects."

Manifestations of febrile seizures

1. Fever >100.4 2. Loss of consciousness 3. Shaky legs or arms

The nurse is caring for a preschooler who has developed a high fever and has just had a seizure. What is the best action by the nurse? Remove any blankets or heavy clothing and replace with a thin sheet Administer acetaminophen by mouth as prescribed. Apply ice packs to the child's axillary and groin area. Place the child in a bathtub filled with cool water.

Remove any blankets or heavy clothing and replace with a thin sheet

When caring for a child who has a history of seizures, which nursing interventions would be appropriate? Select all that apply. The nurse places a washcloth in the mouth to prevent injury during seizure. The nurse stays with the child and calls for help when a seizure begins. The nurse teaches the caregivers regarding seizure precautions. The nurse positions the child on the side during a seizure. The nurse has oxygen available to use during a seizure. The nurse pads the crib or side rails before a seizure.

The nurse stays with the child and calls for help when a seizure begins. The nurse teaches the caregivers regarding seizure precautions. The nurse positions the child on the side during a seizure. The nurse has oxygen available to use during a seizure. The nurse pads the crib or side rails before a seizure.

Manifestations of neonatal seizures

Bicycle pedaling, long periods of apnea, and thrashing or struggling movements

Epilepsy

Characterized as at least 2 unprovoked seizures with more than 24 hours between each episode

Manifestations of atonic seizures

Loss of muscle control causing collapse

Manifestations of a tonic-clonic seizure

Most serious Loss of consciousness, body stiffening, shaking, loss of bladder control or biting tongue

Epilepsy pathophysiology

Brain function altered due to an imbalance between excitatory and inhibitory mechanisms in the brain

Pediatric seizure interventions

Clutter free room Pad bed, lowest position Airway clearance (empty mouth) Stay with patient during entire seizure Discuss seizure triggers Monitor for hyperthermia Eliminate excess clothing Turn onto side

Febrile seizure diagnosis

Thorough history and physical Determine source of fever Lumbar puncture or neuroimaging to rule out infectious disease

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures? Instructing her teacher how to respond to a seizure Understanding the side effects of medications Treating the child as though she did not have epilepsy Placing the child on her side on the floor

Understanding the side effects of medications

Febrile seizure treatment

Treat fever Diazepam, midazolam, lorazepam

A girl who is playing in the playroom experiences a tonic-clonic seizure. During the seizure, the nurse should take which actions? Select all that apply. 1.Remain calm. 2.Time the seizure. 3.Ease the child to the floor. 4.Loosen restrictive clothing. 5.Keep the child on her back.

1.Remain calm. 2.Time the seizure. 3.Ease the child to the floor. 4.Loosen restrictive clothing.

The nurse is providing home care instructions to the parents of a child with a seizure disorder. Which statement indicates to the nurse that the teaching regarding seizure disorders has been effective? 1."We're glad we only have to give our child the medication for 30 days." 2."We will make appointments for follow-up blood work and care as directed." 3."We're glad there are no side effects from taking the antiseizure medications." 4."After our child has been seizure free for 1 month, we can discontinue the medication."

2."We will make appointments for follow-up blood work and care as directed."

Epilepsy treatment

Anticonvulsant drugs (phenytoin, phenobarbital, felbamate, gabapentin) Surgery Keto diet Vagal nerve stimulator

Neonatal seizure diagnosis

Appearance of infant History Location and involvement of extremities EEG

Infantile seizure

Characterized as seizures that occur within the first 4 weeks of life

Most common seizure type in children less than 5

Febrile seizure

Epilepsy diagnosis

From patient history and signs and symptoms EEG

What is a true statement regarding status epilepticus? Children over the age of 3 are more likely to develop status epilepticus. Seizure activity lasts less than 30 minutes. The most common cause is flashing lights. It is a common neurologic emergency in children.

It is a common neurologic emergency in children.

Manifestations of myoclonic seizures

Sudden brief jerks or twitching of the arms and legs

T or F: Febrile seizures are more commonly seen in boys

True

A 12-year-old child has been prescribed phenytoin. What information should be included in discussion about this medication? Use a soft toothbrush. Take medication on an empty stomach. Avoid excessive sunlight. Increase intake of citrus foods to promote absorption.

Use a soft toothbrush.

Generalized seizure

a seizure that affects both sides of the brain

Focal seizure

localized seizure often affecting one limb

A child is brought to the emergency department after experiencing a series of continuous seizures. The nurse is reviewing the orders for care and treatment. Which order would be of the highest priority? serum glucose level white blood cell count urinalysis hemoglobin level

serum glucose level

The nurse is caring for a 3-year-old boy who is experiencing seizure activity. Which diagnostic test will determine the seizure area in the brain? lumbar puncture cerebral angiography computed tomography video electroencephalogram

video electroencephalogram

Neonatal seizure pathophysiology

Can occur as the immature brain is more prone to seizure activity (Hypoxic ischemia, metabolic disorder, infection)

Manifestations of tonic seizures

Muscle stiffening Loss of consciousness

Neonatal seizure treatment

Treat underlying cause

The nurse is performing an admission assessment on a child with a seizure disorder. The nurse is interviewing the child's parents to determine their adjustment to caring for their child who has a chronic illness. Which statement, if made by the parents, would indicate a need for further teaching? 1. "Our child sleeps in our bedroom at night." 2."We worry about injuries when our child has a seizure." 3."Our child is involved in a swim program with neighbors and friends." 4."Our babysitter just completed cardiopulmonary resuscitation training."

1. "Our child sleeps in our bedroom at night."

Which nursing actions apply to the care of a child who is having a seizure? Select all that apply. 1.Time the seizure. 2.Restrain the child. 3.Stay with the child. 4.Insert an oral airway. 5.Loosen clothing around the child's neck. 6.Place the child in a lateral side-lying position.

1.Time the seizure. 3.Stay with the child. 5.Loosen clothing around the child's neck. 6.Place the child in a lateral side-lying position.

The nurse enters a child's room and discovers that the child is having a seizure. Which actions should the nurse take? Select all that apply. 1.Call a code. 2.Run to get the crash cart. 3.Turn the child on her side. 4.Loosen any restrictive clothing. 5.Check the child's respiratory status. 6.Place an airway into the child's mouth.

3.Turn the child on her side. 4.Loosen any restrictive clothing. 5.Check the child's respiratory status.

The nurse creates a plan of care for a child at risk for tonic-clonic seizures. In the plan of care, the nurse identifies seizure precautions and documents that which item(s) need to be placed at the child's bedside? 1.Emergency cart 2.Tracheotomy set 3.Padded tongue blade 4.Suctioning equipment and oxygen

4.Suctioning equipment and oxygen

A nurse demonstrates understanding of the various levels of consciousness as they progress from most alert to least alert. Place the levels of consciousness in the order that reflects this progression.

Alert and oriented Disoriented Obtunded Stupor Coma

Febrile seizure

Characterized are generalized seizure lasting less than 15 minutes, accompanied by a fever, without the presence of a CNS infection

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse will be correct in telling the parent which information in regard to seizures? Seizures are typically provoked by pain. The electroencephalogram (EEG) is normal during a seizure. Seizures are typically outgrown by 4 years of age. Convulsive activity often occurs in seizures.

Convulsive activity often occurs in seizures.

During the trial period to determine the efficacy of an anticonvulsant drug, which caution should be explained to the parents? Drug dosage will be adjusted depending on the frequency of seizure activity Plasma levels of the drug will be monitored on a daily basis The drug must be discontinued immediately if even the slightest problem occurs The child shouldn't participate in activities that could be hazardous if a seizure occurs

The child shouldn't participate in activities that could be hazardous if a seizure occurs

Febrile seizure pathophysiology

Triggered by higher than normal body temperature

Manifestations of clonic seizures

Repeated of rhythmic, jerking movements of the neck, face and arms

Manifestations of absence seizure

Staring off into space Subtle body movements Eye blinking or lip smacking

Types of febrile seizures

Simple: few seconds--> 15 minutes. Does not reoccur within 24 hours Complex: lasts longer than 15 minutes. Occurs more than once during 24 hours. Confined to one part of child's body

The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education? "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully." "When he gets his next set of immunizations, I need to make sure I give him some ibuprofen so he doesn't spike a fever." "I hate to think that I will need to be worried about my child having seizures for the rest of his life." "I need to set an alarm to wake up and check his temperature during the night when he is sick."

"I hate to think that I will need to be worried about my child having seizures for the rest of his life."

The nurse is performing an assessment of a 7-year-old child who is suspected of having episodes of absence seizures. Which assessment question to the mother will assist in providing information that will identify the symptoms associated with this type of seizure? 1."Does twitching occur in the face and neck?" 2."Does the muscle twitching occur on one side of the body?" 3."Does the muscle twitching occur on both sides of the body?" 4."Does the child have a blank expression during these episodes?"

4."Does the child have a blank expression during these episodes?"

The nurse caring for a child with suspected absence seizures is collecting data from the parents on how to manage the disorder. Which statement, if made by the parents, indicates the presence of signs congruent with this disorder? 1."My child does well with group activities." 2."My child leads the other children during group play." 3."My child is doing really well in school and has high grades." 4."My child's teacher mentioned that he seems to daydream a lot."

4."My child's teacher mentioned that he seems to daydream a lot."

The nurse is providing teaching to the parents of a child recently prescribed carbamazepine for a seizure disorder. Which statement by a parent indicates successful teaching? "I'm glad to know he will only need this medication for a short time to stop his seizures." "This medication may cause him to have trouble sleeping. He may need something else to help him sleep." "I need to watch for any new bruises or bleeding and let my health care provider know about it." "I will give the medication to him when I first wake him up in the morning."

"I need to watch for any new bruises or bleeding and let my health care provider know about it."