SEIZURES

status epilepticus

A condition in which seizures recur every few minutes, no consciousness regain

Nursing MGMT

ABC/oxygen, IV access and begin NS, medications (Valium and versed to stop seizure)

Pt Education

AED controls seizures but doesn't correct cause, medical alert bracelet, avoid cessation of AED, avoid CNS DEPRESSANTS

A school nurse is called to the playground where a 6-year-old girl has been found sitting unresponsive and "staring into space," according to the playground supervisor. How would the nurse document the girl's activity in her chart at school?

Absence seizure

Generalized Seizures

Absence- Staring into space, last several seconds, eyelid fluttering Tonic clonic- Sudden LOC, rhythmic jerking, last 1-3 minutes, multiple (status), incontinent

An infusion of phenytoin (Dilantin) has been ordered for a patient whose brain tumor has just caused a seizure. The patient has been receiving D5W at 100 mL/hour to this point and has only one IV access site at this point. How should the nurse prepare to administer this drug to the patient?

Administer normal saline

Meds cont.

Allow brain to rest, slow down electrical activity in CNS

EEG information

Avoid CNS stimulants or depressants, withholding anticonvulsant, wash hair very well, avoid caffeine

Myoclonic

Brief shock like jerks

A patient with generalized seizure disorder has just had a seizure. The nurse would assess for what characteristic associated with the postictal state?

Confusion

How to dx seizure

Detailed hx: Age of onset, frequency and duration, precipitating factors, aura? DX: EEG, CT, MRI, PET scan Lab Values: Therapeutic drug level (Dilantin/phenytoin), CBC, BMP/LFT

Antiseizure Medications

Divalproex (Depakote): Bipolar disorder Phenytoin (Dilantin) Gabapentin (Neurontin): neuropathic pain treatment Carbamazepine (Tegretol) Diazepam (Valium): status epilepticus

During a seizure

Do not restrict them, loosen clothing, protect them from injury, do not put something in mouth, watch them, automatisms, incontinent, unconscious, ASSESS CONFUSION

A nurse is caring for a client admitted to the unit with a seizure disorder. The client seems upset and asks the nurse, "What will they do to me? I'm scared of the tests and of what they'll find out." The nurse should focus her teaching plans on which diagnostic tests?

EEG, blood cultures, and neuroimaging studies

Focal seizure

Focal onset area, automatisms

During assessment of a patient who has been taking dilantin for seizure management for 3 years, the nurse notices one of the side effects that should be reported. What is that side effect?

Gingival hyperplasia

DILANTIN SD EFFECT

Gingival hyperplasia- Gums overgrow teeth, use soft toothbrush

The nurse is caring for a patient on the neurological unit who is in status epilepticus. What medication does the nurse anticipate being given to halt the seizure?

IV diezapam

Nursing dx

Ineffective breathing, risk for injury, ineffective coping

Clonic

Jerking muscle contractions

The nurse is called to attend to a patient having a seizure in the waiting area. What nursing care is provided for a patient who is experiencing a convulsive seizure? Select all that apply.

Loosen clothing, provide privacy, side lying position

Dilantin (phenytoin)

Must maintain therapeutic level in blood

Simple partial seizure

No LOC, may have aura

Nursing assessments seizure

Observations, airway, safety, vital signs, presence of aura, incontinence, privacy, ASSESS CONFUSION

The nurse is caring for a client who has undergone supratentorial removal of a pituitary mass. What medication would the nurse expect to administer prophylactically to prevent seizures in this client?

Phenytoin

A hospital client has experienced a seizure. In the immediate recovery period, what action best protects the client's safety?

Place patient in side lying position

Seizure precautions

Risk- hypoxia, vomiting, aspiration Side lying Check LOC Allow rest Monitor vital signs Neuro checks Privacy

Partial Seizure

Sensory or motor, can be simple or complex (LOC), may have aura, blank stare, hallucinations, bell ringing, dysphasia (trouble speaking)

Post seizure

Small pillow under the head, oxygen, suction, bed in low position, side lying, IV access, oral airway, side rails up, NO TONGUE BLADE

Tonic

Stiffening or arms and muscles

Tonic

Stiffening up

Risk factors for seizure

Stroke, hypertension, fever (children), brain tumor, drug and alcohol withdrawal, hypodermic, head injury, CNS infection, metabolic and toxic conditions, allergies

A young adult has just been diagnosed with atonic seizures. The nurse practitioner explains to the patient that this type of seizure is characterized by:

Sudden loss of muscle tone that results in a fall

Sick days seizure

Take medication, contact provider

Dilantin

This can cause ataxia, ONLY GIVE WITH NORMAL SALINE, DO NO PUSH THIS IV give slowly, always start with new tubing

Surgical intervention seizures

Vagal nerve stimulation, focal resection, partial corpus callosum resection

Epilepsy

chronic brain disorder characterized by recurrent seizure activity

atonic seizure

loss of muscle tone and a drop

EEG procedure

patient is placed on a reclining chair or bed; 16-24 electrodes are attached to scalp with a jelly-like substance; glue is placed over the electrodes to prevent slippage; patient must lie still with eyes closed during the initial recording, hyperventilation (induce seizure)