Seizure Disorders

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Seizure Disorders
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Seizure

• Seizures are episodes of abnormal motor,
  sensory, autonomic, or psychic activity resulting
  from sudden discharge from cerebral neurons.
• Underlying cause electrical disturbance in nerve
  cells in one area of the brain causing cells to
  emit abnormal, recurring, uncontrolled electrical
  discharges

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Classifications

• Two main types
• Partial
• Generalized
• Idiopathic vs. Acquired
• See Chart 61-3, p. 2190 International
  Classification of Seizures

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Nursing Role

• What is the major responsibility of the nurse
  during a seizure?

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Key Elements of Documentation During Seizure

• Circumstances before seizure
• Occurrence of an aura
• First thing patient does during seizure
• Type of movements
• Areas of body involved
• Pupil size, whether eyes open
• Pupil or head deviation

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Key Elements of Documentation During Seizure

• Presence or absence of automatisms
• Incontinence
• Duration of each seizure phase
• Duration of unconsciousness
• Paralysis or weakness
• Movements at end of seizure
• Whether or not sleeps after seizure
• Cognitive status after seizure

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Nursing Role After a Seizure

• Documenting pre-seizure and post-seizure events.
• Maintain seizure precaution
• Prevent complications
• Hypoxia
• Vomiting
• Pulmonary aspiration

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• How will you maintain a patent airway and prevent
  aspiration?

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Nursing Interventions

• See Chart 61-4, p. 2192 Guidelines for Seizure
  Care
• Focus on patient safety
• Do not try to place anything in patients mouth
• Do not attempt to restrain patient
• Provide privacy and promote patient dignity

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Epilepsy

• Group of syndromes
• Recurrent, unprovoked seizure activity
• Classified by patterns of clinical features
• Age of onset
• Family history
• Seizure type
• Primary (idiopathic) vs. Secondary (acquired)

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Pathophysiology

• Neurons carrying messages continue to fire after
  intended task is completed.
• While discharges continue, the part of body
  controlled by the errant cells performs
  erratically.
• Resulting activity ranges from mild to
  incapacitating
• Often accompanied by loss of consciousness

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Collaborative Problems

• Status epilepticus
• Medication toxicity

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Manifestations and Diagnostics

• Manifestations
• Dependent upon location of abnormally discharging
  neurons
• Can range from staring (absence) to prolonged
  convulsive movements

• Diagnostics
• Goal
• Determining seizure type, frequency, severity,
  and precipitating factors
• MRI
• EEG
• EEG telemetry
• Simultaneous video recording
• SPECT

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Medical Management

• Pharmacologic therapy
• Goal achieve seizure control with minimal side
  effects
• Control, does not cure seizures
• Major Seizure Mediations Table 61-4, p. 2194
• Surgical management
• Removal of causative factor
• Excision of causative area of brain
• Implantation of pulse generator

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Nursing Managment

• Prevent Injury
• Reduce fear of seizures
• Improve coping mechanisms
• Provide patient and family education
• Monitor and manage potential complications

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Status Epilepticus

• Acute prolonged seizure activity
• Series of generalized seizures occurring without
  full recovery
• Medical emergency
• Precipitating factors
• Antiseizure medication withdrawal
• Fever
• Concurrent infection

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Medical Managment

• Goals
• Stop seizures asap
• Ensure adequate cerebral oxygenation
• Maintain seizure-free state
• Airway and oxygenation are essential
• Intravenous line
• EEG
• Frequent VS and neurologic checks
• IV general anesthesia

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Nursing Management

• Ongoing assessments and monitoring cardiac and
  respiratory function
• Monitoring and documenting seizure activity and
  patient responsiveness
• Side-lying position
• Accessible suction equipment
• Closely monitor IV line
• Protect from injury but do not restrain