Download Intracranial Regulation

http://img103.imageshack.us/img103/9200/peterrufusgriffen4cr.gif
What is it?
• Seizure: episode of abnormal
motor, sensory, autonomic or
psychic activity (or a combination of
these) resulting from sudden
excessive discharge from cerebral
neurons
• S&S depend on which area of brain
is affected: twitching, convulsions,
atony, mood swing, perception
changes, loss of consciousness,
irritability, etc
What Causes Seizures?
• “Cause” is unknownmisfiring of brain cells!
– Primary (as the underlying disease)
– Secondary (to the underlying disease)
–
–
–
–
–
–
–
–
–
–
Birth trauma
Prenatal asphyxia
Head injuries
Infections-Fever
Metabolic disease
Hypoxia
Tumors
Drug/ETOH W/D
Allergies
CV disease *#1 in elderly*
Risk Factors
• Incidence decreases with age
– 1 per 1000 incidence in 1st yr of life
– Median age dev is 5-6 yrs of age
– Research: 7% of aged 75+yrs
• Complex partial seizure is most common type
• Other Risk Factors (see previous slide):
–
–
–
–
–
–
SGA
Neurological conditions
Cerebral palsy
Autism
Family Hx
etc
Diagnostic Tests
•
•
•
•
EEG
CT, MRI, PET
Angiography
Surgery (rare)
EEG sedation
• Sleep deprived
• Duration~1-1 ½ hrs
– must be very still or asleep
• Age < 5yochloral hydrate po or pr
–
–
–
–
–
25 mg/kg/day as single dose; max 500 mg/day
drowsiness occurs within 10-15 min
sleep usually occurs within 30-60 min
monitor POx sats
fully awake within 2 hrs
• in some cases sleep can last 4 to 8 hours.
Lab Tests
• To rule out metabolic disease or toxicity:
– CBCD
– Blood chemistry
– Liver & Renal studies
– Urine culture
– LP
– Serum drug levels (including Rx)
– Lead level
– Toxicology screening (drugs or poisons)
Epilepsy Facts
• A group of syndromes characterized by
recurring seizures
• 2-4 million ppl- 1 in 100 adults
– **Does NOT affect intelligence
• Usual age of onset < 20 yo
• Women→ childbearing factors
– Meds→birth defects, BC pill
effectiveness ↓ with some meds
– ↑ risk of seizure with menses
– ↑ risk of osteoporosis due to long
term med tx
– ↓ folic acid absorption with meds
Types of Seizure Activity
• Differentiated by how seizure manifests:
– Partial (focal)→begin in only one part of cerebrum
• Simple—motor or sensory, confined to one area (face,
contralateral part of body) then spreads to adjacent parts
• Complex—usually temporal lobe; aura, impaired LOC x hrs,
automatisms (lip smacking, picking at clothes, aimless walking)
followed by amnesia of the event
– Generalized→involves whole brain
• Absence (petit mal)brief cessation of all motor activity:
blank stare & unresponsive (common in children)—may go
unnoticed!
—Clonic (stiffening)/Tonic (alternating contraction &relaxation:
jerking)(grand mal)
Phases of Tonic/Clonic Seizure
• Aura—sensory alteration: visual, smell, taste
• Tonic phase—unconscious & muscle
contractionhigh metabolic demandsugar!
• Clonic phase—alternating contract-relax of
muscles
• Postictal period—sleepy but arousable
Status Epilepticus—”A FIG”Tx
• Con’t seizures w/o recovery time between them
• Seizures lasting >30 minutes
• Medical emergency!!
– high metabolic demand can cause brain damage or respiratory
arrest!!!
• Do A FIG!!
– A - AirwayET tube
– F - Find the cause
–
–
• VS, EKG, Accucheck, drug/toxin levels, ABGs
I - IV access & IV meds (slowly!)
• 50% Dextrose IV to prevent hypoglycemia
• Valium (diazepam) or Ativan (lorazepam) q 10 min
• Dilantin (phenytoin) F/U or longer effect
G-General anesthesia
• Use of short-acting barbiturate-Pentothal, (thiopental) for anesthesia (or
phenobarb)
Nursing Responsibilities
• *KNOW what to do!!!
• Recording sequence
– Dx may depend on description:
– Preceding event, time of day, how long & what
occurred during each phase, both sides or one?
– Objective—which body part 1st, ANS signs (pupil
dilation, salivation, altered breathing, cyanosis, etc),
itericLOC, VS, sleep period, etc
– Subjective –soreness, memory loss, weakness, etc
• Airway mngmt & Safety
– Support & protect head, turn on side, loosen clothing,
ease to floor if seated, oxygen, suctioning, note any
injurty & F/U appropriately
Antiseizure Medications: p1536
stabilize nerve cell membranes
•
•
•
•
Dilantin (phenytoin)
Depakene (valproic acid)
Depakote (divalproex)
Tegretol (carbamazepine)
– No grapefruit juice!
•
•
•
•
Klonopin (clonazepam)
Luminal (phenobarb)
Neurontin (gabapentin)
CAM Fact: Gingko may ↑ risk of seizure if Hx of
seizure disorder
Drug Therapy
•
•
•
•
•
Begin with single drug
Serum levels monitored
Lowest dose is best dose
Many have long half life (daily or bid doses)
Do not DC abruptly!!
Side Effects of Meds
•
•
•
•
•
•
•
•
Drowsiness
Diplopia
Dizziness
Lethargy
Irritability
Somnolence
Anorexia
NV
• Idiosyncratic :
–
–
–
–
Skin rashes
Hepatotoxicity
Blood dyscrasias
Renal disease
• Toxic effects:
–
–
–
–
Nystagmus
Ataxia
LOC changes
Cognitive changes
Gingival Hyperplasia=Dilantin gums!
Client education & Health
Maintenance
•
•
•
•
•
Oral hygiene
Reducing fears
Providing education
Monitoring for complications
Developmental considerations
Public Education
The End
• eheim productions 
All pictures in this PowerPoint are intended for educational purposes only and have been obtained through
internet search engines such as Google & MSN Live Search. I take no individual credit for content other than
assembling them for presentation and learning opportunities.