Download Seizures

Care of the Patient with Seizures
At the end of this session the participant will:
• Describe convulsive seizures
• Describe non-convulsive seizures
• List 3 nursing actions for a patient having a
convulsive seizure
• Describe nursing considerations for select antiseizure medications.
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SEIZURES
• Definition
• An abnormal electro-physiologic phenomenon of the brain
resulting in abnormal synchronization of neuronal activity
manifested as altered mental state, tonic or clonic
movements, convulsions, or various psychic symptoms.
• Incidence
• <20 >60 yrs old, occurs before age 20 in >75% of
cases.
• Epilepsy versus Seizure Disorder
• Seizure Disorder-usually an underlying cause
• Epilepsy-multiple, recurrent unprovoked
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Seizures
Terms:
Aura-occurs before seizure activity, may be
depression, irritability, or unusual sensations.
Ictus-the period of seizure activity.
Postictus (post-ictal)-period after the seizure, pt. may
or may not be conscious. If conscious, may be
confused, disoriented, tired, lethargic, nauseated.
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Precipitating Factors
Metabolic
• Hypoxia
• Hypoglycemia
• Structural
• Trauma
• Toxic metabolites
• Tumors
• Acidosis
• Infection
• Electrolyte imbalances (Na) • Hemorrhage
• Pregnancy
• Stroke, new and old
• (eclampsia/cerebral edema)
• Abrupt withdrawal of drugs/ETOH
• Drugs that alter seizure threshold
4
Age-related Precipitating Factors
Neonate-may have a brain defect, birth injury, meningitis,
hypoglycemia, or hypocalcemia.
Children-febrile illness is a common cause, lead toxicity (lead
encephalopathy), or head trauma.
Adult-head trauma, alcohol withdrawal, metabolic disorders,
tumor, abscesses, meningitis, or encephalitis
5
Generalized, convulsive seizures
•
Generalized, convulsive
• Tonic-Clonic
• Grand mal - “classic seizure”
• Tonic - contraction of voluntary
muscles, stiffening, usually
lasts 10-30 seconds.
• Clonic - rhythmic contraction,
jerking, frothing, seldom lasts
longer than 2 minutes.
• Usually associated with loss of
consciousness. Post-ictal phase
lasts 30 min. to several hours.
6
Generalized non convulsive seizures
• Absence Seizure (Petit mal)
• Rare, more common in children
• Blank stare, eye fluttering, lip smacking- begins
and ends abruptly (approx. 10 seconds), brief
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Generalized non convulsive seizures
• Atonic Seizure (akinetic, astatic, “drop attack”)
• Sudden collapse of individual, lasts only a few
seconds
• The person either doesn’t lose consciousness or
regains it before hitting the ground.
8
Partial Seizures
• Arise from a localized portion of the brain or
foci
• Consciousness may or may not be impaired
• Types of partial seizures:
• Simple partial
• Partial sensory
• Complex partial
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Partial Seizures
• Simple partial
• jerking may begin in one area
of body
• no loss of consciousness
• cannot control movements
• can spread to become
generalized seizure
10
Partial Seizures
• Partial Sensory
• may not be obvious
• experiences distorted environment
• hallucinations
• unexplained feelings
11
Partial Seizures
• Complex Partial
• starts with blank stare, progresses to chewing,
then other random activity
• Patient is unaware of surroundings
EEG during
seizure
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SEIZURES
• Treatment
• Airway Protection
• PREVENT INJURY
• Medical Management
• Evaluate for Cause
• Describe/document
what is seen including
duration
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Nursing Management
Consider
• IV access, oxygen readiness, available suction
• Pad siderails (not a restraint if patient has a convulsive
disorder)
• If convulsive seizure occurs
• Protect from harm - pt and staff
• Do not restrain patient during seizure
• Be prepared to intubate
• Don’t put anything in mouth
• Evaluate for underlying cause
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Medication Management
Fosphenytoin (Cerebryx)Dosage: Load 20mg PE/kg at a rate up to 150mg
PE/minute. Converts to phenytoin in the body.
Therapeutic Level: Monitored with phenytoin level and
should be 10-20mg/dl. Level to be drawn 2 hours
after infusion is completed.
Side Effects: Hypotension.
Instructions: May be diluted with equal volume of D5W
or NS and given on a syringe pump or mixed in a bag
and given as an infusion at 150mgPE/minute.
After mixing, must be refrigerated (max 7days), but
can be kept at room temp. for 24 hours.
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Medication Management
Levetiracetam (Keppra)
Dosage:
Subarachnoid Hemorrhage: 500mg IV/PO x 3 days
then discontinue.
Traumatic Brain Injury: 500mg IV/PO x 7 days then
discontinue.
Therapeutic Level: 5-65mg/dl, how to clinically
interpret this data is unknown yet.
Side Effects: Agitation, fatigue, GI.
Instructions: Must be diluted with NS, D5W, or LR.
Infuse over 15 minutes. Oral and IV doses are
equivalent. Use IV ONLY for patients who cannot
tolerate PO for first dose.
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Status Epilepticus
Definition: one continuous unremitting seizure
lasting longer than 30 minutes or recurrent
seizures without regaining consciousness between
seizures for greater than 30 minutes.
• Emergency!
• Monitor airway, prepare to intubate
• Medical treatment includes benzodiazepines,
primarily Lorazepam (Ativan®)
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Seizure Mapping
• For patients with medically
intractable seizures
(unresponsive to medications)
• Small electrodes, are placed
over the surface of the brain or
skull/face
• Goal: identify areas causing
seizures for possible surgical
removal
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References
•
•
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http://en.wikipedia.org/wiki/Status_epilepticus
http://emedicine.medscape.com/article/793708-overview