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SEIZURES

SEIZURES

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03/18/2014

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Seizures consist of abnormal motor and sensory activity, and are due to a sudden, excessive
discharge from cerebral neurons.
Seizures are symptoms of underlying neurological brain disorder. Can involve part or all of brain
Seizures, generally sudden and transient, should be viewed as a symptom and not a disease
TWO CATEGORIES OF SEIZURES
\u2022
Idiopathic
o
Attributed to a genetic or developmental defect.
o
The definite cause for the seizure cannot be identifies
\u2022
Acquired
o
Cause for seizure can be identified.
o
Brain tumors, stroke,hypoxemi a (anything that decreases O2 to the brain), head injury,
infections, toxic, drug withdrawal, medications, Infants: Fever
o
Leading cause in elderly: Stroke and cerebral metastasis
RESULTS FROM SEIZURES
\u2022
Memory Loss: During the seizure and/or for a short time after the seizure
\u2022
Could have brain damage if the seizure is very severe or prolonged
\u2022
At risk for Hypoxia, Vomiting and Aspiration, and Metabolic abnormalities as a result of a
seizure
\u2022
IMMEDIATE GOAL: Control the Seizure
o
Long Term: Determine the cause and control it
CLASSIFICATION OF SEIZURES
\u2022
Partial Seizures
o
Simple
\ue000
Seizures beginning locally.
\ue000
Arefocal in origin and affect only that part of the brain
\u2022
Generalized Seizures
o
Complex
\ue000
Referred to as \u201cgrand mal\u201d seizures. Involved both hemispheres of the brain,
causing reaction from both sides of the body
SEIZURES
CLINICAL MANIFESTATIONS
\u2022
Partial Seizures
o
Simple Partial Seizures
\ue000
Elementary Symptoms
\ue000
No loss of consciousness
\ue000
Finger or hand shake*
\ue000
Dizziness
\ue000
Mouth jerk*
\ue000
Unintelligent talking*
\ue000
Unusual or unpleasant sights, sounds, odors, or tastes may be experienced*
o
Complex Partial Seizures
\ue000
Complex Symptoms
\u2022
May be motionless or move automatically
\u2022
Brief loss of consciousness
\u2022
Movement is inappropriate for time and place
\u2022
Excessive emotions: Fear, anger, elation, or irritability exhibited
\u2022
No recollection of episode once over
\u2022
Generalized Seizures \u2013 Grand Mal
o
Involves both hemispheres of the brain
o
Causes both sides of the body to react
\ue000
Intense rigidity of the entire body then shaking
\ue000
Jerky alterations of muscle relaxation and contraction (tonic-clonic);
diaphragm and chest muscles contract \u2013 known as \u201cepileptic cry\u201d
\ue000
Tongue chewing
\ue000
Incontinent of urine and stool
\ue000
May be in relaxed state, possibly coma
\ue000
May be difficult to arouse afterwards, may sleep for hours with confusion
\ue000
Complains of headache and sore muscles afterwards
DIAGNOSTIC EVALUATION
\u2022
Determine the type of seizure, frequency and severity and any factors that precipitated the
seizure
\u2022
Dr will get a developmental history \u2013 If past injury or illness
\u2022
Physical and Neuro exam
\u2022
CT/MRI
\u2022
Blood studies
\u2022
EEG
NURSING ASSESSMENT AND MANAGEMENT DURING SEIZURE

It is very important to observe and record sequence of symptoms because the type of treatment may be dependent upon the nature of the seizure. Before and during a seizure, the following are assessed and documented:

1- The circumstances before the seizure (visual, auditory, or olfactory stimuli, tactile stimuli,
emotional or psychological disturbances, sleep, hyperventilation)
2- The first thing the patient does in a seizure \u2013 where the movements or the stiffness starts,
conjugate gaze position, and the position o the patient\u2019s head at the beginning of the

seizure. This information gives clues to the location of the epileptogenic focus in the brain.
3- Type of movements in the part of the body involved
4- The areas of the body involved (turn back bedding and expose patient)
5- The size of both pupils. Are the eyes open? Did the eyes or head turn to one side?
6- Incontinence of urine or stool
7- Duration of each phase of the seizure
8- Unconsciousness, if present, and its duration
9- Any obvious paralysis or weakness of arms or legs after the seizure
10- Inability to speak after the seizure
11-Movements at the end of the seizure
12-Whether or not the patient sleeps afterward
13-Cognitive status (confused or not) after the seizure

\u2022
Providepri vacy for patient
\u2022
If possible, assist patient to floor
\u2022
Protect head
\u2022
Loosen any constrictive clothing
\u2022
Move furniture \u2013 to prevent injury
\u2022
If in bed, raise side rails and remove pillows
\u2022
Never attempt to open jaws that are clenched shut
\u2022
If at all possible, place patient on side with head flexed so that the tongue will fall forward
\u2022
Never attempt to restrain patient
\u2022
Keep patient on side after seizure to prevent aspiration. Assure patient airway \u2013 Possible
short period apnea
\u2022
Apneic and confused state may follow generalized seizure \u2013 reorient
\u2022
Orient confused patient to environment with calmness
AFTER THE SEIZURE
\u2022
Keep the patient on one side to prevent aspiration. Make sure the airway is patent
\u2022
There is usually a period of confusion after a grand mal seizure
\u2022
A short apneic period may occur during or immediately after a generalized seizure
\u2022
The patient, on awakening, should be reoriented to the environment
\u2022
If the patient experiences severe excitement after a seizure, use calm persuasion and
gentle restraint

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