21-Feb-23

Management of patients with

neurologic dysfunction
(seizure disorder, epilepsy, and status epileptics).

objective:

Recognize the type, cause, clinical manifestations,

-

diagnostic test and procedure, medical, surgical

management, and nursing intervention of patients
with neurologic dysfunction(seizure disorder,
epilepsy, and status epilepticus).

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 21-Feb-23

Seizure disorder:

episodes of abnormal motor, sensory, autonomic, or psychic

activity ( or a combination of these) resulting from sudden
excessive discharge from cerebral neurons.

Cause of seizure

Central Nervous
Cerebrovascular Fever Drug and
Hypoxia Head injury system
disease (pediatric) alcohol
infections

Classification of seizure:

1- Generalized seizures
(involve electrical discharges in the whole brain)

-Intense rigidity of the entire body :

-alternating muscle relaxation and contraction ( generalized tonic-clonic).

-The tongue is often chewed

- the patient is incontinent of urine and feces.
- After 1 or 2 minutes, the convulsive movements begin to subside; the
patient relaxes and lies in a deep coma, breathing noisily. (The respirations
at this point are chiefly abdominal).

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2-Focal seizure:

originate within one hemisphere of the

brain.
 impairment of consciousness or awareness
or other dyscognitive features, localization,
and progression of ictal events.

3 -Unknown Unknown: Epileptic spams

Nursing care for seizure

Nursing care during the seizure:

 provide privacy and protect the patient from curious
onlookers.
 Ease the pt to the floor, if possible.
 protect the head with a pad to prevent injury.
 loosen constrictive clothing.
 push aside any furniture that may injure the patient
during the seizure.

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Do not try to open jaws that are clenched in a

spasm to insert anything. broken teeth and injury
to the lips and tongue that may result from such
action.

if possible, place the pt on one side with the head

flexed forward, which allows the tongue to fall
forward and facilitates drainage of saliva and mucus.
if suction is available use it( if necessary) to clean
the secretion.

Nursing care after seizure:

 keep the pt on one side to prevent aspiration
and make sure that the airway is patent.

 There is usually a period of confusion after a

grand mal seizure

 The pt on awakening should be reoriented to

the environment.

 If the pt becomes agitated after a seizure

(postictal) use calm persuasion and gentle
restraint.

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EPILEPSY
-a group of syndromes characterized by recurring seizures.

-It is classified as:

the primary ( idiopathic ).
secondary ( brain tumor).

STATUS EPILEPTICUS
-status epileptics ( acute prolonged seizure activity)is a series of
generalized seizures that occur without full recovery of consciousness
between attacks.
-it can be due to withdrawal of an antiseizure drug, fever, or concurrent
infection.

Clinical manifestation

The person may talk unintelligibly

Dizzy, unpleasant sight, sound, odors.
Rigidity of the body
 Alternation in muscle contraction and
relaxation
 Tongue bite, urine, and feces incontinent.
 Deep coma
 Noise breath ( abdominal breath)
 Confusion/sleep for hours ( postictal state )

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Nice to know:

• Coma is a clinical state of

unarousable unresponsiveness
in which there are no
purposeful responses to internal
or external stimuli, although no
purposeful responses to painful
stimuli and brain stem reflexes
may be present.

Assessment and diagnostic findings ((seizure disorder, epilepsy, and status

epilepticus)).

Determining the type, frequency, severity, and factors

that precipitate them, developmental history is taken.

H/O fall head injury illnesses.

ECG.

physical and neurological evaluation biochemical,

Hematological, and serologic studies are carried out.

MRI is used to detect lesions.

EEG aids in classifying the type of seizure.

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medical management: Pharmacological therapy (page2000)

Surgical management

• Surgical removal of the underlying cause:

-intracranial tumors, abscesses, and cysts vascular
anomalies.

• Surgery includes:
- microsurgical techniques, EEGS with depth
electrodes.
- improved illumination and hemostasis.
- the introduction of neuroleptanalgesia agents (
droperidol and fentanyl ) electrocortical mapping.

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Nursing process

Nursing goals:
Nursing diagnosis:
Prevention of injury
Risk for injury related to seizure activity
Control of seizures
Fear related to the possibility of seizures
Achievement of satisfactory
Ineffective individual coping related to psychological adjustment
stresses imposed by epilepsy
Acquisition of knowledge and
Deficient knowledge related to epilepsy understanding of the condition
and its control
Absence of complications

Nursing
intervention

Preventing - Lowered the pt gently to the floor ( OR the bed )

injury. - Remove the harmful items nearby ( furniture )
- Never attempt to insert anything into the pt mouth.

Reducing fear - Adherence to the prescribed treatment regimen.

of seizure. - Encourage pt for follow-up regular and moderate routine in
lifestyle.
- Avoid excessive exercise.
- Take high protein diet and low carbohydrate

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Teaching - To prevent or control gingival hyperplasia in patients

patient self- resaving phenytoin ( Dilantin ), the patient is advised to
care. :
1.oral hygiene after each meal and regular dental care
2.gum massage

Monitoring -status epileptics: major complication.

and managing - toxicity of medication.
the potential - Pt \ F are instructed about side effects and given
complication.
specific guidelines to assess and report S \ S that
indicate medication overdose Monitoring.

Providing - education & effort to modify the attitudes of Pt F toward the

patient and disorder.
family - educate Pt & F about medication, and care during seizures.
education
Home care - Take medication daily as prescribed
checklist - Report any signs of toxicity( drowsiness, confusion, and
difficulty walking.

Improving - assist the pt and family to understand the condition

coping limitation it imposes.
mechanisms.
- Improve the quality of life for pt with epilepsy by
teaching them and their families about symptoms
and their management.

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Thank you
May Allah bless you

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