NUR 149 2nd SEMESTER

A.Y. 2022-2023 SEIZURE DISORDER

SEIZURE DISORDERS

Seizures
- Abnormal sudden, explosive, disorderly
discharge of electrical impulses from the
cerebral neurons characterized by episodes of
abnormal motor, sensory, autonomic or
psychic activity (or combination)
- Part or all of the brain may be involved
2. PETIT MAL (LITTLE SEIZURE)
- Not preceded by an aura - Little or no tonic-
clonic seizures - There is sudden cessation of
ongoing physical activities by blank facial
expression, automatism like lip-chewing, lip
smacking

2 main types:
1. PARTIAL
- begin in one part of the brain
2. GENERALIZED
- involve electrical discharges in the whole
brain.
3. MYOCLONIC SEIZURES
- Associated with brain damage - Generalized
GENERALIZED SEIZURES jerking or stiffening of extremities (arms and
shoulders) - “jumps”- sudden muscle jerks
1. GRAND MAL
- May be preceded by AURA; tonic and
clonic phase involve both hemispheres of
the brain
- TONIC PHASE: limbs contract or stiffen;
pupils dilate and eyes roll up to one side;
glottis closes; may be incontinent; occurs
at the same time as loss of consciousness,
lasts 20- 40 seconds
- CLONIC PHASE: Repetitive movement
(elbows, legs and head will flex then relax.,
increased mucus production
- characteristic EPILEPTIC CRY.
- Tongue is often chewed, incontinent of
4. AKINETIC SEIZURES
urine & feces.
- (Drop Attack, Astatic, Atonic) - Related to
- Patient relaxes & lies in deep coma,
organic brain damage - Sudden brief loss of
breathing noisily
postural tone, and temporary loss of
- Seizure ends with post-ictal period of
consciousness
confusion and drowsiness
- Many pts. report headache, sore muscles, 5. FEBRILE SEIZURE
fatigue & depression - Seizures occurs only when fever is rising -
Common among 6 mos. to 5 years
- Febrile seizures are convulsions brought on
by a fever in infants or small children. Most
febrile seizures last a minute or two,
although some can be as brief s a few
seconds while others last for more than 15
minutes.

MEDICAL SURGICAL LEC, TCGGUILLERMO 3BSN5

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 - The majority of children with febrile
seizures have rectal temperatures greater
that 102 degrees Fahrenheit (38.9o C). Most
febrile seizures occur during the first day of
a child’s fever.
PARTIAL/ FOCAL SEIZURES
1. SIMPLE PARTIAL SEIZURES
- produces sensory symptoms accompanied
by motor symptoms that are localized or
confined to a specific area only a finger or
hand may shake, or the mouth may jerk
uncontrollably
- person may talk unintelligibly, dizzy,
experience of unusual or unpleasant sights,
sounds, odors or tastes
- No loss of consciousness
2. COMPLEX PARTIAL
SEIZURE/PSYCHOMOTOR SEIZURES
- may follow trauma, hypoxia, drug use
- characterized by periods of altered
behavior that the client is not aware of
- Aura present; dreamlike state
- The client loses consciousness for a few
seconds the person either remains
motionless or moves automatically but
inappropriately for time & place
- may experience excessive emotions of fear,
anger, elation, or irritability.
3. ABDOMINAL SEIZURE
- These seizures are accompanied by
autonomic symptoms or signs, such as
abdominal discomfort or nausea which may
rise into the throat (epigastric rising),
stomach pain, the rumbling sounds of gas
moving in the intestines (borborygmi),
belching, flatulence, and vomiting. Also
referred to as abdominal epilepsy.
SPECIFIC CAUSES:
• IDIOPATHIC
• ACQUIRED
- Cerebrovascular disease
- Hypoxemia of any cause
- Fever
- Head injury
- Hypertension
- CNS infections
- Metabolic & toxic conditions
- Brain tumor
- Drug & alcohol withdrawal
- Allergies
NURSING MANAGEMENT
• Before & during a seizure
✓ Observe & record the sequence of signs.
o The circumstances before the seizure.
o Occurrence of an AURA
o The first thing the patient does in the
seizure
o Type of movements in the body involved
o Pupil size & if the eyes are open
o AUTOMATISMS
o Incontinence of urine or stool
o Duration of each phase of seizure
o Duration of unconsciousness
o Obvious paralysis or weakness
o Inability to speak after the seizure
o Cognitive status
Nursing Care during Seizure
• Prevent injury & support not only physically but
also psychologically
• Provide privacy & protect the patient.
• Place patient on the floor if possible.
• Protect the head with a pad.
• Loosen constrictive clothing
• Push aside any furniture
• If the patient is in bed, raise side rails.
• If an aura precedes the seizure, insert oral
airway equipment.
• Don’t attempt to open jaws clenched during
spasm or insert anything.
• Don’t restrain the patient during seizure.
• If possible, place the pt. on one side with head
flexed forward.
MEDICAL SURGICAL LEC, TCGGUILLERMO 3BSN5
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 Cause
• Inherited
• Idiopathic
• Birth trauma
• Asphyxia neonatorum
• Head injuries
• Some infectious diseases
• Toxicity
• Circulatory problems, fever, metabolic &
nutritional disorders, drug or alcohol intoxication
• Brain tumors, abscesses, congenital
malformations

After the seizure Pathophysiology

• Keep the patient on one side. Make sure the NEURONS carry messages from the body
airway is patent. ↓
Impulses occur in bursts whenever a nerve cell has a
• There is usually a period of confusion after a
task to perform
grand mal seizure.
↓
• A short apneic period may occur during or
Permanent changes occur in brain tissue
immediately after generalized seizure.
↓
• Pt. should be reoriented to the environment.
Brain becomes too excitable or jumpy
• If the pt. becomes agitated after a seizure, use
↓
persuasion & gentle restraint
Brain sends out abnormal, recurring, uncontrolled
signals
↓
Repeated & unpredictable seizures

Clinical Manifestations
• Simple staring spells
• Violent shaking and loss of alertness.
• The type of seizure depends on the part of the
brain affected and cause of epilepsy.
• Strange sensation

Diagnostic tests
• EEG
• Blood chemistry
• Blood sugar
• Kidney function tests (electrolytes)
• Head CT & MRI
• Lumbar puncture
The Epilepsies • Tests for infectious diseases
- A group of syndromes char. by unprovoked,
recurring seizures.
Medical Management
- If seizures repeatedly continue after the ❖ Pharmacologic Therapy
underlying problem is treated, the condition is ✓ Objective: To achieve seizure control with
called epilepsy. minimal side effects
- It can be primary or secondary. ✓ Medication therapy controls rather than
cures seizures.
✓ Major antiseizure medications:

MEDICAL SURGICAL LEC, TCGGUILLERMO 3BSN5

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 o Carbamazepine, clonazepam,
gabapentin, phenobarbital, phenytoin,
valproate

Nursing considerations to IV Phenytoin

❖ Give phenytoin over 30-40 minutes (rate

<50mg/min). In patients who are elderly, or have
pre-existing cardiac disease, give phenytoin over
60 minutes. N.B. administration should
commence immediately after the mixture has
been prepared and completed within 1hour.
❖ Ideally, administer undiluted via a syringe pump
through a large gauge needle or IV catheter into
a large forearm vein.
❖ If dilution is essential, mix with 100–250ml
sodium chloride 0.9% to a final concentration of Monitor for signs of carbamazepine toxicity:
<10mg/ml, and administer by infusion pump.
❖ Use the solution immediately, ideally with a 0.2–
0.5micron in-line filter.
❖ To avoid local venous irritation, inject sterile
sodium chloride 0.9% through the vein or
catheter before and after each phenytoin
infusion.
❖ Do not administer as a continuous infusion.
❖ Continuous ECG and blood pressure monitoring
is essential during infusion.

Monitor for signs of phenytoin toxicity:

• S - Slurred speech
• T - Tremors
• A - Ataxia
• N - N/V
** Serum phenytoin levels should be
maintained at 10-20 mg/Dl

Nursing Considerations for Carbamazepine

Surgical Management
• Indicated for patients whose epilepsy results
from intracranial tumors, abscesses, cysts, or
vascular anomalies.

MEDICAL SURGICAL LEC, TCGGUILLERMO 3BSN5

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 Status Epilepticus
– Acute prolonged seizure activity
– A series of generalized seizures that occur
without full recovery of consciousness between
attacks.
– A medical emergency
– A tonic-clonic seizure lasting longer than 5
minutes.
– Repeated episodes of cerebral anoxia & edema
may lead to irreversible & fatal brain damage.

Management
• Stop the seizures as quickly as possible
• Airway & adequate oxygenation
• IV diazepam (Valium), lorazepam (Ativan)
• IV line is established & blood samples are
obtained • EEG monitoring
• VS & neurologic signs are monitored.
• Cardiac & respiratory depression should be
monitored

MEDICAL SURGICAL LEC, TCGGUILLERMO 3BSN5