SEIZURES

SEIZURES
Abnormal
electrical
signals in the
brain are fired
from neurons
Two Categories
Generalized:
affecting both sides
of the brain

Focal or Partial:
specific area of the
Barbiturates
stimulates the GABA
receptors to
decrease the
excitation and
stimulation
Neurons

Excitatory Neurons:
causing a response,
Glutamate

Inhibitory Neurons:
inhibit a response,
Causes of
Seizure Hyperthermia
CNS infection
Hypoglycemic
conditions
ETOH withdrawal
AB imbalances
Epilepsy – frequent
seizure r/t chronic
condition
-brain injury
-congenital birth
defect
Stages of
Seizure I – Prodromal
II – Aura
III – Ictus
IV – Post Ictus
Prodromal
Symptoms start to appear
prior to the event
-depression
-anger
-anxiety
-GI and urinary disturbance
- May start days before
seizure happens
Aura
-not present in all types of
seizure
(focal seizure or tonic-clonic
types)
-happens at the beginning
-warning sign and bigger
attack is expected
-happens within seconds or
Aura
-altered vision or hearing
-anxiety or dread
-dizziness
-unable to speak
-déjà vu
-sudden weird taste or smell
Ictus
Actual seizure about 1 to 3
minutes, this is the time of
seizure
-greater than 5 minutes or
starts to have a back-to-
back seizure is called
STATUS EPILEPTICUS
-needs immediate medical
Post Ictus Happens after the episode
of seizure
-this is the time for the brain
to recover
-takes hours or days (tonic-
clonic) or immediate
(absence)
- Very tired
- Want to sleep
- Headache
Types of
Seizures
A. Generalized (whole
areas of the brain)
B. Focal (specific area of
the brain)
Generalize Tonic-clonic (grand-mal)
d -most common, 1 to 3 mins
-aura
-loss of consciousness
(injury!)
-tonic: body stiffening
(groan, cry, may bite tongue,
foaming, apnea, cyanosis)
-clonic: recurrent jerking,
relaxation-spasm
Generalize
d Post Ictus:
Sore
Sleepy
Headache
Can’t recall the event
Generalize Absence( petit-mal)
d -most common in pediatric
patients
-hallmark: staring (appears
to be daydreaming)
-go unnoticed, won’t
respond to you
-very short (seconds)
Post Ictus:
they recover immediately
Generalize Atonic (Drop Attack)
d -without muscle tone
-goes limp, falls (standing)
slumps (sitting)
-head trauma
-not aware during the event
Post Ictus:
immediate regain
consciousness
Focal Focal Onset Aware (simple
partial)
-symptoms vary (location
dependent)
-small area of lobe, occipital
–changes in vision
-patient is aware of the
surrounding
-aura (shorter than 2 mins)
Focal Focal Impaired Awareness
(complex partial)
-unaware
-motor symptoms:
AUTOMATISMS (lips
smacking, grab things not
belonging to them)
-arise commonly from
temporal lobe
Nursing Intervention
Assess Risk Factors
-Seizure precations:
Oz and suction
Pillow (firm foam)
IV access
Padded side rails
Bed at lowest level
Restrictive clothing
Nursing Intervention
Assess History
-Prodromal
-Aura – s/sx
-how long did the seizure
last: time the seizure
-last anti-seizure medication
taken
Nursing Intervention
During the seizure:
-Patient on side (standing or
sitting) lay down with pillow
under head
-Do not restrain
-Do not insert anything by
mouth
-Remove restrictive items or
Nursing Intervention
During the seizure:
-Time the seizure, should
not be more than 5 minutes
-Note the characteristics:
cry out, stiffening, jerking,
blood
-Before and during: be calm
and reassure the patient
Nursing Intervention
After the seizure:
-vital signs esp. airway
- neuroassessment
-behavior of the patient
-draw blood, medications,
EEG (painless) assess the
brain activity
Nursing Intervention
Electroencephalogram
(EEG)
- Painless
- No caffeine prior
- No seizure meds and
stimulants
- Can eat before
- Wash and dry hair
Seizure Triggers
“STOP SEIZURE”
Stress
Trauma
Overexertion
Period, pregnancy
Seizure Triggers
“STOP SEIZURE”
Sleep loss
Electrolytes and metabolic issues
(hypoglycemia, acidosis, dehydration)
Illness
viZualization disturbances,
smells, sounds
Undermedication
Recreational drugs
ETOH (alcohol)
Medications
Barbiturates: Phenobarbital
-Used for tonic clonic or
focal seizure and status
epilepticus
-Stimulates GABA
receptors, inhibits
neurotransmission
S/E
-drowsiness, ataxia,
Medications Hydantoins: Phenytoin
-Used for tonic-clonic or
focal seizures
-monitor gums for gingival
hyperplasia (enlarged and
bleeding)
-bone marrow suppression
(PC and WBC)
Monitor for rashes (Steven-
Johnson)
Medications Benzodiazepines
-used for absence, tonic-
clonic or focal seizures
Diazepam, Lorazepam
-fast-acting for status
epilepticus
S/E
-drowsiness
-tolerance
-liver impairment
Medications
Valproates: Valproic Acid
-used for all types
S/E
-liver impairment
-WBC and platelets
-GI disturbances
Diet
Ketogenic Diet
-for pediatric patient whose
epilepsy is not controlled by
medications
-high in fats, low in carbs
Challenge Question
CEREBROVASC
ULAR
ACCIDENT
Cerebrovascular Accident
(Stroke) Blood that is rich in oxygen
cannot reach the brain cells
and they begin to die
-Blockage or Bleeding
Brain Function: Anatomy
Blood Supply: carotid and
vertebral arteries
-each area of the brain has
specific function
-cells are affected w/n 5
minutes without O2 (not
replaced)
 Frontal Lobe Parietal Lobe
thinking, speaking, language, touch
memory, movement

Occipital Lobe
vision, color
Temporal Lobe reception
hearing, learning, Cerebellum
feelings balance,
coordination
Brain Stem
breathing, heart rate,
temperature
• Right Side: • Left Side:
Hemiplegia Hemiplegia
• Aphasia • Impairment in
• Depression creativity
• Anger • Confused on date,
• Frustration time and place
• Agraphia • Cannot recognize
• Impaired math faces or the
skills person’s name
• Memory intact • Loss of depth
• Issues with seeing perception
on the right side • Trouble in staying
• Trouble on topic when
understanding talking
written texts • Left side neglect
• Very impulsive
• Poor ability to
make decisions
Types of Stroke
I. Ischemic
II. Hemorrhagic
III. Transient
Ischemic Attack
CVA Ischemic (Stroke)
Blockage of artery that
supplies blood to the brain
-also known as brain
ischemia or cerebral
ischemia
-the blockage reduces blood
flow and oxygen to the brain
CVA Ischemic (Stroke)
Embolism: blocks blood
flow, a clot that travelled
from a part of the body to
the brain
Thromobosis: clot within
the artery wall (neck, brain)
in patients with
hyperlipidemia or
CVA Hemorrhagic (Stroke)
Bleeding in the brain due to
break in the blood vessel
-no blood perfusion to the
brain cells and excessive
swelling from leakage of
blood
Causes: brain aneurysm
bursts, uncontrolled HTN,
TIA – mini Stroke
S/Sx lasts few minutes to
hours then resolves
This should be considered a
WARNING SIGN because at
times this is being ignored
RISK FACTORS: “STROKES
HAPPEN”
Smoking Hypertension
Thinners Atherosclerosis
(blood) Physical
Rhythm inactivity
changes Previous TIA
Oral Elevated
contraceptives glucose
Kin (family hx) aNeurysm
Signs and Symptoms
Happen suddenly
Need to act FAST to
save the brain cells
Call rapid response or
the emergency team
Note the TIME
Signs and Symptoms
Aphasia – unable to speak (comprehend
and producing it)
Types:
RECEPTIVE: unable to
comprehend speech
(Wernicke’s area)

EXPRESSIVE:
comprehends speech
but can’t respond back
(Broca’s area)
Aphasia – unable to speak (comprehend
and producing it)
MIXED: combination of
the two

GLOBAL: complete
inability to understand
speech or produce the
speech
DYSARTHRIA – unable to speak clearly due to
weak muscle (hard to understand, slurring)
APRAXIA – can’t perform voluntary
movements even though muscles function is
normal
AGRAPHIA – loss the ability to write
ALEXIA – loss the ability to read, does not
understand the words and the texts
AGNOSIA – does not understand sensation or
recognize known objects or people
DYSPHAGIA – difficulty swallowing
DIAGNOSIS: CT Scan
(cranial)and MRI
tPA (tissue plasminogen
activator) – for Ischemic
Stroke NOT for
Hemorrhagic Stroke!
- Dissolves the clot by
activating the protein
that causes
fibrinolysis
- Given within 3h from
DIAGNOSIS: if Ischemic to
receive tPA
CT scan negative
Labs within normal
limits (glucose, INR)
BP controlled (<185/110)
Has not recently
received heparin or
other anticoagulants
Nursing Interventions for tPA
-Check for bleeding
-Neuro checks round the
clock using NIH Criteria
-BP meds if needed
-Vital Signs
-Labs, Glucose
-Avoid veni, IM
injections
-prevent falls
Nursing Interventions –NIH
stroke scale
Nursing Interventions
Monitor: VS (inc ICP), LOC,
n and v
Airway: swallowing, suction
at bedside
Assess CN fxn: pupils,
swallowing, facial, gaze, gag
reflex
Bladder and Bowel:
bedpan, IC
Nursing Interventions
Hemianopsia: injury (turn
head side to side to see all
visual fields
Diet: evaluated by
SLP(thick liquids, crushed
meds, mechanical soft
meals)
Assist with eating
WOF pouching of food in
Nursing Interventions
Communication: Aphasia
Receptive-unable to
comprehend
-short phrases and simple
details
-use gestures to point
-be patient
-remove distractions
-reinforce
Nursing Interventions
Communication: Aphasia
Expressive- comprehends
but have trouble responding
back
-be patient and let them
speak
-don’t rush
-ask one Q at a time
-be direct and provide