Convulsive disorder

Name : patel diya

Roll no : 25
Subject : CHILD HEALTH NURSING
Introduction

 The word convulsion descirbes an involuntary violent spams , or a series of jerking of

face , trunk,or extremities with or without loss of consciousness, sensory, automatic or
behavioral distribution.
 The word epilepsy describes a syndrome of recurrent unprovoked, seizure unrelated to
fever or to acute “ cerebral insult”
 Defination

 Neonatal seizure is defined clinically as “a paroxysmal alteration in neurological function

either or all three , occuring within 28 days.
 In general : a convulsive or seizure is a paroxysmal manifestations of neurological
dysfunction
 Seizure classification

 Generalized seizures
1. Tonic – clonical seizures
2. Absence seizures
3. Atopic seizures
4. Myoclonic seizures
 Partial seizures
1. Simple partical seizures
 With elementary symptoms
 No impaired consciousness
 With motors signs
 With somatory – sensory visual or auditory
 With autonomic manifestations ( abdominal ) epilepsy
2 . Complex Partial seizures
 Includes psychomotor or

Temporal lobe seizures

 With impaired consciousness
Risk factors

 MAJOR. MINOR
 Age < 1 year Family h/o of febrile seizures
 Prolonged fever Family h/o of epilepsy
 Hyper pyrexia Complex febrile seizures
 Infections male gender
Etiology

 Non Recurrent ( Acute ) Recurrent ( chronic )

 Febrile episode Idiopathic
 Intracranial infections Trauma
 Intracranial hemorrhage Infections
 Cerebral edema Congenital defects
 Brain tumors parasite brain diseases
 Anoxia Hormonal disorders
 Toxins ( e.g drugs, tetanus , lead ) Hepatic disorder
Pathophysiology
 Risk factors and etiology factors

 Altered integrity of neuron in the epileptogenic focus

 Hyperexcitability of neurons

 Partial decolorization

 Partial stimulations of neurotransmitter molecules

 Imbalanced release of excitatory and inhibitory neurotransmitters

 Lowered seizures threshold

 Abnormal spontaneous spread of electrical discharge

 Clinical manifestations
Clinical manifestations

 Onset
 Aura
 Tonic phase
 Rigidity of entire body
 Jerky muscle movement
 Epilepatic cry due to contraction of diaphragm
 Tongue bite
 Excessive salivation
 Urinary and fecal incontinence
 Unconscious
Diagnostic evaluation

 History taking
1. Maternal history
2. Family history
3. Labour and delivery history
4. Baby conditions at birth
 Neonatal examination
1. General examination
2. Neurological examinatio
3. CBG
4. Spo2
 Metabolic work up
 Infections work up
 CBC
1. Culture
2. Torch
 4. IMG
5. CRP
 Blood gas analysis
 Inborn errors of metabolism
 CT – Scan
 MRI
 EEG
 Lumbar puncture
Complications

Cranial nerve palsies

Raised ICP
 Subdural effusion
 Cerebral palsy
 Hydrocephalus
 Mental physical handicaps
 Learning disability
 Recurrence
Preventions

Regular ANC check up

 Treatment of infections during ANC period.
 Correction of anemia and control of gestational diabetes.
 Raising awareness about institutional delivery.
 Mange actively fetal distress
 Ensuring proper training of neonatal resuscitations
Management

Medical
 Goals
 To control convulsions
 To treat underlying pathology
1. Initial stabilizations
2. Establised TABC
3. Apply O2 and ventilations
 Establish IV access
2. Drugs
 First line ( benzodiazepines )
1. Diazepam – 0.5 mg / kg ( max 10 mg ) IV slow
2. Lorazepam – 0.05 – 0.1 mg / kg IV per rectum or sublingual
3. Midazolam – 0.1 – 0.2 mg / kg IV or IM

4. Dose may be repeated q5 minutes up to 3 doses

 Monitor respirations
3. Second line drugs ( Phenytoin and barbiturates )
Phenytoin : 20 mg / kg slow IV ( no faster than 1mg / kg / Min with a maximum of 50 mg / Min )
1. Phenobarbitone : 15 – 20 mg / kg slow IV
 Monitor blood pressure
4. Other drugs
1. Carabamzepine : 10 – 15 mg / kg / Day
2. Sodium valproate : 20 – 60 mg / kg / Day
3. Felbamate : 15 mg / kg / Day
Surgical management

Resective surgery
Callostomy
 Multiple subpial transection
Nursing management

 Maintain patient airway and promote safety before seizure activity.

 Avoid precipitating stimulus such as bright lights and noise.
 Administer medications as order.
 Monitoring and documenting the seizure activity and the patients responsiveness
 The IV line is closely monitored
Nursing diagnosis

 Risk for injury related to uncontrolled seizure activity.

 Ineffective airway clearance related to blockage of the tongue , endotracheal tube
increased secretion of Saliva.
 Social isolation related to low – self against the disease state , and the bad stigma against
epilepsy in the community.
 Ineffective breathing pattern related to dyspnoea and apnoea.
 Activity intolerance related to decreased cardiac output , tachycardia.
 Impaired sensory perception related to disturbances in nerve sensory organs of perception.