Nursing care for Seizures

I was given an opportunity to create a learning presentation for nurses in a place that I work part time about seizures. This topic is exciting to tackle as I have seen seizures and nurses sometimes tend to be overwhelmed.

I hope you will enjoy the lesson that I presented.

SEUZURES

Objectives:

1.  Define a seizure

2.  Differentiate a seizure from epilepsy

3.  Be able to differentiate types of seizures

4.  Review Causes of Seizures

5.  Review nursing responsibilities and priorities during a seizure

What is a seizure?

A seizure is an episode of abnormal electrical activity in the brain. A seizure, just like headache, is a symptom rather than a disease.

What is epilepsy?

Epilepsy is a diagnosis given when a person has two or more unprovoked seizures.

Difference between seizure and epilepsy:

All people with epilepsy have seizures but not all people with seizures have epilepsy. A seizure is a symptom of an underlying condition. Epilepsy is a clinical diagnosis assigned to a patient having more than two unprovoked seizures.

Types of Seizures:

There are two main categories of seizures: –

1.      Generalized Seizures

a.       Tonic Clonic Seizures (Grand mal)

b.      Absence Seizures (Petit mal)

2.      Partial Seizures.

a.       Simple partial

b.      Complex partial

Tonic Clonic Seizures (Grand mal)

Signs and symptoms:

1.      Sudden loss of consciousness

2.      Muscle rigidity and stiffening

3.      Jerking movements

4.      Shrill cry

5.      Incontinence

6.      Apnea (pt may turn blue)

7.      Dilated Pupils

Absence seizures

Signs and symptoms

1.      Sudden behavioral arrest

2.      Staring

3.      Unresponsiveness

4.      Only last for 1-15 seconds

Simple partial seizures:

Signs and symptoms

1.      No alteration or loss of consciousness

2.      There could subjective symptoms reported by the patients in absence of objective signs (smell, sound, taste or visual perception)

3.      Pt remains awake and aware, sometimes unable to communicate until the seizure is over

Complex Partial Seizures:

Signs and symptoms

1.      Alteration of consciousness (Not complete loss of consciousness)

2.      Automatisms: Simple repetitive uncontrollable actions performed during the seizure.

a.       Lip smacking

b.      Chewing

c.       Picking at clothes, etc

3.      Patient has no awareness of what they are doing

4.      Patient cannot remember what happened

5.      This is the most common seizure by those diagnosed with epilepsy.

Causes of seizures:

1.      Trauma

2.      Drug overdose

3.      Alcohol or drug withdrawal

4.      Non-compliance of anti-epileptic medications

5.       Stroke

6.      Febrile

7.      Intracranial processes and increase in intracranial pressure. E.g. tumors. A seizure occurring in an adult without any obvious underlying cause like alcohol, etc should be evaluated for brain cancer.

8.      Infections. E.g. Meningitis

9.      Metabolic and electrolyte imbalance. E.g. Uremia and Hyponatremia

Nursing Responsibilities and Priorities During Seizures.

What Do I do?

1.      Remain calm. This is your strength during any medical emergency. Make it an active process and tell your self: “I need to remain calm to help the situation and avoid causing errors, accidents or downright malpractice”.

2.      Mark the seizure start time.

3.      If a patient is standing, lay them to the ground and roll them to the side

4.      If the patient is in bed, roll them to the side;

5.      The patient can never swallow their tongue. Never place anything in patient mouth or try to open their mouth. This can compromise the airway or cause more harm to the patient.

6.      Never hold the patient down or try to stop their movements. This can cause injury to the patient. Instead, protect the patient from hitting hard surfaces with soft puddings like pillows.

Priorities

ABC assessments

1.      By rolling the patient to the sides, you may achieve a patent airway.

2.      Administer 100% oxygen

3.      Check oxygen saturation. It may be below 90 due to apnea. The patient may turn blue on the lips and fingers. Do not panic!

4.      Patient will have oral secretions. Suction at bedside to keep the airway patent.

5.      If help is available, establish an IV- line for possible IV medication administration if the seizure continues for a long time (Status epilepticus). You do not have to have a physician order to start an IV line in this case.

Safety:

1.      Do not run or panic. You may become a victim of the circumstance.

2.      Put the side rails up to prevent falls

3.      Pad the bed of any patient expected to get seizures. Injuries caused by unpadded bed can count against you.

4.      Your drug of choice during seizure is Ativan IV push.

Test.

1.      You are taking care of a patient with history of seizures. A nursing assistance calls you to the room and you find the patient having seizures. You should do all of the following except.

a.       Remain calm

b.      Roll the patient to the side

c.       Ask the nursing assistant to hold down the patient while you try to open their mouth

d.      Monitor oxygen saturation

2.      You are passing medication in a psychiatric unit and Mr. Crazy is sited quietly staring at you. You notice Mr. Crazy smacking his lips and making repetitive hands movements as if he is wiping the table. This goes on for a while and then stops. Mr Crazy cannot remember anything about the occurrence. What type of seizures did Mr. Crazy has?

a.       Simple partial seizures

b.      Grand mal Seizures

c.       Complex partial seizures

d.      Alcohol seizures.

3.      The drug of choice during a seizure activity is_____________.

a.       Methadone IV Push

b.      Morphine IV Push

c.       Lorazepam IV Push

d.      Dilantin IV Push

4.      The following are causes of seizures expect?

a.       Alcohol or drug withdrawal

b.      Infections like meningitis

c.       Toothache

d.      Trauma

5.      What is the first thing you should do as soon as notice a patient is having grand mal seizures?

a.       Note the time the seizure started

b.      Run down the hall and get the crash cart

c.       Administer IV Ativan per PRN orders

d.      Call 911

6.      What is the therapeutic level for dilantin that you must monitor on patients taking this medication? (Nurses only)

a.       1-5 ug/ml

b.      5-10 ug/ml

c.       10-20 ug/ml

a.       20-40 ug/ml

All patients with epilepsy have _______________ but not all patients with _________ have epilepsy.

 

Updates on Nursing Care of Patient with Seizure & Epilepsy:

Assessment

Risk Factors

◯ Genetic predisposition – Absence seizures are more common in children and tend to occur in families.

◯ Acute febrile state – particularly among infants and children younger than the age of 2 years

◯ Head trauma – May be early or late onset (up to 9 months) and incidence is increased when the head trauma includes a skull fracture.

◯ Cerebral edema – especially when it occurs acutely and seizure activity tends to disappear when the edema is successfully treated

◯ Abrupt cessation of antiepileptic drugs (AEDs) – as a rebound activity

◯ Infection – if intracranial, a result of increased intracranial pressure; if systemic, a result of the persistent febrile state

◯ Metabolic disorder – a result of insufficient or excessive chemicals within the brain such as occurs with hypoglycemia or hyponatremia

◯ Exposure to toxins – especially those associated with pesticides, carbon monoxide, and lead poisoning

◯ Brain tumor – if benign, seizures caused by the increased bulk associated with the tumor; if malignant, associated with the ability of the brain tissue to function

◯ Hypoxia – results in a decreased oxygen level of the brain; necessary for neuronal activity

◯ Acute drug and alcohol withdrawal – dehydration that accompanies withdrawal, creating a toxic level of the drug in the body

◯ Fluid and electrolyte imbalances – results in abnormal levels of nutrients required for neuronal function

Subjective and Objective Data

Generalized seizure

 During a seizure:

Post seizure:

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