A Review of Seizures & Nursing Care

1. A Review of Seizures & Nursing Care Emily Booth RN(EC) BScN MN emily@shalomvillage.ca

2. Goals: • To understand the signs and symptoms of a seizure • To understand the nursing care that can be offered pre, during and post seizure activity • To understand how to use the suctioning machine

3. What is a Seizure? • A sudden, abnormal, excessive electrical discharge from the brain that can change motor and/or autonomic function, consciousness or sensation

4. Epileptic vs Non-Epileptic • Epileptic An abnormal excessive amount of neural activity in the brain that originates in the central nervous system • Non-Epileptic A response to stimulus that does not originate in the central nervous system What are some causes of non-epileptic seizures?

5. Alcohol withdrawal • Fever • Hypoxia • Drug Intoxication • Poisoning • Cardiopulmonary • Blood Loss • Metabolic • Tumours • Head Injury • Hyperthermia …and many more

6. 2 Basic Types of Seizures • Partial Start in a specific part of the brain Simple – no loss of consciousness Complex – loss of consciousness • Generalized Affect the whole brain (Absence/petit mal and tonic-clonic/grand mal) If a partial becomes a generalized, called a secondary generalized seizure

7. Signs and Symptoms of Impending Seizure Activity The person reports unusual symptoms including: • Smelling burnt toast • Feeling of spiders crawling on arms • Other odd odours, tastes or sensations • Auras

8. Terminology • Ictus The actual seizure activity • Postictal phase Post seizure

9. Confined to 1 brain lobe Person is fully aware but unable to control what is happening May have sudden intense feelings of fear, bliss or déjà vu May have aura, tingling/numbing sensation, see flashing lights Ictus phase usually short, which can make it difficult to identify true seizure activity Partial Seizure - Simple Symptoms correspond to brain lobe involved…

10. Frontal: movement of extremity or change in speech Parietal: tingling or feeling of warmth down one side of body Occipital: see flashing lights, fireballs, bright colours shooting across half visual field Temporal: memory, sound, smell, emotions*

11. Nursing Management of a Partial Seizure • Symptoms can be frightening to the conscious person • Offer reassurance this will pass • Assess immediate environment • Remember – a partial can be a warning sign for a stronger seizure

12. Partial Seizures - Complex • Affects an entire hemisphere; does not spread • Person can not respond to commands and will not remember event • May appear to be fully awake but with a blank stare • Automatisms – involuntary automatic behaviours such as chewing, lip smacking, hallucinations, odd behaviour (undressing or laughing uncontrollably) • Postictal phase may be minimal or nonexistent • Without warning, mall fall to the ground

13. Nursing Management • Same as partial seizures • If person falls to the ground, assess for injury, limb displacement • Behaviour may change if person thinks he is being restrained – do not restrain! • Use a calm and reassuring voice • If the person gets up and starts walking away, be prepared to follow

14. Generalized Seizures – Non Convulsive • Also called Absence or Petit Mal • May stop speak mid sentence, blank stare • Repeated lip smacking/eye blinking • Sudden brief lapse of consciousness • Will not remember event • Can be frequent but very short duration • Can normally continue with activities they were doing before seizure

15. Generalized – Atypical Absence/Petit Mal • Longer than generalized non convulsive • Up to 45 minutes • Longer recovery time • Loss of awareness not always complete

16. Generalized – Myoclonic Seizures • Sudden brief jerking of muscle group(s) lasting a few seconds • Affected areas can range from pinky finger to entire torso • Person may report soreness or cramping in area that was affected • Can affect bowel/bladder control • May lead to a tonic clonic seizure

17. Generalized – Atonic Seizures • Occurs as result of sudden loss of tone in postural muscles • Will drop to ground if standing/slump if in chair • Consciousness will be lost for a split second • Common injuries include ankles, knees, chin (site of impact)

18. Generalized – Convulsive Seziures • Tonic-Clonic/Grand Mal • Muscle spasm in which arms and legs flex • Alternates between contraction and relaxation • Can strike without warning • Initial tonic phase – falls, brief flexion of back followed by staring • Arms may be up in air, signalling tonic phase is about to start

19. Generalized – Convulsive Seizures Continued May scream or moan as air is pushed from lungs in a tight spasm Breathing could be impaired during this time/become cyanotic May lose bladder/bowel control Pupils may become dilated Muscular contractions start at 8 spasms per second and intensify Can appear very violent

20. Generalized – Convulsive Transition from Tonic to Clonic • As tonic evolves, periods of muscle relaxation will occur/lengthen until end of seizure • Postictal phase – will be very still with flaccid muscles • Excessive salvation can obstruct airway • Minutes to hours to regain consciousness • Exhaustion – may sleep for hours • Will not remember the episode • May have head ache, muscle aches, injuries

21. Nursing Management of a Generalized Seizure • Communicate throughout the episode, give reassurance it will be stopped and he won’t be left along • Protect ehad from banging on floor while convulsive movements occur • Loosen tight clothing • Try to turn into recovery position • Do not force anything in mouth • Check frequently after all seziure activity ends Status epileptics – lasts longer than 30 minutes – an emergency!

22. Suctioning Equipment • Suction machine • Suction tubing and oral sucker/younker • Sterile water • Personal protective equipment as needed

23. Suctioning Procedure • Attach tubing and younker, ensure good fit; turn on machine • Gently insert younker into mouth • Move to all parts of mouth as necessary • Clean suction tubing/younker by suctioning sterile water • Oral younker may be used on same person for 24hrs • Collection container good for 24hrs • Document – Amount, appearance, any trauma

24. Suctioning Reminders • Never use the younker to ‘pry’ open the mouth/teeth • Never use fingers to pry open mouth/teeth • If person starts biting, do not use the younker as a bit block • Talk to the person during the entire procedure