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ALTERATION OF THE CENTRAL NERVOUS SYSTEM

Learn about the non-surgical and pharmacological approaches for the treatment and management of seizures, including drug therapy, nursing interventions, and surgical options.

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ALTERATION OF THE CENTRAL NERVOUS SYSTEM

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  1. ALTERATION OF THE CENTRAL NERVOUS SYSTEM TREATMENT OF SEIZURES

  2. Nonsurgical Management • Antiepileptic drugs (AEDs) • Importance of compliance • Health teaching

  3. Drug Therapy • Evaluate most current blood level of medication, if appropriate. • Be aware of drug-drug and drug-food interactions. • Maintain therapeutic blood levels for maximal effectiveness.

  4. Acute Seizure Management • Lorazepam (Ativan) • Diazepam (Valium) • Diastat (Valium rectal gel) • IV phenytoin or fosphenytoin (Dilantin)

  5. MEDICATIONS & NURSING INTERVENTIONS Dilantin (phenytoin) Therapeutic drug level 5-20 mcg/mL • Cannot be withdrawn suddenly • Watch for toxicity (nystagmus, ataxia, dysarthria, encephalopathy) • Do not combine with warfarin (Coumadin) SIDE EFFECTS: • Lethargy, abnormal movements, Gingival hyperplasia, mental confusion, cognitive changes

  6. MEDICATIONS & NURSING INTERVENTIONS • Carbamazepine (Tegretol): expensive, monitor h/a, diplopia, CBC • Valproic acid (Depakene): effects liver, causes tremors, alopecia, N/V. -Monitor CBC, PT, PTT, AST • Gabapentin (Neurotonin): wgt gain monitor dizziness, ataxia,fatigue

  7. MEDICATIONS & NURSING IMPLICATIONS Clonazepam (Klonopin): drowsiness, palpitations, monitor liver function Levetiracetam (Keppra): somnolence, monitor renal function Oxcarbazepine (Trileptal): tremor, loss of coordination, monitor for hyponatremia

  8. MEDICATIONS & NURSING IMPLICATIONS • Phenobarbitol (Luminal): overdose can be fatal; monitor for sedation, cognitive impairment • Topiramate (Topamax): monitor for fatigue, anorexia, depression, ataxia

  9. Status Epilepticus • Medical emergency • Prolonged seizures or repeated seizures over the course of 30 minutes • Establish an airway • ABGs • IV push lorazepam, diazepam; rectal diazepam • Loading dose IV phenytoin

  10. Surgical Management • Vagal nerve stimulation (VNS) • Conventional surgical procedures • Anterior temporal lobe resection • Partial corpus callosotomy

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