Seizure

1. Seizure Fion Kung

2. Objectives • Define seizure • Types of seizure • Understand current treatmentand prevention • Understand the diagnostic test • Nursing diagnosis, outcome and intervention • NCLEX style questions

3. Epidemiology • According to the Centers for Disease Control and Prevention • Epilepsy is the fourth most common neurological disorder in the U.S. after migraine, stroke, and Alzheimer's disease. • Ten percent of the American population will experience a seizure in their lifetime. • Epilepsy affects 2.2 million Americans • Epilepsy affects 65 million people worldwide.

4. What causes seizures? • 50-70% of all cases of epilepsy is of unknown origin • Some known causes: • Birth trauma • Infectious diseases • Ingestion of toxins • Brain tumors • Inherited disorders • Cerebrovascular accident

5. What is a seizure? • A single sudden temporary event that consists of uncontrolled, electrical neuronal discharge in the brain • It interrupts the normal function in the brain • When a person has recurrent seizures, they are called epilepsy • Affect variety of mental and physical functions • Two categorized • Partial (Focal) • Generalized

6. Types of Generalized seizures • Absence seizures • Brief alteration in consciousness • Mild increase or decrease in muscular tone • Blinking or rolling eyes, a blank stare, slight mouth movements • Usually last 5-30 seconds

7. Types of Generalized seizures • Tonic-clonic seizures • Loss of consciousness • Stertorous respirations • Dilated pupils, hypertension, fast heart rate • Tonic phase • Clonic phase

8. status epilepticus (Fitzsimons, 2011) • Severe seizure activity known as “status epilepticus” and is a medical emergency characterized by either continuous seizures lasting at least 5 minutes or 2 or more separate seizures where recovery is incomplete. • Epilepticuscan culminate in severe neurological injury due to cerebral hypoxia and death can occur from respiratory and/or cardiovascular failure.

9. Common Diagnosis tests • Electroencephalography (EEG) • Computed tomography scan (CT) • Magnetic resonance spectroscopy (MRS) • Magnetic resonance imaging (MRI)

10. Medical Interventions (Rebecca, 2009) • Antiepileptic Drugs (AEDs) • Dilantin (phenytoin) • Phenobarbital • Tegretol (carbamazepine) • Surgery • Ketogenic diet • Vagus nerve stimulation therapy

11. Nursing Diagnosis (Ackley 2009) • Acute confusion related to postseizure state • Social isolation related to unpredictability of seizures, community-imposed stigma • Risk for ineffective airway clearance • Risk for falls • Risk for powerlessness • Risk for trauma • Readiness for enhanced knowledge • Readiness for enhanced self-care

12. Nursing outcome (Ackley 2009) • Rest and maintain functional capacity • Remain free of falls • Remain free of injuries • Prevent seizure • Monitor level of self-care

13. Nursing Intervention (Ackley 2009) • Keep the bed in low position with siderails up, and use the padded siderails • Monitor the vital signs, behaviors, consciousness • Give the antiepileptic drugs as ordered • Reinforce learning through educational follow-up • Use combination of teaching methods • Show respect for the person and support the person’s awareness.

14. Prevention • Getting enough sleep • Controlling stress • Take the anticonvulsant medications daily. Do not stop suddenly • Avoid brain injury • Avoid fall

15. During Seizure • Move things out of the way so patient won't injure him or herself. • Loosen any tight clothing around the neck. • Put a pillow or something soft under the head. • Lay him or her on one side. • Time the seizure • Don't put anything in the mouth.  • Don't try to hold the child down.  • Don't give mouth-to-mouth resuscitation until the seizure is over

16. After Seizure • Allow the patient to rest • Check for the vital signs, consciousness • Conduct post seizure evaluation • Check if it was the first seizure • Check what was the patient doing prior to the seizure • Check for other illness • Review current medications

17. Case Scenario • CC: “Patient admitted to ER with loss of consciousness related to seizure” • PMH: hypertension • FMH: Father has stroke and died on his 68. mother is healthy. • Allergies: aspirin

18. Medical Interventions • Phenytoin (Dilantin) 3 times per day • Therapeutic effect: reduction of seizure activity. • Side effects: suicidal thoughts, Stevens-Johnson Syndromes, diplopia, dizziness, headache, confusion, hypotension (Davis’s Drug Guide (2012)

19. Nursing Diagnosis & Outcome • Nursing Diagnosis: • Risk for falls • Risk for trauma • Acute confusion related to postseizure state • Goal/Outcome: • Remain free of falls • Remain free of injuries • Rest and maintain functional capacity

20. Nursing intervention • Keep the bed in very low position with siderails up, and use the padded siderails • Monitor the vital signs, behaviors, consciousness • Give the antiepileptic drugs as ordered • Call light/personal assistance systems in reach • Provide quiet place for patient to rest • Assess the patient’s behavior and cognition systematically and continually throughout the day ad night

21. NCLEX style Question 1 • Generalized seizure is happening in only one part of the brain. A. True B. False

22. NCLEX style Question 2 • What of the following does not prevent seizures? A. Get enough sleep B. Controlling stress C. stop the anticonvulsant medications when there is no seizure symptom present D. prevent fall

23. NCLEX style Question 3 • The nurse answers a call bell and finds a frightened mother whose child, the patient, is having a seizure. Which of these actions should the nurse take? A. The nurse should insert a padded tongue blade in the patient’s mouth to prevent the child from swallowing or choking on his tongue. B. The nurse should help the mother restrain the child to prevent him from injuring himself. C. The nurse should call the operator to page for seizure assistance. D. The nurse should clear the area and position the client safely. 

24. NCLEX style Question 4 • The nurse is caring for the male client who begins to experience seizure activity while in bed. Which of the following actions by the nurse would be contraindicated?A. Loosening restrictive clothingB. Restraining the client’s limbsC. Removing the pillow and raising padded side railsD. Positioning the client to side, if possible, with the head flexed forward 

25. NCLEX style Question 5 • The most important responsibility of the nurse when a patient has a seizure is to: A. Maintain the head-tilt-chin lift method. B. Provide oxygen immediately C. Prevent injury of the patient D. Prevent status epilepticus

26. References • Silvestri, L. A. (2008). Comprehensive review for the nclex-rn examination . (4 ed.). St. Louis, MO: Saunders Elsevier. (Silvestri, 2008) • Leone, M. (2011). Treatment of first tonic-clonic seizure does not affect mortality: long-term following a randomised clinical trial. J NeurolNeurosurg Psychiatry. (Leone, 2011) • Faught, E., Duh, M., Weiner, J., Guerin, A., & Cunnington, M. (2008). Nonadherence to antiepileptic drugs and increased mortality: findings from the ransom study Neurology, 11(71(20):1572), (Faught , Duh, Weiner, Guerin & Cunnington, 2008) • Ackley, B. J., & Ladwig, G. B. (2010). Mosb'ys guide to nursing diagnosis . (5th ed.). Mosby. (Ackley & Ladwig, 2010) • Mary, F., (n.d). Review Article: Evidence-based models of care for people with epilepsy. Epilepsy And Behavior, 231-6. doi:10.1016/j.yebeh.2011.10.019 • Rebecca, E., Review Article: care plan for people with epilepsy. Epilepsy,211-1. doi:8.1621/j.yebeh.2009.10.019 • Ackley K, S., Epilepsy data.About Epilepsy. N.p., n.d. Web. 13 Nov. 2012.  • Davis’s Drug Guide (2012) In nursing central [software] retrieved from PDA