Hehi Test 3 - Management Of Patients With Problems Of The Ns

Front 1

Epilepsy:

3 possible causes?

Back 1

a chronic disorder characterized by recurrent unprovoked seizure activity. May be caused by an abnormality in electrical neuronal activity, an imbalance of neurotransmitters (esp GABA), or a combination of both.

Front 2

Seizure:

2 possible causes:

etiology

Back 2

an abnormal, sudden, excessive, uncontrolled electrical discharge or neurons w/in the brain that may result in an alteration of consciousness, motor or sensory abilty, and/or behavior.

may be caused by: no known reason, pathologic condition of the brain (ie: tumor)

any condition or process that disrupts neuron cell stability can result in a seizure.

Front 3

Seizure threshold:

Back 3

tolerance point at which a seizure can be induced

Front 4

Focus:

Back 4

small area of the brain where a seizure originates

Front 5

Incidence of seizure is more common in?

Back 5

Developing countries - 100 in 100,00
(in US 50 in 100,000)

globally 1/4 of people receive no treatment for seizures

Front 6

Seizure incidence

Back 6

70% have no identified cause

May have a convulsion – but may not reoccur. – so its not a diagnosis of seizure or seizure disorder.

Front 7

Epilepsy incidence
age:
sex:
race:
type most common:
risk during lifetime:

Back 7

hightest < 2yo > 65
males > females
minorities > caucasians
50% have generalized (entire brain)
10% risk during lifetime

Front 8

3 Mechanisms of action for seizures

Back 8

A. Suppression of sodium channel activation
B. Inhibition of T-type calcium channels
C. GABA potentiation

Front 9

Increase in seizures is affected by a negative feedback loop. How?

Back 9

damaged cells increase the risk for seizure -> subsequent seizure results in more damaged cells..and so on.

Front 10

risk of epilepsy
__ children with MR
__ children w/ CP
__ children w/ both MR and CP
__ Alzheimer patients
__ stroke patients

Back 10

MR 10%
CP 10%
both 50%
10% Alz
22% stroke

2.4% of children w/ father; 8.7% w/mother

Front 11

Preventable risk factors for seizures

Back 11

dec sleep
emotional distress
ETOH w/drawl
excess caffeine
fever
hypoxia

Front 12

Most common KNOWN cause of seizure?

Back 12

head trauma

Front 13

Course of a seizure

Back 13

1) Preictal
2) Ictal 1 to 3min.
3) Postictal
4) Interictal

Front 14

Preictal:

-Autonomic S&S:
-Cognitive S&S:
-Affective S&S:
-Automatism S&S:

Back 14

what happens before a seizure- very specific to each person, person will learn to recognize what happens just before occurrence.

Autonomic - "fullness" in stomach, blushing, changes in respiration

Cognitive - deja vu, jamais vu ("ive never been here before" feeling), dreamy states

Affective - fear, panic, depression, elation

Automatism - (most assoc w/ partial complex seizures) lip smacking, chewing, rubbing

Front 15

Postictal

common states:

Back 15

when LOC occurs, takes a while for person to reorient - depen on person many who have seizure dont have this phase.

common states: slurred speech, confusion, inability to follow commands, lethargy

Front 16

Classification of seizures
Partial 2 types

Generalized 5 types

Back 16

- Partial
Simple
Complex

- Generalized 5 types
Absence (petit-mal)
Tonic-clonic (grand-mal)
Atonic
Myoclonic
Febrile

Front 17

Partial seizure:

Back 17

Partial: begin in one part of cerebral hemisphere, can evolve into gen. tonic-clonic, tonic, or clonic, most ofent in adults, less responsive to treatment

Front 18

Partial seizures - characteristics of simple vs complex seizures

Back 18

Simple: *no LOC (postictal state), visual sensations, feeling of doom, arrest of speech

Complex: *LOC, may progress from simple partial, *"automatic" behaviors (client not aware - lip smacking, patting, etc)

Front 19

Generalized absence seizures (petit-mal)

Back 19

Brief loss of consciousness
Unresponsiveness
no motor signs - may stare off into space
no postictal phase b/c seizure is so brief

Front 20

Generalized Tonic-clonic (grand-mal)

Back 20

- brief LOC
- Tonic phase - rigidity of all muscles (diaphragm - cant breathe)
- Clonic phase - rhythmic jerking of muscles (incontinence, tongue biting)
- postictal phase

(may fluctuate back and forth btwn tonic and clonic)

Front 21

Generalized Atonic

Back 21

- brief loss of tone in one or more muscles, "drop attacks"
- no postictal phase
- few seconds of consciousness impairment

Front 22

Generalized Myoclonic

Back 22

- no or a few seconds impairment of consciousness
- brief jerking of one or more muscles
- no postictal phase

Front 23

Status Epilepticus:

Therapeutic management:

Back 23

Generalized convulsive
unrelenting tonic-clonic lasts more then 5 min OR consecutive w/o recovery (some define as 30min)
**medical emergency can result in permanent neurologic injury or death

TM:
-airway and O2
-IV access
-labs: electrolytes, ABGs and toxicology
-**IV Benzodiazapines until seizure has stopped.
-Concurrent IV anticonvulsants
-search for the cause

Front 24

What medication will be given IV to stop a seizure?
How will it be given? Why?

Back 24

Benzodiazapines - acts quickly
Give by slow IV push to activate GABA receptors to calm everything down.

Front 25

Therapeutic mangagement - What information should be gathered r/t History and System Assessment

Back 25

1) Perinatal, childhood, family
2) CNS trauma, infections, or tumors
3) Recent illness, meds, exposure, etc
4) Detailed seizure description
aura, precipitators, behaviors, length, postictal phase?, incontinence, frequency and iterval

Front 26

Diagnostic tests are used to identify what?

what are some diagnostic tests that are done?

Back 26

Location and pathway of seizures

CT and/ or MRI
Labs: SMA-6, BUN, toxicology, ABGs
EEG

Front 27

Antiseizure medication - sodium channel suppression works to

Back 27

medication binds to inactivate sodium channels -> prolonged inactivation
this delays return of neurons to active state, which dec the neurons ability to fire rapidly.

Front 28

Seizure precautions purpose:

how is this handled at the bedside?

Back 28

identification of risk prevention of injury

side rails up, padded
O2 at bedside
suction equipment at bedside
NEVER use oral thermometer
have IV access

Front 29

During a seizure what should be done?

Back 29

-turn on side
-DO NOT restrain
-protect from hitting body parts
-nothing in mouth
-observation
-reassurance

Front 30

Post seizure what should be done?

Back 30

-airway clearance
-airway maintenace and O2
-assessment for injury
-monitoring of LOC

Front 31

Education for the the individual and family should include?

Back 31

-medication regime adherence
-identification card or bracelet
-safety considerations (driving)
-lifestyle changes and psychosocial issues (change of job)
-support organizations

Front 32

At risk diagnosis medical priority for seizure patients?

Back 32

-Alteration in fluid volume: deficit
-Asperation
-Airway clearance
-Alt gas exchange