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34 Cards in this Set
- Front
- Back
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Seizure phases
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-Prodromal phase
-Aural phase -Ictal phase -Postictal phase |
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Prodromal phase
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-Precedes seizure
-No warning signs |
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Aural phase
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-Sensory warning
-Light/color precedes seizure |
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Ictal phase
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-Full seizure
-Active stage |
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Postictal phase
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-Rest & recovery
-(need to reoriente/reassure pt) |
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Seizure classes
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-Generalized
-Partial |
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7 Types of generalized seizures
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-Tonic-clonic
-Tonic -Atonic -Clonic -Myoclonic -Typical (petit-mal) -Atypical |
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Tonic-clonic seizure
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-"Grand mal"
-Loss of consciousness -Falling to the ground -Stiffening of the body (tonic) -Jerking of extremities (clonic) -Muscle soreness -May sleep for hours -May not feel "normal" for days -No memory of seizure |
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Tonic seizure
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-Muscle tone is increased
-Patients often fall -Most often during sleep - < 20 sec -Affects both sides of the body |
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Atonic seizure
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-Loss of muscle tone
-Loss of consciousness -"Drop attacks" -Patient falls - < 15 sec |
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Clonic seizure
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-Loss of consciousness
-Sudden loss of muscle tone |
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Myoclonic seizure
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-Very brief jerks
-Only a second or two -Alone or in clusters -Like "hiccups" |
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Typical (petit-mal) seizure
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-Usually only in children
-Staring spells -Can occur up to 100 x's/day if untreated -Precipitated by hyperventilation & flashing lights -Usually develops into another type of seizure |
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Atypical seizure
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-Staring spell
-Brief warnings -Peculiar behavior -Postictal confusion |
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2 types of partial seizures
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-Simple partial seizure
-Complex partial seizure |
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Simple partial seizure
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-No loss of consciousness
- < 1 minute -Focal in nature |
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Complex partial seizure
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-No loss of consciousness
- > 1 minute -Lip smacking -Postictal confusion |
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Status epilepticus
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-Constant seizure or occurance in rapid succession w/out return to consciousness
-Neuro emergency -Any type of seizure -Permanent brain damage may result -Tonic-clonic status epilepticus MOST DANGEROUS |
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What action do you take when a patient seizes?
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-Time the seizure
-Usually over w/in 1 minute -If doesn't stop, monitor airway b/c pt not breathing properly -Emergency: Ativan IV push -NOTIFY PHYSICIAN |
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Important question in health hx assessment
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Has there been any drug abuse?
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Diagnostic studies
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-EEG, usually monitor 24-48 hours
-CBC -Serum chemistries for Rx therapeutic levels -Liver & kidney function -UA to rule out metabolic disorders & presence of drugs -Electrolytes -Cardiac workup |
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New onset seizure diagnostic
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-CT & MRI to rule out structural lesion
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CNS SEs of antiseizure drugs
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-Diplopia (double vision)
-Drowsiness -Ataxia -Mental slowing |
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Why does a pt not discontinue antiseizure drug abruptly?
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By stopping abruptly, it can precipitate seizures
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SEs of antiseizure drugs OUTSIDE of CNS
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-Rashes
-Hyperplasia of gingiva (especially w/ Dilantin) -Blood dyscrasias (unspecified disorder) -Effects on liver & kidneys |
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What are you checking for in a neurologic assessment?
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-Nystagmus
-Hand & gait coordination -Cognitive function -General alertness |
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Primary drugs for tonic-clonic & partial seizures
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-phenytoin (Dilantin)
-Tegretol -Depakote -Neurontin -Keppra |
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Primary drugs for typical/atypical, myoclonic & atonic seizures
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-Depakote
-Zarontin -Klonopin |
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Primary drugs for status epilepticus
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-Ativan (short-term/emergency)
-Valium *Must be followed w/ long-acting drugs |
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Why is phenytoin problematic for some older adults?
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Compromised liver function
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Questions to ask regarding compliance
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-What medication are you on?
-How often? -Last time blood level was drawn? |
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Possible conditions leading to seizures
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-Metabolic alkalosis/acidosis
-Hyperkalemia -Hypoglycemia -Dehydration -Water intoxication |
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Assessments to watch for in postictal phase
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-Bitten tongue
-Soft tissue damage -Cyanosis -Abnormal RR -Apnea -Absent or abnormal breath sounds -Airway occlusion |
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Nursing Diagnoses
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-Ineffective breathing pattern
-*Risk for injury* -Ineffective coping -*Ineffective therapeutic regimen management* -Risk for falls |
