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38 Cards in this Set
- Front
- Back
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How do seizures and convulsions differ from one another, and what is the foci/focus of a seizure? |
seizure: disruption of neural electrical impulses convulsion: involuntary contractions of body which are manifestations of a seizure foci/focus: region of the brain in which the seizure originates |
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How does the incidence of a first seizure incidence relate to age? |
300k people have first incidence each year 120k are < 18 75k to 100k are febrile seizure in kids < 5 |
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How does the risk of epilepsy correlate to age, sex, & race? |
age: < 2 yo to > 65 yo are highest sex: males > females race: racial minorities > causasian |
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How does epilepsy risk change with relation to intellectual disability, CP, alzheimers, stroke, and paternal/maternal inheritance? |
KIDS: intellectual disability: 25% of children CP: 10% of children intellectual disability + CP: 50% ADULTS: Alzheimer: 10% stroke: 22% INHERITED: paternal: 2.4% maternal: 8.7% |
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What are some preventable risk factors for seizures? |
sleep deprivation emotional distress EtOH withdrawal Excess caffeine Fever Hypoxia |
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How does the movement of sodium into a cell change the cell from activated to inactivated? |
Na+ channel in activated state + Na+ influx = neuron action potential propagated ==> Na+ channel inactivated |
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What happens when Ca2+ flows into a the T-channel of a cell, and in what part of the brain can we find neurons with T-currents large enough to cause an action potential to fire? |
what happens: Electrical current is generated where in the brain: hypothalamus |
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What effect do seizures have on neurons and how is the risk of seizures impacted by this effect? |
effect: seizures increase damage to cells risk: increased damage = increased risk of seizures = self-propagating cycle |
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what two events need to happen concurrently in order for a seizure to be initiated? |
1) high-frequency bursts of action potentials, and 2) hypersynchronization of a neuronal population |
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What two things need to happen for "high-frequency bursts of action potentials" to occur? |
1. influx of Ca++ causing long-lasting depolarization 2. opening of voltage-dependent Na+ channels = high frequency burst of action potentials |
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What does hypersynchronization mean with relation to neurons? |
a large electrical impulse generated in a focus of brain tissue which excites other nearby neurons |
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How are potassium, calcium, and, excitatory amino acid receptors (NMDA subtype) affected by repeated seizures? |
potassium: increased extracellular K+ calcium: accumulation of pre-synaptic Ca++ amino acid receptor: repeatedly activated by depolarization * amino acid activation also causes more Ca++ influx * |
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Describe and order the phases of a seizure: postictal, ictal, preictal, interictal? |
preictal = state immediately preceding seizure ictal = physiologic state of seizure postictal = state shortly after the seizure interictal = state between seizures |
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What are affective and involuntary preictal sx? |
affective: fear, panic, depression, elation involuntary: lip smacking, chewing, rubbing, other "odd behavior" |
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What are some autonomic and cognitive sensations correlated with preictal auras? |
autonomic: fullness of stomach, blushing, ∆ in respiration cognitive: deja vu, jamais vu, dream-like state |
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What are sx correlated with postictal states? |
slurred speech confusion inability to follow commands lethargy |
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what is the difference in cause between an unprovoked and a provoked seizure; which is primary and which is secondary? |
unprovoked cause: idiopathic provoked: precipitated by an event i.e. febrile, metabolic condition, CNS insult primary/secondary: unprovoked/provoked |
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What are the two classifications of partial seizures and how are they different from one another with respect to consciousness and postictal states? |
classifications: simple & complex ------------------------------------------------- simple: aware & consciousness and no postictal state complex: impaired consciousness (automatic behavior seen sometimes) & postictal state is present *simple partial may progress to complex partial* |
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What are characteristics of simple partial seizures with respect to visual, affective, and speech? |
visual: see bright lights or hallucinations affective: feelings of doom speech: cannot speak |
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What are the sx of a generalized petit mal or absence seizures and is there a postictal phase? |
sx: non-convulsive, brief loss of consciousness, unresponsiveness, no motor sx postictal phase: none |
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What are the general sx of a generalized tonic-clonic/grand mal seizure, what are sx specific to tonic and clonic phases, and is there a postictal phase? |
general sx: loss of consciousness tonic sx: rigidity of muscles clonic sx: rhythmic jerking of muscles, possible incontinence & tongue biting postictal phase: present |
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What are the sx of a generalized atonic seizure? |
few seconds of impaired consciousness brief loss in tone of one or more muscles = drop attacks usually no postictal phase but there might be confusion |
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what are the sx of myoclonic seizures? |
few seconds or no impaired consciousness brief jerking of one or more muscles usually no postictal phase but there might be confusion |
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What sx constitute status epilepticus? |
unrelenting tonic-clonic > 5 min OR consecutive seizures w/o recovery ≈ 30 min *medical emergency* |
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How do we manage status epilepticus? |
airway & O2 IV access Labs = electrolytes, ABG, tox *IV benzo until seizure is stopped* concurrent IV anticonvulsants tx of cause & effects |
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what is SUDEP, how might it be prevented, and what is the cause? |
what it is: sudden unexpected death in epilepsy prevention: prevention of seizures and awareness of night time seizures cause: unknown |
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What are some descriptions of the seizure experience we are going to be looking for when doing an assessment for seizures? |
aura precipitators behaviors length is there a postictal phase incontinence frequency & interval |
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what are some diagnostic tests and labs we'll do for the physical exam? |
test: CT and/or MRI labs: SMA-6, toxicology, ABG, EEG * SMA-6 = sequential multiple analysis = sodium, potassium, chloride, glucose, blood urea nitrogen, and carbon dioxide* |
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what is the MOA of sodium channel suppression anticonvulsant meds? |
binds to inactivated sodium channels which prolongs channel inactivation delays return of neurons to active state & inhibits the ability of neurons to fire |
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what is the goal of tx with regard to inhibition/antagonism or potentiation of T-type Ca++ channels, glutamate, and GABA? |
T-type Ca++ channels: inhibit/antagonize GABA: potentiate glutamate: antagonize/inhibit |
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what is Ezogabine (Potiga) used to tx, what is the MOA, what are the benefits, and what are the adverse effects? |
tx: partial seizures MOA: potentiates potassium efflux which slows the repetitive firing of neurons during seizures benefits: few drug-drug interactions adverse: psychotic sx, vision loss, potentially going to be scheduled by FDA |
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what are seizure precautions taken by the inpatient nurse? |
never use an oral thermometer side rails up side rails padded O2 at bedside suction at bedside IV access observe and reassure |
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What are actions taken by the nurse during a seizure? |
turn pt on side DO NOT RESTRAIN protect from hitting body parts nothing in mouth observe and reassure |
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what are the actions taken by the nurse post-seizure? |
airway clearance airway maintenance & O2 assess for injury monitor LOC |
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what are non-surgical and surgical interventions for seizures? |
non-surgical: ID triggers, rest & sleep, change diet surgical: vagus nerve implant, neurosurgery |
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What are some of the nursing education points we will provide to individuals and families? |
importance of med adherence ID cards/bracelets lifestyle changes support organizations |
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What are priority at-risk nursing diagnoses for seizures? |
aspiration airway clearance alteration in gas exchange volume deficit |
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What are the psychosocial related risks that may occur as a result of seizures (i.e. coping, feelings, socialization, behavior)? |
anxiety ineffective coping self-concept disturbance social isolation non-compliance with tx violence altered though process |
