Adult 2

Seizures
Objectives:
Compare and contrast with regard to cause, assessment findings,
management and the significance of preventive health care.
Identify the clinical significance and related nursing implications of
the various tests and procedures used for diagnostic assessment.
Use the nursing process as a framework for care of patients with
disorder.
Demonstrate appropriate documentation and reporting.
Seizure Disorder
Seizures are an abnormal, sudden, excessive discharge of
electrical activity within the brain. (chaotic pattern that yields
abnormal activity and behavior)
Epilepsy is a disorder characterized by chronic seizure activity
and indicates brain or CNS irritation.
Causes include genetic factors, trauma, tumors, circulatory or
metabolic disorders, toxicity, and infections.
Status epilepticus involves a rapid succession of epileptic spasms
without intervals of consciousness; it is a potential complication
that can occur with any type of seizure, and brain damage may
result.
Seizure Disorder: Types of seizures
Generalized Seizures
Tonic-Clonic (grand mal or major motor)
Tonic-clonic seizures may begin with an aura.
The tonic phase involves the stiffening or rigidity of the muscles of
the arms and legs and usually lasts 10 to 20 seconds, followed by loss
of consciousness.
The clonic phase consists of hyperventilation and jerking of the
extremities and usually lasts about 30 seconds.
Full recovery from the seizure may take several hours.
Seizure Disorder: Types of seizures
Generalized Seizures
Absence (Petit Mal)
A brief seizure that lasts seconds, and the individual may or may not
lose consciousness.
No loss or change in muscle tone occurs.
Seizures may occur several times during a day.
The victim appears to be daydreaming.
This type of seizure is more common in children.

Myoclonic
Myoclonic seizures present as a brief generalized jerking or stiffening
of extremities.
The victim may fall to the ground from the seizure.

Atonic or Akinetic (Drop Attacks)

An atonic seizure is a sudden momentary loss of muscle tone.
The victim may fall to the ground as a result of the seizure.
Seizure Disorder: Types of seizures
Partial Seizures
Simple Partial
The simple partial seizure produces sensory symptoms accompanied by
motor symptoms that are localized or confined to a specific area.
The client remains conscious and may report an aura.

Partial Seizures
Complex Partial
The complex partial seizure is a psychomotor seizure.
The area of the brain most usually involved is the temporal lobe.
The seizure is characterized by periods of altered behavior of which
the client is not aware.
The client loses consciousness for a few seconds.
Seizure Disorder: Types of seizures
Miscellaneous
Febrile
Seizure threshold lowered by elevated temperature; only one seizure
per fever; common in 4% of population younger than age 5; occurs
when temperature is rapidly rising; lasts less than 5 minutes.
Generalized, transient, and non-progressive; doesnt generally result
in brain damage; EEG is normal after 2 weeks.

Status Epilepticus
Prolonged or frequent repetition of seizures without interruption;
results in anoxia and cardiac and respiratory arrest.
Consciousness not regained between seizures; lasts more than 30
minutes
Seizure Disorder
Assessment Findings:
1. Seizure history
2. Type of seizure
3. Occurrences before, during, and after the
seizure
4. Prodromal signs, such as mood changes,
irritability, and insomnia
5. Aura: Sensation that warns the client of the
impending seizure
6. Loss of motor activity or bowel and bladder
function or loss of consciousness during the
seizure
7. Occurrences during the postictal state, such
as headache, loss of consciousness,
sleepiness, and impaired speech or thinking
Seizure Disorder
Diagnostic Evaluation:
Accurate history of the seizure disorder
Electroencephalogram (EEG) may reveal abnormal
patterns of electrical activity
CT scanning or MRI may reveal that an underlying
pathology precipitated the seizures.
ABG levels may reveal acidosis, hypocapnia, or hypoxia.
CSF analysis may point to increase ICP or infection (for
example, meningitis) as the underlying pathology that
precipitated the seizures
Blood chemistry test results may reveal acidosis,
elevated prescription drug levels, hypoglycemia,
hyponatremia, toxic conditions (such as uremia), r toxic
substances (such as cocaine or heavy metals).
Resolution of the underlying condition
Removal of seizure foci in the temporal lobe and
pallidotomy or vagal nerve stimulator
Anticonvulsant drug therapy
Seizure Disorder
Treatment:
Resolution of the underlying condition
Supportive oxygen therapy and suctioning, as needed
(maintaining airway and preventing injury), until seizure
ends
Removal of seizure foci in the temporal lobe and
pallidotomy or vagal nerve stimulator
Cortical resection of epileptic focus
Corpus callosotomy
Anterior temporal lobe resection
Vagal nerve stimulator implant (focal seizures)
Transcranial magnetic stimulators.
Anticonvulsant drug therapy
Seizure Disorder
Treatment: Drug Therapy Options
Barbiturates: phenopbarbital (luminal)
Benzodiazepine: Diazepam (valium)
Deoxybarbiturate: primidone (mysoline)
Hydantoin: phenytoin (Dilantin)
Iminostillbene: carbamazepine (tegretol)
Miscellaneous drugs: felbamate (felbatol), gabapentin
(neurontin), lamotrigine (lamictal), valproic acid
(depakene)
Oxazolidinedione: trimethadione (tridione)
Succinimed: ethosuximide
Seizure Disorder:
Nursing Diagnosis:
Risk for Injury
Ineffective airway clearance
Risk for aspiration
Disturbed body image
Ineffective Coping and Deficient Knowledge
Nursing Planning and Goals:
The client will maintain a patent airway
The client will regain his normal LOC, cognition, and motor sensory function after and
between seizures.
The client will avoid preventable complications and injuries associated with seizures.
The client will develop strategies to effectively cope with health problems and body
image disturbances associated with seizures.
Nursing Evaluation:
The client maintains a patent airway
The client regains his normal LOC, cognition, and motor sensory function after and
between seizures.
The client avoids preventable complications and injuries associated with seizures.
The client develops strategies to effectively cope with health problems and body
image disturbances associated with seizures.
Seizure Disorder
Nursing Intervention:
Note the time and duration of the seizure.
Assess behavior at the onset of the seizure: If the client has experienced an
aura, if a change in facial expression occurred, or if a sound or cry occurred
from the client
If the client is standing or sitting, place the client on the floor and protect
the head and body.
Support the ABCsairway, breathing, and circulation.
Administer oxygen.
Prepare to suction secretions.
Turn the client to the side to allow secretions to drain while maintaining the
airway.
Prevent injury during the seizure.
Remain with the client.
Do not restrain the client.
Instruct the client about the importance of lifelong medication and the
need for follow-up determination of medication blood levels.
Instruct the client to avoid alcohol, excessive stress, fatigue, and strobe
lights.
References:

Springhouse review for NCLEX RN. Lippincott Williams and Wilkins

Lippincott Manual of Nursing Practice. Lippincott Williams and Wilkins
Saunders Comprehensive Nursing Review
For images taken from https://www.google.com.sa