SEIZUREFion Kung

OBJECTIVES Define seizure Types of seizure Understand current treatment and prevention Understand the diagnostic test Nursing diagnosis, outcome and intervention NCLEX style questions

EPIDEMIOLOGY According to the Centers for Disease

Control and PreventionEpilepsy 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 AmericansEpilepsy affects 65 million people worldwide. 

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

WHAT CAUSES SEIZURES?

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

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

TYPES OF GENERALIZED SEIZURES

Tonic-clonic seizures Loss of

consciousness Stertorous

respirations Dilated pupils,

hypertension, fast heart rate

Tonic phase Clonic phase

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.

Epilepticus can culminate in severe neurological injury due to cerebral hypoxia and death can occur from respiratory and/or cardiovascular failure.

STATUS EPILEPTICUS (FITZSIMONS, 2011)

COMMON DIAGNOSIS TESTS

Electroencephalography (EEG) Computed tomography scan (CT) Magnetic resonance spectroscopy (MRS) Magnetic resonance imaging (MRI)

MEDICAL INTERVENTIONS (REBECCA, 2009) Antiepileptic Drugs (AEDs)

Dilantin (phenytoin) Phenobarbital Tegretol (carbamazepine)

Surgery Ketogenic diet Vagus nerve stimulation therapy

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

NURSING OUTCOME (ACKLEY 2009)

Rest and maintain functional capacity Remain free of falls Remain free of injuries Prevent seizure Monitor level of self-care

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.

PREVENTION Getting enough sleep Controlling stress Take the anticonvulsant medications daily. Do

not stop suddenly Avoid brain injury Avoid fall

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

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

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

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)

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

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

NCLEX STYLE QUESTION 1 Generalized seizure is happening in only one

part of the brain.

A. True

B. False

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

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. 

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 

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

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 Neurol Neurosurg 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