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8/2/2019 Tonic - Clonic Seizures Marco, Carmela Dawn M.
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Tonic Clonic SeizuresMarco, Carmela Dawn M.
BSN II - 3
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Tonic Clonic Seizures Also known as Grand mal Seizure Generalized seizures consisting of
four stages:1. Prodromal Period2. Aura3. Tonic- Clonic Stage4.
Postictal Stage Not all four stages occur with every
seizure
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Tonic Clonic Seizures
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Four Stages:I. Prodromal Period1. Prodromal Period Manifestations:
Drowsiness
DizzinessMalaiseLack of coordinationTension
Parents may observe simply that the child is not himselfSchool- Age ChildrenMay able to predict from vague preliminary feelings whenthey are going to have seizure
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Four Stages:II. Aura2. Aura May reflect the portion of the brain in which
seizure originates Manifestations:
Smelling unpleasant odors Denotes activity in medial portion of the temporal lobe
Seeing flashing lights Suggests occipital area
Repeated hallucinations Arise from the temporal lobe
Numbness of the an extremity
Relates to the opposite parietal lobe
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Cheshire- cat grin Relates to the frontal lobe
Young Children Unable to describe or understand an aura
Expected Actions During Onset: May scream in fright Run to their parents
Note exactly what symptoms the child experiencesduring the onset It may help to localize the involvement of brain portion
Four Stages:II. Aura
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3. Tonic Clonic Stage Tonic Stage
It lasts only about 20 seconds Manifestations:
All muscles of the body contract Child falls on the ground Extremities stiffen Face distorts May experience hypoxia and become cyanotic
Due to contraction of respiratory muscles
Four Stages:III. Tonic Clonic Stage
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Collection of saliva in the mouth Due to contraction of the throat and prevent
swallowing Child might bite the tongue
Due to contraction of the jaw Guttural Cry
Due to initially contraction of the chest muscle and airpushed through the glottis
Clonic Stage It usually lasts about 20-30 seconds Manifestations:
Quick, Jerky Motions Muscles of the bod ra idl contract and relax
Four Stages:III. Tonic Clonic Stage
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May blow bubbles or foamy saliva Incontinent of stool and urine
If the child bite his tongue when his jaw spasmed shut Presence of blood in the mouth
Four Stages:III. Tonic Clonic Stage
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Tonic Clonic Seizures Seizures may occur at night When the child wake up in the morning
expect: Blood on the pillow
Due to bitten tongue
Bed wet with urine Persistent Bedwetting
Considered possibility of nocturnal seizures
Abnormal EEG patterns
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Therapeutic Management: Daily administration of Anticonvulsant
Valproic Acid (Depakene) Care should be taken when giving this medication to very
young children and clients with liver disorders Due to hepatoxicity for possible adverse reaction
Carbamazepine (Tergetol)
Used to control this type of seizure that have not respondedto other anticonvulsant therapy Avoid drinking grapefruit juice
May cause toxicity
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Therapeutic Management: Phenobarbital
Inexpensive anticonvulsant that lowers the seizure threshold Drowsiness and Sleepiness
Phenytoin Sodium (Dilantin) To prevent this type of seizure Non-toxic side effects
Painless Hypertrophy of the gums Unless the gum hypertrophy is extensive, it is not sufficient reason
to discontinue the medication.
Prescription of Ketogenic Diet High in fat and low in proteinand carbohydrate To causes an increased level of ketones
Decrease tonic- clonic seizure activity
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