CNS/Neuro

Epilepsy is

a term that describes an individual with long term seizure disorder

Epilepsy is characterized by

Sudden abnormal hyperscynchronous firing of neurons

There is how many classifications of epilepsy and what are they?

Idiopathic: unprovoked

Attributable or provoked

Causes of provoked epilepsy/

• Development defects

• Metabolic disease

• Birth injury

• Fever

• Alcohol or other drug effects

Treatment for epilepsy

Just depends on whether it is idiopathic or attributable

Can we do surgery for epilepsy?

Yeah, sometimes if drugs are working well then we can do a surgical intervention to remove the causative agent such as a tumor or place a VNS (vagal nerve stimulator)

What is status epilepticus?

It is life threatening emergency seizure

How is status epilepticus characterized?

Generalized tonic-clonic convulsions lasting for several minutes

Tonic-clonic convulsions occurring which consciousness sis not regained

Seizures that last 30 minutes on EEG

There is high risk of what status epilepticus?

Permanent brain damage or death if treatment is not given

What are causes of status epilepticus?

Stopping medications abruptly

Brain trauma or tumors

Systemic or CNS infections

Alcohol withdrawal

Drug overdose

What is the treatment for status epilepticus

Pharmacological interventions

Environmental safety

CVA are also known as

strokes

What is a stroke?

Sudden loss of function resulting from a disruption of the blood supply to a part of the brain

Ischemic stroke

Most common

Thrombus or embolism or clot that is lodged in the artery or vein

Hemorrhagic stroke

More deadly

Aneurysms

Caused by bleeding in the brain tissues, the ventricles or subarachnoid space

Spontaneous rupture of small vessels related to hypertension

ICP increases blood

What is an ischemic stroke?

A stroke caused by a blocked blood vessel (clot) that stops blood flow to the brain.

What happens in an ischemic stroke?

No blood → no oxygen → brain cells die.

What is a hemorrhagic stroke?

A stroke caused by a burst blood vessel that bleeds into the brain.

What is the main problem in a hemorrhagic stroke?

Bleeding increases pressure in the brain (ICP) and damages tissue.

What usually causes a hemorrhagic stroke?

High blood pressure, aneurysm, or AVM.

What lifestyle changes help prevent stroke?

Healthy diet, exercise, no smoking, healthy weight control.

Barbiturates Nursing Implications

• Avoid sudden stoppage as may cause status epilepticus

• Monitor for safety & implement SZ precautions

• Assess and monitor IV status if EMERGENT

• Monitor for reactions with other CNS depressants

• Long term therapy = Requires a loading dose for 6 hours and then can transition to maintenance

• Requires serum therapeutic drug monitoring

Benzdiazepines drugs end with what?

diazempam, lorazepam, clonazepam

end in “pam'“

Benzdiazepines Use

Adjutant therapy: Used as antidepressants, antieplipetics, skeletal muscle relaxants, or sedative

Benzdiazepines S/E

• respiratory depression

• bradycardia

• hypotension

• disorientation

• sedation

• confusion

Benzdiazepines Nursing implications

• Understand goals of treatment: SZ prevention vs SZ elimination

• Monitor for safety & implement SZ precautions

• Assess and monitor IV status

• Monitor for reactions with other CNS depressants

levetiracetam (keppra) S/E

anti- seizure

drowsiness, fatigue, depression

levetiracetam (keppra) nursing implications

monitor for CNS depression

DO NOT CRUSH OR SPLIT ER TABLETS

lacosamide (vimpat)

anti-seizure

decrease sodium channel

lacosamide (vimpat) S/E

prolonged PR interval

SI

somnolence

Ataxia

lacosamide (vimpat) nursing considerations

monitor mental status

S/sx of depression

Monitor EKG