ICR: Exemplar: Seizures

what is a seizure?

Periods of abnormal electrical discharges in the brain that may cause involuntary movement and/or behavior and sensory alterations

what is focal seizure?

limited area in the brain

What does aware mean with a focal seizure?

no loss of consiousness

what does impaired awareness with focal seizures?

can affect memory, awareness, etc

what is a generalized seizure?

both hemisphere of brain, but it includes many stubtypes like absence and tonic-clonic

what are the stages of a seizure?

• aura stage

• tonic stage

• clonic stage

• postictal stage

what’s the aura stage?

early warning signs

what are some adverse outcomes for aura stage?

• hallucinations

• dizzy

• numbness

• confusion

• distorted emotions

what’s the tonic phase?

lose consciousness and sharp muscle tone

what are some adverse outcomes for tonic phase?

• back arched

• incontinence

• stiff body

• epileptic cry

what is the clonic phase?

alternating contraction and relaxation

what are some adverse outcomes of clonic stage?

• jerky movements

• frothy saliva

• blinky eyes

what’s the postictal period?

gradual wakening and fatigue

what are the adverse outcomes of postictal period?

• weak limbs 

• exhaustion

• sleepy

what to keep in mind with seizures?

• some people have ticks with them

• lose control of urine/bowel movements

• don’t put anything in mouth

• don’t try to stop it

• pad bed, but put something at the back of head

• if greater than 5 minutes, cal 911

• if at hospital, important posticlateusres after seizures will go into postictal, and will sleep for minutes to hours, length varies

what are status epilepticus?

continuous seizures that lasts > 5 minutes or a series of seizures when patient does not regain consciousness

what is the top priority nursing action for status epilepticus?

• airway and oxygen: prep for possible intubation

• IV 50% dextrose for hypoglycemia: check glucose and be prepared to administer

• IV diazepam or lorazepam: often repeated every 10 minutes prn

• IV phenytoin or other anti-seizure medication

• IV general anesthesia as a last resort

What are lifespan considerations for children and seizures?

• febrile seizures (doesn’t mean seizure disorder)

• make a plan for school

• try to withdraw meds if seizure free for 1-2 years (MD)

what lifespan considerations for pregnant women with seizures?

• eclampsia (seizure)

• med management for existing seizure disorders

what are lifespan considerations for older adults with seizures?

• half of seizures in older adult are idiopathic

• epilepsy can threaten independence and increase risk of falls (absent)

• More frequently have focal seizures: blank stare, brief unresponsiveness, language difficulties, confusion, automatisms, postictal phase can last 2 weeks

• often misdiagnosed as stroke, dementia, and heart disease