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 consciousness

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

what are nursing interventions for seizures?

• provide for patient safety (side rails, padding, have suction, safety comes first)

• maintain the airway

• Pharmacologic therapies (have them ready, but no IV)

• Support home management (provide meds, safety proof house to decrease injury risk)

what is the goal of anti-epileptic drugs?

reduce or stop seizure activity

how would you describe anti-epileptic drugs?

• highly individualized medication plan

• balance of seizure control against acceptability of side effects

• act by suppressing abnormal neuronal discharges

what are benzodiazepines?

they calm down neuro sinapses and GABA is given to stop the electricity

what are the prototype of anti-seizure medications?

Phenytoin and levetiracetam

what are the primary symptom targets for phenytoin and levetiracetam?

decrease:

• neuron membrane excitability

• seizure occurrence and duration

• decreases seizures

what is the mechanism of action for phenytoin and levetiracetam?

• suppresses abnormal neuronal discharges 

• prevents seizures from spreading to other parts of the brain

what are things to know about phenytoin?

• therapeutic range 10-20 mcg/dl

• SE: gingival hyperplasia, vision issues, GI upset, and rash

what are things to know about levetiracetam?

behavioral effects in pediatric patients such as agitation, depression, hostility

What are adverse outcomes for phenytoin and levetiracetam?

• sedation and drowsiness

• hypotension and dizziness

• suicidal ideation and depression (Not expected)

• safety considerations

• discontinuation risk

• pregnancy and newborn risk (Not expected)

what to monitor for sedation and drowsiness?

• level of consciousness

• confusion

• disorientation

• fall risk

what to response for sedation and drowsiness?

• expected in first 24 hrs

• hold and notify provider

• avoid other CNS depressants

• fall prevention

what to monitor for hypotension and dizziness?

• low BP

• report dizziness

what is the response for hypotension and dizziness?

• expected in 24 hrs

• hold and notify provider

what to monitor for suicidal ideation and depression?

• suicidal thoughts

• mood

• affect

what is the response for suicidal ideation and depression?

• ensure safety

• notify provider

what to monitor for safety considerations?

driving or need to alertness during tasks

what is the response for safety considerations?

patient should not drive until seizures are under control

what to monitor for discontinuation risk?

• recurrence of seizures

• status epilepticus

what is the response for discontinuation risk?

instruct patient not discontinue medication for risk of seizure return

what to monitor for pregnancy and newborn risk?

• birth control

• chance of pregnancy

• breastfeeding

what is the response for pregnancy and newborn risk?

instruct patients to notify if they are planning for pregnancy or get a positive pregnancy test