ADH2 Seizures+Encephalitis

Whats epilespy?

when person has 2+ unprovoked seizures (chronic, recurring)

• seizures form identifiable causes does NOT = epilepsy!!

• ex: low sodium

  • alcoholic

  • drugs)

What things increases seizure risks? (10)

1. head trauma

2. fever (especially children)

3. brain swelling

4. infx

5. stroke

6. brain tumor

7. hypoxic

8. alcohol withdrawal

9. stopping seizure meds abruptly 

10. electrolyte imbalances

What is a tonic seizure?

s/s: (5)

only STIFFENING part happens

s/s:

1. increased muscle tone

2. loss of LOC

3. stop breathing

4. pee themselves

5. salivate

Whats a clonic seizure?

only JERKING phase

• repeated rhythmic twitching for several minutes

Whats a tonic-clonic seizure aka grand mal? (3)

1. starts w/ tonic episode where muscle stiffens, person collapses and loses LOC

2. then clonic episode where pt jerks for 1-2 minutes 

3. may bite tongue and lose bladder control

Whats the post ictal phase?

• after seizing the pt is very tired, confused and wants to sleep

Whats a myoclonic seizure?

Sudden quick jerks/ twitches of muscles (like being startled)

Whats an atonic (drop) seizure?

sudden LOSS of muscle tone → person drops to ground

• very high falls/banging head risk

Whats a complex partial seizure? (4)

• hint:

  • what actions do they perform?

  • duration

  • whats their LOC?

1. person not fully aware (can blackout)

2. may do repeated actions (automatisms)

3. lasts minutes

4. no memory of it

What are automatisms? (3)

1. lip smacking

2. picking at clothes

3. staring

Whats a simple partial seizure?

• whats their LOC?

• what do they sense? (6)

1. person stays conscious

2. has strange sensations

• deja vu

• weird smell/taste (rubber burning)

• one-sided mvmts

• heart racing

• flushing

• tingling/ pain

What would nurse do DURING seizure? (4)

1. turn on side

2. loosen clothes

3. suction PRN

4. pad head

What to NOT DO during seizure? (4)

1. DONT restrain pt

2. DONT open jaw or put anything in it

3. DONT give food/water

4. DONT use padded tongue blade

Nurse care during POST-Ictal phase: (5)

1. keep side-lying

2. check for injuries+breathing

3. assess neuro status

4. reorient and calm them

5. ask abt aura and triggers 

List the meds/therapeutic procedures for seizures: (4)

1. antiepileptic (phenytoin)

2. Vagal Nerve Stimulator

3. Conventional Surgery

4. Partial Corpus Callosotomy

Teachings for phenytoin: (5)

1. take @ same time daily

2. causes gum overgrowth → good oral care

3. no oral contraceptives (reduced effectiveness)

4. no WARFARIN!!!!!

5. need blood level monitoring 

What to avoid w/ VNS (vagal nerve stimulator) (4)

1. microwaves

2. shortwave radios

3. MRI (implanted in left chest wall like a pacemaker)

4. ultrasound

What can the pt do @ seizure onset if they have VNS?

swipe a magnet over device to stop/reduce seizure activity

What surgeries help treat seizures? (2)

1. conventional: remove seizure-causing brain area

• discontinue AEDs first

2. partial corpus callosotomy: for those that arent candidates for conventional surgery

• resects corpus callosum so prevents seizures from spreading b/w hemispheres

Major complication from a seizure?

• what are 2 scenarios?

Status Epilepticus

• one seizure lasts 5+ minutes OR

• multiple seizures back to back for 30 mins

What causes Status Epilepticus? (5)

1. stopping seizure meds abruptly

2. alc/drug withdrawal

3. head injury

4. infx

5. metabolic problems

Emergency Actions for Status Epilepticus? (6)

1. maintain airway

2. give O2

3. IV access

4. diazepam or lorazepam IV (benzos)

5. then phenytoin or fosphenytoin

6. check ABGs

What is Encephalitis?

Inflammation of the brain, usually caused by a virus

Common causes of Encephalitis? (3)

1. Herpes simplex virus (HSV)

2. Mosquito-borne viruses (West Nile, St. Louis)

3. Fungal infx

Symptoms of encephalitis: (6)

1. Photophobia (light sensitivity)

2. Phonophobia (sound sensitivity)

3. Nuchal rigidity (stiff neck)

4. fever

5. HA

6. neurological problems

Meds for encephalitis? (2)

1. antivirals (HSV)

2. antifungals 

Nursing interventions for encephalitis? (6)

1. HOB 30-45 degrees

2. dark, quiet room (phonophobia, photophobia)

3. seizure precautions

4. encourage fluids

5. reposition q2hrs

6. stool softeners (no straining)