Seizure and spinal cord injuries

Seizures

Arrhythmia in the nerve cells- defined as episodes due to abnormal electrical activity in the the nerve cells, a localized area or all of the brain is involved

Types of seizures

generalized- petite mal and tonic clonic (whole brain is affected) , focal, and epilepsy- chronic seizure condition

Seizures are caused by

tumors, cvd, cns, infection, withdrawal, fever in children, head injury, hypertension, hypoxemia, and metabolic/ toxic conditions, need to find underlying cause !

what to give during a seizure

Lorazepam

medication given after seizure

Iv infusion phosphenytoin

seizures are dx by

eeg , ct and MRI

med mgmt for seizures

Carbamazepine , anticonvulsants, diazepam benzodiazepines, and surgery- if epilepsy is due to a tumor or abscess

DX of epilepsy

two or more seizures in a lifetime, unprovoked recurring seizures

Nursing mgmt durring seizures

prevent injury and aspiration , time the seizure, loosen clothing, protect head, implement seizure precautions low bed, side rails up, padded rails, don’t restrain, monitor airway,

position of seizure patient

turn them on their side

document seizure

length of seizure, warning sign, movements during, any incontinence , paralysis following

Education

Taking their meds daily at the same time and get serum labs drawn regularly , dont put anything in their mouth !!

Carbamazepine

anti convulsant med worried about bone marrow suppression and drawing labs

Absence seizures petit mal time

lasts 2-15 seconds

s/s of absence seizures

staring, eye fluttering, automatisms - if prolonged, lip smacking, picking at clothes and fumbling

post absence seizures s/s

amnesia, no confusion and promptly resumes activity - these patients act like nothing happened post seizure

Generalized tonic clonic seizures time

1-2 minutes

signs and symptoms of generalized tonic- clonic seizures

crying, falls, tonicity, rigidity, cloniciity , jerking , incontinence of urine potentially cyanosis, tongue is often chewed

Tonic clonic patients may experience

an Aura ; taste, smel, sound and sight

post tonic clonic seizure s/s

amnesia, confusion, and deep sleep. involves both hemispheres of the brain causing both sides of the body to react - these patients are affected post seizure !

Status epilepticus time

lasts 5+ minutes or involved serial seizures without full recovery of consciousness in between

tx for status epilepticus

stop the seizure, give iv benzodiazepines, then an anticonvulsant, medical emergency

EEG

measure electrical activity of the brain - appears as wavy lines like a ekg strip- tall waves called spikes indicate brain cells are firing strongly -means pt is going to have a seizure

spinal cord injury

defines as the result of concussion, contusion , laceration or compression of the spinal cord

primary sci

initial trauma - permanent damage

secondary sci

result of ischemia, hypoxia or hemorrhage that destroys nerve tissue- can be treated if caught early

sci caused by

mvas, falls, violence, and sport injury

risk factors sci

alcohol, drug use, and male gender about 80% of sci

major cause of death in sci

PNA, PE and sepsis

SCI dx by

xray and ct initially, then mri potential ligamentous injury can be present without bony injury , myelogram -if mri is contraindicated

s/s of sci

depend on location of injury

at or above c4

respiratory paralysis and tetraplegia

c5-6

paralysis of leg/wrists/hands, weakness of shoulders, loss of bicep reflex

c6-c7

paralysis of legs/wrists/ hands

c8-T1

horner syndrome and paralysis of legs

T1 and conus medullaris

paralysis of legs

med mgmt for sci

methylprednisolone, riluzole - prevents further damage to nerves , eeg( bradycardia and asystole common), oxygen (hypoxia can worsen neuro deficits), spinal surgery

nursing mgmt sci

monitor respiratory status , changes in motor and sensory function , temperature, monitor for bladder retention and distention, assess skin integrity and traction and pin care

complication of sci

spinal shock, neurogenic shock- risk for within first 24-72 hours and autonomic dysreflexia- always at risk

spinal bcord injury between c3 and c5

will impact breathing

Horner syndrome

constricted pupils, ptosis, and facial anhidrosis

emergency mgmt sci

1st cervical collar 2nd log roll onto back board 3rd run tests to determine if its an SCI ( any twisting or moving can cause permanent damage)

spinal shock

results in sudden depression of reflex activity in the spinal cord aka areflexia that occurs below the level of injury

s/s of spinal shock

paralyzed , flaccid, absent reflexes - below level of injury , bradycardia, hypotension, bowel bladder dysfunction * distention and paralytic ileus- often occurs within the first 2-3 days after sci and resolves within 3-7 days

med mgmt of sci

maintain a mean arterial pressure map of 85 or higher during hyperacute phase and NG tube for decompression * paralytic ileus and bowel distention

Neurogenic shock

develops due to the loss autonomic nervous system function below the level of the lesion - affects vital organs

s/s of neurogenic shock

decrease in bp, hr, cardiac output, peripheral edema, peripheral vasodilation, lack of ability to perspire in paralysed locations - monitor for fever - most of concern bc it affects ANS

Autonomic dysreflexia aka autonomic hyperreflexia

defined as acute life threatening emergency that occurs due to exaggerated autonomic response to stimuli that are harmless in people without sci - occurs after spinal shock has resolved

risk factors for autonomic dysreflexia

patients with cord lesions above T6- the sympathetic visceral out flow level, after spinal shock has subsided

Triggers for autonomic dysreflexia

distended bladder (most common cause )- insert cath drain bladder , distention or contraction of visceral organs, constipation-impaction, or stimulation to skin tactile, pain thermal stimuli, pressure injury

s/s of autonomic dysreflexia

severe pounding headache, sweaty, confused hypertension , diaphoresis, nausea, congestion, and bradycardia

mgmt of autonomic dysreflexia

remove and avoid triggering stimulus, IV hydralazine tx htn

nursing mgmt for autonomic dysreflexia

place in sitting position hob 90 degrees and legs lower - lowers bp, empty bladder with catheter, manual removal of fecal mass , admin topical anesthetic 10-15 min prior , if not can enhance the dysreflexia, assess skin, increase fluids and fiber, remove cold drafts

complications of autonomic dysreflexia

due to htn, retinal hemorrhage, hemorrhagic stroke, MI, seizures , emergent situation usually happens years after sci !

post spinal surgery

pain mgmt, cervical collar , no prone , no driving, immobilize neck

tx for spinal cord alterations

conservative rest and meds, steroids , surgery is last option . NSAIDS good medication ice

spinal cord alterations assessment

neuro exam - DTR deep tendon reflex

Brain tumor

usually discovered after patient has had seizure

blood brain barrier

control what comes in and out of brain , 98% of meds do not pass blood brain barrier , if tumor there it is difficult to tx with meds very hard to penetrate barrier

clinical manifestations of neurological tumors

based on location, change in loc, visual disturbances loss of hearing seizures, headache, hormonal effects, increased icp and herniation

temozolomide

med mgmt for brain tumor- oral chemo that is able to cross blood brain barrier

Brachytherapy

seed that is placed directly into cancer, worry about skin integrity - stay away from children and pregnant women

Corticosteroids

dexamethasone - tx for brain tumor , relieves headache and altered loc

pre op brain tumor

prophylactic meds antibiotics to reduce potential infection , diazepam for anxiety , antiseizure, mannitol diuretics fluid restriction ,baseline needed! , ct, mri, angiography or doppler flow studies

assessment post of care brain tumor

neuro assessment compare baseline , VS, loc, CSF leak, cerebral edema, icp , periorbital edema, gag reflex, motor function

CSF leak post off brain tumor

fluid, dressing post nasal drop, salty taste= finger stick strip

nursing intervention post op care brain tumor

cool compress, elevate hob, suction with caution, position, regulate temp, ROM