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,Seizures abrupt, abnormal, excessive and uncontrolled electrical discharge of neurons
Epilepsy a syndrome characterized by chronic recurring abnormal brain activity
Epilepsy dx 2 or more unprovoked seizures
Risk factors for seziures =febrile
-cerebral edema
-head trauma
-abrupt cessation of anti-seziure meds
-infection
-metabolic disorders
-exposure to toxins
-brain tumors
-hypoxia
-ETOH/drug withdrawal
-fluid and electrolyte imbalance
Triggering factors for seizures -increased physical activity
-excessive stress
-hyperventilation
-overwhelming fatigue
-acute ETOH ingestion
-excessive caffeine intake
-exposure of flashing lights
-specific chemicals
tonic-clonic seizure a seizure characterized by both a tonic and a clonic phase
Atonic/Akinetic Seziure few seconds of muscle tone is gone followed by a period of confusion, can cause
severe injuries
Diagnostics for seizures EEG, CT/MRI/PET scan
Labs for seizures -tox screen
-HIV
-Chem panels-BS, Na+
-CBC
status epilepticus prolonged seizure activity lasting greater than 5 minutes leading to hypoxia
Status epilepticus treatment Valium or Ativan
Nursing care for status epilepticus -protect airway
-provide O2
-establish 2 IVs
-continuous tele and pulse ox
-lay pt on L side
,Levetiracetam (Keppra) therapeutic level 35-120
Phenytoin (Dilantin) therapeutic level 40-80
Dilantin considerations -want more than 1 IV site
-good oral hygiene
-tissue damage with phlebitis and IV infiltration
-vesicant!
Stroke/Brain Attack/CVA acute interruption of blood flow to the brain causing cell death
TIA temporary ischemia without infarction, warning signs
thrombotic clot forms in narrowed artery (HTN, DM)
embolic clot from elsewhere lodges in brain artery, sudden onset
Hemorrhagic stroke ruptured blood vessel
Stroke motor manifestations -weakness/paralysis
-flaccidity followed by spasticity
-loss of coordination, reflex changes
Stroke speech manifestations -aphasia
-dysarthria
Aphasia inability to speak, receptive, excessive, or global
Dysarthria difficulty with articulation
Stroke cognitive manifestations -judgement, memory issues
-emotional instability
Stroke spatial-perceptual manifestations -neglect
-agnosia
-apraxia
-hemianopsia
Agnosia unable to recignize a sense they could previously
, Hemianopsia loss of half of visual field
Hemorrhagic stroke manifestations -headache 10/10
-N/V, projectile vomiting
-neurologic deficits
-decreased levels of consciousness
-HTN
Preventive stroke surgery -carotid endarterectomy
-stenting
-transluminal angioplasty
Stroke diagnostics -Head CT (non-contrast)
-MRI
-CT Angiogram
-NIH Stroke Scale
Acute hemorrhagic stroke priorities -maintain ABCs
-manage ICP
-lower BP slowly
-avoid anticoagulants
Acute hemorrhagic stroke possible interventions -surgical evacuation
-aneurysm clipping
-seizure precautions
tPA Inclusion criteria -ischemic stroke
-known symptoms onset < 4.5 hours
-age > 18
tPA exclusion criteria -active bleeding
-recent stroke/surgery/ on anticoagulants
-very high BP
post- tPA monitoring -neuro checks
-vitals q15min for 2 hours then spaced
-monitor for bleeding
Left-sided stroke -right sided hemiplegia
-impaired speech/language
-slow, cautious performance
-aware of deficits, risk for depression
-impaired math comprehension
Right-sided stroke -left sided hemiplegia
-spatial perceptual deficits
-impulsive
-rapid performance, short attention span
-impaired judgement
Fluent aphasia -speech flows smoothly, words connected
-speech lacks meaning
-impaired ability to comprehend speech
-person cannot understand the speech of others or own
Non-fluent aphasia -minimal speech activity with slow speech
-speech frequently halts
-person knows what they want to say
-impaired ability to speak