NUR2020 Exam 2- Seizures,
Kidney Disease, & Liver Disease
Test Study Guide
What are seizures? - Answer electrical disturbances (arrthymias) in the nerve cells in
one section of the brain
What causes seizures (primary vs. secondary causes) - Answer - Primary: 75% of
seizures are idiopathic - causes is unknown
- Secondary: the rest are caused by structural, febrile, or metabolic reasons
Examples of secondary: cortical dysplasia, double cortex, low electrolytes (any),
maternal drug use, stroke, meningitis (ESP. BACTERIAL), TORCH infections, genetic
disorders, etc.
What are generalized onset vs. partial/focal onset seizures? - Answer - Generalized
affect BOTH sides of the brain: includes motor (tonic clonic) and nonmotor (absence)
seizures
- Partial/focal: start in one area on one side of the brain: includes focal aware and focal
impaired awareness seizures
What are some triggers for seizures? - Answer flashing lights, missed medications,
temperature extremes, sounds, illness, stress, anxiety, overstimulation/sensory
overload, lack of sleep, alcohol abuse/withdrawal
What data should be assessed with a seizure patient? - Answer How often do seizures
occur?
Are there any warning signs?
What are the symptoms present during the seizure?
How long are your seizures?
phenytoin (Dilantin) - Answer - Used for tonic-clonic & partial seizures
- S&S: gingival hyperplasia, hystagmus, hirsutism (male pattern hair on women), ataxia,
folate deficiency, drug induced lupus, myelosuppresion
- Signs of toxicity: ataxia, rash that could indicate Steven-Johnson syndrome
- Nursing considerations: do not give with milk or antacids, monitor serum levels closely
,(should be 10-20 mcg); will prolong the half-life of warfarin & coumadin (PT/INR will get
longer - patient more likely to bleed b/c even slower clotting); may worsen MG
symptoms; will deactivate oral contraceptives- use alternative birth control methods
carbamezepine (Tegretol) - Answer - Used for secondary tonic-clonic & partial seizures
- S&S: ataxia, diplopia, hepatitis, aplastic anemia, behavior changes
- Nursing considerations: monitor for visual changes, monitor liver function (AST/ALT),
monitor CBC, do not crush or chew
All the drugs ending in -pam
(Lorazepam, Diazepam, Clonazepam) - Answer - anti-seizure meds (anxiolytics, benzos)
- S&S: sedation, amnesia, hallucinations, insomnia, visual disturbances, respiratory
depression, lack of appetite or appetite changes
- Nursing considerations: ANTIDOTE: Flumazenil, monitor renal & liver function and labs
if using long-term, do not discontinue rapidly, can exacerbate MG symptoms, patients
can develop tolerance if used often and it will not be as successful
What diet can help with epilepsy? - Answer Keto (high fat, low carb) - still need to use
medications
Vagus nerve stimulator therapy (VNS) - Answer Sends electrical impulses to the vagus
nerve which carries pulses to the brain (runs up the side of the nck)
- This helps prevent or shorten length of seizures
What are seizure precautions? - Answer Oxygen
Suction equipment
Bed close to ground
IV access ready
Side rails up and padded w/one pillow or pad each
Teaching plan fro patient & family w/epilepsy - Answer - It's not contagious, not a mental
illness, or cognitive disability
- Can start at any point in life
- Adhere to your medication regimen
- Citrus, especially grapefruit can interfere with the metabolism of many seizure meds
- Period blood work is needed - monitor albumin and electrolyte levels
- Know your state's law for driving after seizures: MD is 90 days seizure free, DC/VA are
, 12 months
How is epilepsy diagnosed? - Answer 1. Medical History
2. Tests: lab studies, serum electrolytes, lumbar puncture and brain studies (CT, MRI,
PET scan) to look for abnormalities and rule out other diseases
3. **Electroencephalography (EEG) to look at electrical activity of the brain
3. Clinical Observation: motor function, sensory function, neuropsychological eval
Notes: accurate description and video recordings help diagnose & classify types of
seizures
What is an Electroencephalogram (EEG)? - Answer An amplified recording of brain
activity is measured by electrodes placed on the scalp - the technician will ask you to
picture certain things, look at images, etc.) and the EEG will evaluate how you respond
to stimuli
- Considerations: DO NOT TAKE SEIZURE MEDS before an EEG, avoid caffeine and
other stimulants before, sleep deprivation is good, patient CAN eat
What are the stages of a seizure? - Answer - Prodromal: warning signs before a seizure
- Aura/preictal phase: Visual, auditory clues that happens seconds-minutes before a
seizure (such as smelling things that are not there)
- Ictal phase: SEIZURE phase (Tonic stage: incontinence, stiff, cry & clonic stage: jerky,
frothy saliva, blinking)
- Postictal: hangover phase from the seizure - may be confused, tired, have a headache
What is status epilepticus? - Answer May be life threatening!
Seizure more then 5 minutes long, repetitive without periods of consciousness
May lead to - Hypoxia, trauma, hyperthermia, hypoglycemia, aspiration, dehydration.
**PRIORITY**: STOP the seizure - give rectal or IV benzos (the -pams)
Nursing Care During a Seizure - Answer - Turn patient to side
- Provide privacy
- Ease to floor if possible
- Protect the head
- Loosen any tight clothing
- Push away furniture
Kidney Disease, & Liver Disease
Test Study Guide
What are seizures? - Answer electrical disturbances (arrthymias) in the nerve cells in
one section of the brain
What causes seizures (primary vs. secondary causes) - Answer - Primary: 75% of
seizures are idiopathic - causes is unknown
- Secondary: the rest are caused by structural, febrile, or metabolic reasons
Examples of secondary: cortical dysplasia, double cortex, low electrolytes (any),
maternal drug use, stroke, meningitis (ESP. BACTERIAL), TORCH infections, genetic
disorders, etc.
What are generalized onset vs. partial/focal onset seizures? - Answer - Generalized
affect BOTH sides of the brain: includes motor (tonic clonic) and nonmotor (absence)
seizures
- Partial/focal: start in one area on one side of the brain: includes focal aware and focal
impaired awareness seizures
What are some triggers for seizures? - Answer flashing lights, missed medications,
temperature extremes, sounds, illness, stress, anxiety, overstimulation/sensory
overload, lack of sleep, alcohol abuse/withdrawal
What data should be assessed with a seizure patient? - Answer How often do seizures
occur?
Are there any warning signs?
What are the symptoms present during the seizure?
How long are your seizures?
phenytoin (Dilantin) - Answer - Used for tonic-clonic & partial seizures
- S&S: gingival hyperplasia, hystagmus, hirsutism (male pattern hair on women), ataxia,
folate deficiency, drug induced lupus, myelosuppresion
- Signs of toxicity: ataxia, rash that could indicate Steven-Johnson syndrome
- Nursing considerations: do not give with milk or antacids, monitor serum levels closely
,(should be 10-20 mcg); will prolong the half-life of warfarin & coumadin (PT/INR will get
longer - patient more likely to bleed b/c even slower clotting); may worsen MG
symptoms; will deactivate oral contraceptives- use alternative birth control methods
carbamezepine (Tegretol) - Answer - Used for secondary tonic-clonic & partial seizures
- S&S: ataxia, diplopia, hepatitis, aplastic anemia, behavior changes
- Nursing considerations: monitor for visual changes, monitor liver function (AST/ALT),
monitor CBC, do not crush or chew
All the drugs ending in -pam
(Lorazepam, Diazepam, Clonazepam) - Answer - anti-seizure meds (anxiolytics, benzos)
- S&S: sedation, amnesia, hallucinations, insomnia, visual disturbances, respiratory
depression, lack of appetite or appetite changes
- Nursing considerations: ANTIDOTE: Flumazenil, monitor renal & liver function and labs
if using long-term, do not discontinue rapidly, can exacerbate MG symptoms, patients
can develop tolerance if used often and it will not be as successful
What diet can help with epilepsy? - Answer Keto (high fat, low carb) - still need to use
medications
Vagus nerve stimulator therapy (VNS) - Answer Sends electrical impulses to the vagus
nerve which carries pulses to the brain (runs up the side of the nck)
- This helps prevent or shorten length of seizures
What are seizure precautions? - Answer Oxygen
Suction equipment
Bed close to ground
IV access ready
Side rails up and padded w/one pillow or pad each
Teaching plan fro patient & family w/epilepsy - Answer - It's not contagious, not a mental
illness, or cognitive disability
- Can start at any point in life
- Adhere to your medication regimen
- Citrus, especially grapefruit can interfere with the metabolism of many seizure meds
- Period blood work is needed - monitor albumin and electrolyte levels
- Know your state's law for driving after seizures: MD is 90 days seizure free, DC/VA are
, 12 months
How is epilepsy diagnosed? - Answer 1. Medical History
2. Tests: lab studies, serum electrolytes, lumbar puncture and brain studies (CT, MRI,
PET scan) to look for abnormalities and rule out other diseases
3. **Electroencephalography (EEG) to look at electrical activity of the brain
3. Clinical Observation: motor function, sensory function, neuropsychological eval
Notes: accurate description and video recordings help diagnose & classify types of
seizures
What is an Electroencephalogram (EEG)? - Answer An amplified recording of brain
activity is measured by electrodes placed on the scalp - the technician will ask you to
picture certain things, look at images, etc.) and the EEG will evaluate how you respond
to stimuli
- Considerations: DO NOT TAKE SEIZURE MEDS before an EEG, avoid caffeine and
other stimulants before, sleep deprivation is good, patient CAN eat
What are the stages of a seizure? - Answer - Prodromal: warning signs before a seizure
- Aura/preictal phase: Visual, auditory clues that happens seconds-minutes before a
seizure (such as smelling things that are not there)
- Ictal phase: SEIZURE phase (Tonic stage: incontinence, stiff, cry & clonic stage: jerky,
frothy saliva, blinking)
- Postictal: hangover phase from the seizure - may be confused, tired, have a headache
What is status epilepticus? - Answer May be life threatening!
Seizure more then 5 minutes long, repetitive without periods of consciousness
May lead to - Hypoxia, trauma, hyperthermia, hypoglycemia, aspiration, dehydration.
**PRIORITY**: STOP the seizure - give rectal or IV benzos (the -pams)
Nursing Care During a Seizure - Answer - Turn patient to side
- Provide privacy
- Ease to floor if possible
- Protect the head
- Loosen any tight clothing
- Push away furniture
