NUR114 Exam 3 Study Guide

NUR 114 Exam 3 Study Guide


SEIZURES
Seizure:
 abnormal, sudden, excessive, uncontrolled electrical discharge of the neurons in the brain
 results in change in LOC, motor/sensory ability, and/or behavior
Epilepsy:
 two or more seizures experienced by a person
 chronic disorder in which repeated, unprovoked seizures occur
 may be caused by an imbalance of neurotransmitters, especially gamma aminobutyric acid
(GABA)
Seizure vs. Epilepsy:
 Seizure:
o Generalized
o Partial (these may unclassified or idiopathic)
o Secondary seizures (have a known cause/trigger and aren’t considered epilepsy)
 Epilepsy:
o Primary or idiopathic (not associated with any identifiable specific cause)
Risk Factors:
 Genetic predisposition
 Fever
 Cerebral edema
 Abrupt cessation of antiepileptic drugs (AEDs)
 Infection
 Metabolic disorders (hypoglycemia)
 Exposure to toxins
 Stroke
 Heart disease (increased risk in elderly with heart disease)
 Brain lesions/tumors
 Hypoxia
 Acute alcohol withdrawal
 Head trauma
Triggers:
 Increased physical activity
 Excessive stress
 Hyperventilation
 Overwhelming fatigue
 Acute alcohol ingestion
 Excessive caffeine intake
 Exposure to flashing lights
 Cocaine, aerosols, inhaled glue products
Classification of Seizures:
 Generalized: involve both cerebral hemispheres; 6 different types
 Partial: involve part of one cerebral hemisphere; 2 main classes
 Unclassified/Idiopathic: account for half of all seizure activity; occur for no known reason
Types of Generalized Seizures:
 Tonic-clonic:
o LOC, stiffening of muscles (tonic episode)
o 1-2 min of rhythmic jerking of extremities (clonic episode)

, o Breathing can stop (tonic) and become irregular with cyanosis (clonic)
o Biting of cheek/tongue (clonic)
o Incontinence can occur after
o Post-ictal: confusion/sleepiness
 Tonic:
o Generally last < 30 sec
o Muscular rigidity, LOC, arrythmia, apnea, vomiting, salivation, incontinence
 Clonic:
o Lasts several minutes
o Muscles contract/relax
 Absence:
o Often appear staring into space
o May/may not stop talking when seizure hits
o If continuing to talk, speech will suddenly switch to slurring/slowing down
o No jerking/twitching
 Myoclonic:
o Lasts for seconds
o Brief jerking/stiffening of extremities (symmetrical or asymmetrical)
 Atonic (Akinetic):
o Few seconds in which muscle tone is lost
o Followed by period of confusion
o Loss of muscle tone results in falling
Partial/Focalized Seizures:
 Complex Partial:
o Associated with automatisms (behaviors pt unaware of): lip smacking, picking at
clothes, etc
o LOC/blackout for several minutes
o Amnesia immediately prior to/afterwards
 Simple Partial:
o Consciousness maintained
o Unusual sensations, déjà vu, changes in HR/abnormal flushing, pain, offensive smell,
unilateral abnormal extremity movements




Aura: Early warning sign before seizure that manifests as a sensory disturbance
 Auditory: voices, buzzing, rings, drumming sounds
 Visual: flickering lights, blurry vision, dark spots, partial vision loss, seeing things not there
 Gustatory: bitter/salty/sweet/metallic tastes
 Nausea
Diagnostic/Laboratory Tests:

,  Laboratory: used to rule out metabolic causes; HIV, ETOH, drugs, toxins
 Imaging:
o Electroencephalogram (EEG)
o CT scan
o MRI
o PET scan
o Skull x-ray
 CSF analysis
Seizure Precautions:
 O2 equipment
 Suction equipment
 IV access
 Padded side rails
 Side rails up
 NO tongue blades
Seizure Management:
 Depends on seizure type
 Observation/documentation
 Patient safety
 Side-lying position to keep airway clear
 Loosen restrictive clothing
 NO restraints of tongue blades
Acute Seizure Pharmacological Management:
**Emphasize that AEDs must not be stopped without provider direction**
 Lorazepam (Ativan)
o Benzodiazepine
o Assess for visual changes/eye pain
o IV Push: observe for hypotension, muscular weakness, tachycardia, respiratory
depression
 Diazepam (Valium)
o Benzodiazepine
o Assess for visual changes/eye pain
o IV Push: observe for hypotension, muscular weakness, tachycardia, respiratory
depression
 Diastat (Diazepam Rectal Gel)
o Benzodiazepine
 Phenytoin (Dilantin)
o Hydantoin
o Monitor serum Ca+ level (can demineralize bone)
o Monitor for gingival hyperplasia, nystagmus, drowsiness, somnolence, dizziness
o DO NOT administer with Warfarin (Coumadin)
o May decrease effectiveness of oral contraceptives
o Therapeutic Level: 10-20 mcg/mL
o Toxic Level: > 30 mcg/mL
 Gingival hyperplasia
 Use alternate birth control
 Mouth care
 Soft tooth brush, don’t stop abruptly
 Fosphenytoin (Cerebyx)
o Hydantoin
o Monitor for gingival hyperplasia, nystagmus, drowsiness, somnolence, dizziness
Pharmacological Therapy:
 Carbamazepine (Tegretol)
o Side effects: H/A, vision loss