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seizures
pn141 test 3 book:burke pg 932`
| Question | Answer |
|---|---|
| what is a seizure | a brief disruption of brain function caused by abnormal electrical activity in the nerve cells of the brain |
| where in the brain does the electrical activity involve | all or part of teh brain |
| what kind of manis can one cause | sensory, motor or autonomic manifestations |
| what is a convulsion | an involuntary muscle contraction and relaxation, which involves the entire body |
| what is epilepsy (a seizure disorder) | when a seizure occurs in a chronic pattern |
| what is the cause of siezures | unknown |
| what do seizures in adulthood usually result in | other conditions, brain infection, CVA, brain tumor |
| what carry messages by electrical impulses from the body to the cerebral cortex | neurons |
| what happens when a few unstable neurons continue sending electrical impulses what occurs | a sezures |
| what is an epileptogenic focus | a group of abnormally firing neurons that start a seizure |
| what happens to metabolism when a seizure occurs | it greatly increases (consumption of oxygen and glucose to the brain increases) |
| how are seizures classified as | parital or general |
| partial seizures: what are they | they start in one part of the cerebral cortex |
| partial seizures: simple- what does it cause | uncontrollable jerking, movements of a finger, hand or foot, leg or the face |
| partial seizures: simple- what is the jacksonian march | the motor activity may spread to other body areas (the jerking of a certain body part) |
| partial seizures: simple- sometimes they involve the brain, what are the s/s when they involve the brain | flashing lights, tingling sensations, or hallucinations |
| partial seizures: simple- how long does it last | 20-30 min |
| partial seizures: simple- does pt lose consiciousness | no |
| partial seizures: complex- what are they also known as | psychomotor seizures |
| partial seizures: complex- s/s | repetitive, nonpurposeful actions (lip smacking, aimless walking, paicking at clothing |
| partial seizures: complex- what are these repetitive behaviors called | automatisms |
| partial seizures: complex- how long does it last | < 1 min |
| partial seizures: complex- what happens to patient afterwards | they may be confused or not remember the siezure |
| partial seizures: complex- what can precede the seizure | an aura |
| what is an aura | a warning sign that something is going to happen |
| what can teh aura be | unusual smell, a sense of deja vu or a sudden intense emotion |
| generalized seizures: what are they | they involve both hemispheres of the brain and result in a loss of consiousness |
| generalized seizures: what are the two kinfs | absence and tonic -clonic |
| generalized seizures: absence seizures- who do they occur more often in | children |
| generalized seizures: absence seizures- s/s of it | a brief change of consciousness such as a blank stare, blinking of the eye, eyelid fluttering and lip smacking |
| generalized seizures: absence seizures- what happens to the motor activity | it is stopped during the seizure |
| generalized seizures: absence seizures-how long does it last | 5-10 seconds |
| generalized seizures: absence seizures- what makes pt unaware that they are having a siezure | because it lasts for such a short time |
| generalized seizures: absence seizures- do they have them often | yes |
| generalized seizures: tonic-clonic seizures- they are the most common what | seizure disorder in adults and children |
| generalized seizures: tonic-clonic seizures- what is pt at increased risk for | potential injury |
| generalized seizures: tonic-clonic seizures- what injuries can occur | head trauma, Fx, burns, MVA |
| generalized seizures: tonic-clonic seizures- what is the pattern (4 phases) | 1-aura, 2-tonic phase 3- clonic phase, 4- post ictal phase |
| generalized seizures: tonic-clonic seizures- what aura does the client experience | bright light, an odd taste in mouth, unusual sound |
| generalized seizures: tonic-clonic seizures- what may be heard from pt lungs | a loud cry when the air is forced out of the lungs |
| generalized seizures: tonic-clonic seizures- what happens to the pt s/s | falls to the ground, loss of consciousness, has tonic contractions followed by clonic contractions |
| generalized seizures: tonic-clonic seizures- what is a tonic contraction like | the muscles are rigid with the arms and legs extened and jaw clenched, pupils become fixed and dilated, breathing stops briefly and cyanosis develops |
| generalized seizures: tonic-clonic seizures- what is a clonic contraction like | movements are jerky as the muscles alternately contract and relax, eyes roll back, cheek biting, frothing at the mouth, urinary and bowel incontinence |
| generalized seizures: tonic-clonic seizures- how long does it last | 1-2 minutes |
| generalized seizures: tonic-clonic seizures- what is the psotictal phase | the pt is unconscious for up to 30 minutes, the pt regains conssciousness and its confused and disoriented, with HA, muscle ache and fatigue |
| generalized seizures: tonic-clonic seizures- what is normal of events prior to the seizuer | amnesia |
| status epilepticus: what is it | a continuous period of tonic clonic siezures in which pt does not regain consciousness |
| status epilepticus: constant seizure activity can do what to brain; why | can harn brain's nerve cells; due to o2 and glucose depletion and impaired ventilation and perfusion |
| status epilepticus: what else can happen | physical exhaurtion and respiratory ditress |
| status epilepticus: is it life threatening | yes |
| status epilepticus: what can trigger it | abrupt dc of anticonvulsant meds, acute head injury or hypoxia |
| what is initital tx focused on | controlling the seizure |
| what is long term tx | identifying the cause and preventing seizures |
| diagnostic tests: eeg- why is it done | it can dtermine the type of seizure and locate the seizure focus |
| diagnostic tests: skull xray- why is it done | may identify possible skull Fx |
| diagnostic tests: CT or MRI- why is it done | can detect a tumor, CVA, or hemmorhage |
| diagnostic tests: eeg- nursing considerations | withold tranquilizers and depressant meds 24-48 hours b4 and with hold caffeine and food, shampoo hair the night b4, test lasts 1-2 hours, painless, electrodes are applied to scalp w/ thick paste |
| meds: what meds can decrease and controll most seizure activity | anticonvulsants |
| meds:anticonvulsants- what is the goal with dosing | to use the least amount of dosing possible, with the fewest side effects |
| meds:anticonvulsants- why are routine serum blood levels drawn | to determine the effective doses and the potential for toxicity, to identify if the pt is or is not taking their meds |
| meds:anticonvulsants- what two levels do they have | a therapeutic and toxic level |
| meds:anticonvulsants- if pt does not have well ontrolled seizures with one med, what is done | a second med is added |
| meds:anticonvulsants- how long do they have to take them | usually their entire life |
| status epilepticus: tx first what is established | an airway |
| status epilepticus: what meds are give n in acute | iv admin od diazepam (valium) or lorazepam (ativan) to stop seizure activity, dose may need to be repeated b/c the meds are short acting |
| status epilepticus: what meds are given in long term control | phenytoin and phenobarbital |
| surgery: when is it an option | when meds do not control pt seizures |
| surgery: is pt awake; why or why not | yes , while they are awake surgeon can mapthe area of abnormal electrical discharges and remove it (only abnormal, not brain tissue) |
| ginkgo: why is it an issue | it decreases the effectiveness of dilantin |
| grapefruit juice: why should pt taking anticonvulsants avoid drinking it | it can reduce metabolism of these drugs and raise plasma levels of the drug |
| nx Dx: risk for ineffective airway clearence: why should clothing be loosened around the neck | in order to maintain a patent airway |
| nx Dx: risk for ineffective airway clearence: why should pt be turned on their side during a seizure | b/c during a seizure the tongue may fall back and obstruct the airway, secretions may pool at the back of the mouth, turning to side allows secretions to drain from the mouth |
| nx Dx: risk for ineffective airway clearence: why give oxygen | seizures can cause hypoxia |
| nx Dx: risk for ineffective airway clearence: why suction | to prevent aspiration |
| nx dx: risk for injury- why shouldn't pt be restained during a seizure | restaining can cause fx of extremities |
| the longer the seizure takes place the more _______ is lost | oxyge nand glucose |
| what hx shuld be taken when pt reports seizure: | get a reliable witness of behaviors before,durign and after, find out about health hx, |
| what is an acquired seizure | it has a cause as to why the seizure happens (lytes, trauma, cerebral perfusion, infection, tumors, genetics ect) |
| what is an ideopathic seizure | its cause is unknown |
| are the majority of seizures ideopathic or acquired | ideopathic |
| what should we help pt identify in teh future so they can figure out when they are going to have a seizure | their aura |
| why shuold seizure be timed | so we know how long they were without oxygen |
| what type of seizure may be mis dx as something else | the absence seizure |
| generalized seizures: absence seizures- when do most go away | at puberty |
| partial seizures: simple- what two strips does this seizure follow | motor and sensory |
| partial seizures: complex- what happens to pt thoughts postictal | they become impaired |
| status epilepticus: what damage can occur | perminent brain damage |
| status epilepticus: what is the 1st drugs of choice to stop activty | valium and ativan |
| medical management: treat the _ first then treat the ___________ | seizure first, cause |
| meds: what is the most common aniconvulsant used | dilantin (phenytoin) |
| surgery- what is a craniotomy | opening the skull |
| surgery- what is a craniectomy- | removal of partions of the brain |
| meds: dilantin- what does tube feeding do | it can decrease the absorbtion up to 70% ofthe drug |
| meds: dilantin- nursing interventions when used for pt w/ tube feedings | holf feeds one hours before and after drug, increase the dose of the drug, give med BID, cyclic feeding (feed pt at night and give double amount) |
| meds: anticonvulsant- general action | they act in the motor cortex of the brain to prevent abnormal electrical discharges from teh epileptic foci in this area. they control chronic sezures, but do not cure seizure disorders. they raise the seizure threshold so they do not begin |
| meds: anticonvulsant- why are they given the same time each day with meals | to prevent gastic upset |
| meds: anticonvulsant- why should serum drug levels be monitored | for therapeutic range |
| meds: anticonvulsant- with dilantin, what should be monioted in regards to the gums | ginival hyperplasia |
| meds: anticonvulsant- examples | dilantin (phenytoin), keppra (levetiracetam), tegretol (carbazapine), klonopin (clonazepam), depakote (civalproex), cerebryx (fosphenytoin), neurotin (gabapentin) |
| meds: anticonvulsant- what one is also used for perihperal neuropathy | neurotin |
| meds: dilantin (phenytoin)- use | tonic-clonic seizures, status epilepticus, and prophylactic seizure prevention |
| meds: dilantin (phenytoin)- adverse reactions | ataxia, CNS deprssion, HA, hypotension, nystagmus, mental confusion, slurred speech, dizziness, drowsiness, N/V, gingival hyperplasia, rash |
| what is gingival hyperplasia | overgrowth of gum tissue |
| meds: dilantin (phenytoin)- who is it contridicted in | pt w/ sinus bradycardia, sinoatrial bloack, adams-stokes sydrome, AV block, during pregnancy and lactation |
| meds: anticonvulsant- dosage adjustants are based on what | pt response to therapy |
| meds: anticonvulsant- why is their a Nx Dx for impaired oral mucous mucosa | b/c of gum overgrowth |
| meds: dilantin (phenytoin)- most common what | prescribed anticonvulsant |
| meds: dilantin (phenytoin)- s/s of toxicity | slurred speech, N/V, dizziness, lethargy, ataxia |
| meds: dilantin (phenytoin)- what should it be administered with orally | with meals |
| meds: dilantin (phenytoin)- what should therapeutic levels be | between 10-20 mcg/mL |
| meds: dilantin (phenytoin)- s/s of thrombocytopenia | bleeding gums, easy brusing, increased menstrual bleeding, tarry stools |
| meds: dilantin (phenytoin)- what is its class | hydantoins |
| meds: anticonvulsant- what do hydantoins do (action); what are names of them | they stabilize the hyperexcitabilty in the motor cortex of the brain; dilantin (phenytoin), cerebyx (fosphenytoin) |
| meds: anticonvulsant- hydantoins what do all the generic names end in | toin |
| meds: anticonvulsant- hydantoins- nursing considerations | inform dentist of this drug, brush and floss teeth after each meal, take med with food to prevent GI upset, inform MD of s/s of toxicity |
| meds: cerebyx (fosphenytoin)- what is the use | status epilepticus |
| cerebyx (fosphenytoin)- class | hydantoins |
| meds: anticonvulsant- what do carboxulic acid derivatives do (action); what are names of them | they increase the levels of GABA, which stabilizes cell membranes; depakote (valproic acid) |
| meds: depakote (valproic acid) use | elilepsy |
| meds: depakote (valproic acid) - class | carboxylic acid derivatives |
| meds: depakote (valproic acid) - who is it contraindicated in | pregnancy, and ppl with renal impairement |
| meds: depakote (valproic acid)- adverse effect | HA, somnolence, dizziness, tremor, N/V, diplopia |
| meds: anticonvulsant- what do benzodiazepines do (action); what are names of them | they elevate the seizure threshhold by decreasing postsynaptic excitation; klonopin (clonazepam) |
| meds: klonopin (clonazepam)- class | benzodiazepines |
| meds: klonopin (clonazepam)- use | seizure disorders, panic disorders |
| meds: klonopin (clonazepam)- adverse effects | drowsiness, depression, ataxia, anorexia, diarrhea, constipation, dry mouth, palpations, visual disturbances, rash |
| meds: ( tegretol) carbamazepine- class | miscellaneous preparations |
| meds: ( gabapentin) neurotin- class | miscellaneous preparations |
| meds: ( levetiracetam) keppra- class | miscellaneous preparations |
| meds: ( tegretol) carbamazepine- use | epilepsy , others bipolar, |
| meds: ( gabapentin) neurotin- use | partial seizures (adults), other - pastherpetic neuralgia |
| meds: ( levetiracetam) keppra- use | parital seizures, tonic clonic seizures, bipolar disorders, migraine, HA |
| why should pt keep a daily record of seizures | the journal will help them figure out triggers |
| meds: anticonvulsants all have the same adverse effect of what | drowsiness |
Created by:
jmkettel
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