Epilepsy

Difference Between Seizure and epilepsy A seizure is a brief, temporary disturbance in the electrical activity of the brain Epilepsy is a disorder characterized by recurring seizures (also known as “seizure disorder”)

Key Fctors Seizures are abrupt, uncontrolled electrical brain discharges that cause alterations in level of consciousness and changes in motor and sensory behavior. Epilepsy can be idiopathic ) 70 %) or secondary (30%) It is not associated with alterations in intellectual capabilities. Seizures are classified as neurologic emergencies. Sustained untreated seizures can result in hypoxia, cardiac dysrhythmias, and lactic acidosis.

A seizure may appear as: A sudden cry and fall, followed by Convulsive movements of all limbs Shallow/interrupted breathing - cyanosis Loss of bowel/bladder control Slow return to consciousness, post-seizure confusion and/or fatigue

Risk Factors Genetic predisposition Acute febrile state/ febrile convulsion in kids Head trauma Cerebral edema Abrupt cessation of antiepileptic drugs (AEDs) Infection; meningitis Metabolic disorder (for example, hypoglycemia) Exposure to toxins Brain tumor, CVA Hypoxia Acute drug and alcohol withdrawal Fluid and electrolyte imbalances Complication of diabetes or pregnancy

Triggering factors Increased physical activity. Stress, illness Reading Fatigue. Alcohol, and Caffeine. Flash light, lack of Sleep Some chemicals, dehydration Sun light & Hot water Menstruation

Types of epilepsy 1. Generalized; involve the whole brain & loss of consciousness Partial; involve part of the brain, may / may not involve loss of consciousness

Diagnostic Procedures and Nursing Interventions Electroencephalogram (EEG) Blood and urine tests, magnetic resonance imaging (MRI), computed tomography imaging (CT), positron emission tomography (PET) scan, cerebrospinal fluid (CSF) analysis, skull x-ray, Electrolyte profile and drug screen

Assess/Monitor Airway patency Aspiration Injury post seizure If client experienced an aura (warning sensation); possible indication of the origin of seizure Possible trigger factors (for example, fatigue)

NANDA Nursing Diagnoses Risk for injury Risk for impaired spontaneous ventilation Risk for ineffective tissue perfusion (cerebral)

Treatment Goals in Epilepsy Help person with epilepsy lead full and productive life Eliminate seizures without producing side effects Tailor treatment to needs of individuals/special populations :Women, Children, Elderly, Hepatic or renal failure and other diseases

Nursing Interventions Protect the client from injury . Maintain a patent airway. Be prepared to suction. Turn the client to the side (??). Loosen clothing. Do not attempt to restrain the client.

Nursing Interventions Do not attempt to open jaw during seizure activity . Do not use padded tongue blades. Administer oxygen as prescribed. Administer prescribed medications Document onset and duration of seizure and client findings/ observations prior to during, and following the seizure (level of consciousness, apnea, cyanosis, motor activity, incontinence).

Post Seizure Maintain the client in a side-lying position to prevent aspiration and to facilitate drainage of oral secretions. Check vital signs. Perform neurological checks. Reorient and calm the client Institute seizure precautions. Provide client education regarding seizure management: The importance of monitoring AED levels and maintaining therapeutic medication levels. Possible drug interactions (for example, decreased effectiveness of oral contraceptives). Encourage the client to wear a medical alert bracelet (necklace) at all times.

Seizure Precautions Standby oxygen, airway, and suctioning equipment IV access (medication administration during seizure) Side rails in up position and bed in lowest position

Potentially Dangerous Responses to Seizure Don’t restrain person Don’t put anything in the person’s mouth Don’t try to hold down or restrain the person Don’t attempt to give oral antiseizure medication Don’t keep the person on their back face up

Complications and Nursing Implications Aspiration Turn the client to side, suction as needed. Status Epilepticus Establish airway, provide oxygen, ensure IV access, perform EKG monitoring,and monitor ABG results. As prescribed, administer diazepam (Valium) or and a by a continuous infusion of phenytoin (Dilantin).