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Terms in this set (58)
caused by fever, not epilepsy
-most within first 24 hrs of illness
-sudden cry, stiffness, jerking of body, lasts only a couple of minutes
-generalized tonic clonic
-quick change in fever: why it occurs
-don't need to treat with anti epileptic
-if have febrile seizure, up until age of 6 now more prone to have febrile seizures
-try to keep fever down= treatment
-small chance to have epilepsy in future
quick and repetitive movements, can be numerous.
Have to watch closely: occur between 2 months and 2 years of age. Appear in clusters .
Can be mistaken for hiccups, colic or bad stomach ache
-note how many sasms occur, call doc immediately
-partial- only portion of brain
-blank starre, altered awareness, repetitive behavior: chew/picking
-speak calmly, stay with child til end
DO NOT HOLD CHILD DURING SEIZURE
Call 911 if symptoms persist may progress
sudden loss in muscle tone
-stumbles or falls-->injury
Clumsy or poor coordination
Usually better in minutes
Some need head gear
Myoclonic- sudden jerk, happen in morning
looks up, briefly stare into distance; blank stare begins and ends abruptly; day dreaming/ADHD
-rapid link and chew, unaware of what's going on,quick return to full awareness
Can occur a few or up to 100x a day
generalized tonic clonic
Most dramatic: sudden cry, fall, rigid, muscle jerks, may last just a couple of minutes
Unresponsiveness, loss of consciousness, loss of bladder or bowel, sleepy, breathing issues
what to do when gen. tonic clon
Call 911 if stop breathing
Monitor it- look for progression
Put pt on side incase aspirate
If over 5 minutes- treat this. Benzo like ativan - rectal gel
Clear area around child; to help avoid injury- something soft by head and hard surface
Longer than 5—immediate attention
NOTHING IN MOUTH, don't hold tongue (it wont be swallowed) no food or drink, no restrain
when are you more susceptible to tonic clonic seizure?
Susceptible: fever, illness, infection, tired, overheated, stressed, excited, anxious, fearful, sleepy
Never allow child to swim alone. Have child take showers instead of baths. Avoid heights. Videotape seizure
Transient clinical event resulting from abnormal and excessive activity of cerebral neurons
Results in paroxysmal disorganization of one or more brain functions
Psychogenic seizure or a brief convulsion as the result of a syncopal event
Not associated with epileptic discharge in the brain
i.e. Febrile, head trauma, low blood sugar, infection
Diagnosis of Seizure Disorders
1. Determine that epilepsy or seizures exist and that another diagnosis should not be ruled out.
2. Determine the underlying cause
-History, observation, and diagnostics are essential
3. Determine the cause of the event w/ diagnostics
-Labs—glucose, electrolytes, -BUN, Ca++
-LP (lumbar puncture)
a seizure is an ________ and epilepsy is the _______ involving recurrent unprovoked seizures.
definition of epilepsy
1. Disease characterized by two or more unprovoked seizures. Or one unprovoked and high probability of recurrence
2. Cause: a variety of pathologic processes in the brain.
3. Child with single seizure should not be diagnosed as epileptic and are usually not treated with medication.
4. A seizure can result from an acute medical or neuro illness and cease with treatment.
5. a seizure is an event and epilepsy is the disease involving recurrent unprovoked seizures.
Seizure activity - characteristics
Tachycardia and increased BP
Movement is not suppressed by gentle restraint
Seizure activity unchanged by sensory stimuli
Non-epileptic movements - characteristics
No changes in vital signs
Movement suppressed easily with gentle restraint
Enhanced non-epileptic movements with sensory stimuli
can stop by gentle restraint
Your patient has a "blank stare, altered awareness and looks "out of it". What kind of seizure is this?
Simple partial - focal seizure
Simple partial - focal seizure
-Simple partial- consciousness is not impaired
-Brief - less than a minute
-Divided into categories depending on type of symptoms:
Motor, sensory, autonomic, psychic
Your patient starts smacking their lips, picking at their clothes, and fumbling. They become unaware of their surroundings. What type of seizure is this?
Complex partial seizure
MOST COMMON type in children (can mimic absence seizures)
Complex partial seizures
Seizures that are characterized by various complex psychological phenomena and are thought to result from temporal lobe discharges
Complex partial seizures include the following
Prodrome: aware of upcoming seizure before it occurs
Aura : part of ictal seizure phase before LOC
Difficult to controlling
Automatisms: i.e. lip smack, pick at clothes, fumbling; unaware of surroundings or may wander
symptoms depend on part of brain misfiring
infants vs older children complex partial seizure
Infants: Lip smacking, chewing, swallowing, excessive salvation
Older Children: Picking, pulling
Day dream vs seizure;
in what situations do they occur?
do they begin abruptly
can they be interrupted?
not frequent - DD
complex partial: rarely more than several times per day or week
Absence: could be many times per day
boring situations -DD
any time, including during physical activity
usually yes. some complex partial seizures begin slowly with a warning
no with seizure
how long last?
does the person do anything during the episode?
what is the person like immediately after the episode?
until something interesting happens- DD
Prob just stares- DD
complex partial duration, do they do anything during the episode, how about after
up to several minutes
automatism are common
confused after epidode
abscence seizure: duration, do they do anything during episode, how about after
rarely more than 15-20 sec
seizures that involve the entire brain
LOSS OF CONSCIOUSNESS= initial manifestation
(gran mal, myoclonic, atonic, absence)
Generalized tonic-clonic seizures (grand mal)
Most common, stiffening of body for 10-20 sec. then jerking extremities for another 30-40 secs
Prodrome and aura (aura and post ictal phase)
Post-ictal phase can be incontinent or cyanotic
Brief muscle jerking
sudden loss of muscle tone and consciousness
Less than 30 seconds
loss of motor function, blank stare and no memory of the activity
Generalized tonic-clonic seizures
Formerly known as grand mal
aura and post ictal phase
Consist of two distinct phases (tonic and clonic)
Lasts between 10 -20 seconds
eye rolling and loss of consciousness
Tonic muscle contractions
Apneic, may become cyanotic
Lasts 30 - 50 seconds
may have incontinence, caution with airway concerns
Intense jerking motions
Initial manifestation of generalized seizures
Loss of consciousness
Formerly called petit mal or lapses
often stop spontaneously in the teenage years
sudden onset of 20+ events per day
No warning, no aura
Motor -> lip smacking, twitching of eyes, face, slight hand movements, blinking.
May drop object; child rarely falls.
Duration 5 - 10 seconds
Often misdiagnosed thought to be daydreaming or have ADD; can have school/ behavior issues
complex absence seizures
During a complex absence seizure, a person will make some kind of movement in addition to staring into space.
In fact, 7 out of 10 kids with absence seizures will stop having them by age 18. Children who start having absence seizures before age 9 are much more likely to outgrow them than children whose absence seizures start after age 10.
sudden momentary loss of muscle tone
Loss of consciousness only momentary
Sudden fall to the ground, often on face
Less severe - head droops forward several times
Events recur frequently during the day usually in the AM shortly after waking up
Sudden brief contractions of muscle group
May be singe or repetitive
May or may not lose consciousness
No post-ictal state
Often occur when falling asleep
May be non-specific symptom in many CNS disorders
May be mistaken as exaggerated startle reflex or tics, tremors or clumsiness
usually occur between ages 6 mo - 3 years (rare after age 5)
Cause: unknown + family history
core temperature increases rapidly/suddenly to 102.2
Seizure occur when temperature is rising, not after
Febrile seizures management
Avoid tepid baths - usually ineffective
Vigorous use of antipyretics
Protect child from injury during a seizure
When to call 911 for a seizure
If the seizure lasts more than 5 minutes
Nonepileptic seizures or events
Usually associated with psychological conditions or other physical problems
caused by subconscious thoughts emotions or stress
NOT abnormal electrical activity in the brain
Seizure last more than 30 minutes or a series of seizures without regaining premorbid LOC
Status epilepticus can l/t
Respiratory failure and death
Status epilpticus management
establish IV access
Seizure treatment and nursing
Medications and ketogenic diet
Medications for seizures (immediate action)
Valium, ativan, dilantin ad phenobarbital
PO, IV, PR (Diastat)
Long-term medications for seziures
Tegretol, klonopin, depakene
Ketogenic diet; done for seizures
high fat, low CHO and adequate protein
NEVER 1st LINE
Vagus nerve stimulator
localized limitation - Implanted device
Stimulates left vagus nerve 30 seconds/5min
30% experiences 50% reduction
shortness of breath
sore throat, coughing
ear and throat pain
nausea and vomiting
Left side of chest; prevents abnormal electrical activity that causes a seizure and pts are able to activate the CNS when they feel one coming on
other times to call 911 w seizures
Injured, preg, diabetes, prolonged or reoccur—CALL 911
invasive therapy for seizures
Nursing interventions for seizures- priority
Priority = staying with the child is a priority nursing action. Send someone else for help
Protect from injury
Remain with child
Privacy if possible
more nursing for seizures
Describe and document the observed seizure activity.
Note general description, time of onset ,behavior ,movement,face, eyes, respiratory effort, any evidence of incontinence.
Observe the postictal period.
Home Management of Seizures
-CPR training for family members.
-Rectal diazepam available for intractable seizures.
-Activity restriction on individual basis.
-Safety devices—helmets, no swimming alone, awareness of school, other caregivers.
-Instruct parents to put something under the child's head during a seizure.
Treatment/Nursing for seizures: SAFETY
Protect from injury
Do not put anything into the mouth
Importance of taking medication
Importance of close follow-up
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