Angelite Nurses

1. General information
1. Seizures: recurrent sudden changes in consciousness, behavior, sensations, and/or muscular activities beyond voluntary control that are produced by excess neuronal discharge
2. Epilepsy: chronic recurrent seizures
3. Incidence higher in those with family history of idiopathic seizures
4. Cause unknown in 75% of epilepsy cases
5. Seizures may be symptomatic or acquired, caused by
1. Structural or space-occupying lesion (tumors, subdural hematomas)
2. Metabolic abnormalities (hypoglycemia, hypocalcemia, hyponatremia)
3. Infection (meningitis, encephalitis)
4. Encephalopathy (lead poisoning, pertussis, Reye's syndrome)
5. Degenerative diseases (Tay-Sachs)
6. Congenital CNS defects (hydrocephalus)
7. Vascular problems (intracranial hemorrhage)
6. Pathophysiology
1. Normally neurons send out messages in electrical impulses periodically, and the firing of individual neurons is regulated by an inhibitory feedback loop mechanism
2. With seizures, many more neurons than normal fire in a synchronous fashion in a particular area of the brain; the energy generated overcomes the inhibitory feedback mechanism
7. Classification (see Table 5.3 below)
1. Generalized: initial onset in both hemispheres, usually involves loss of consciousness and bilateral motor activity
2. Partial: begins in focal area of brain and symptoms are appropriate to a dysfunction of that area; may progress into a generalized seizure, further subdivided into simple partial or complex partial
2. Medical management
1. Drug therapy (refer to Anticonvulsants, in Unit 2)
1. Phenytoin (Dilantin)
1. often used with phenobarbital for its potentiating effect
2. inhibits spread of electrical discharge
3. side effects include gum hyperplasia, hirsutism, ataxia, gastric distress, nystagmus, anemia, sedation
2. Phenobarbital: elevates the seizure threshold and inhibits the spread of electrical discharge
2. Surgery: to remove the tumor, hematoma, or epileptic focus
3. Assessment findings
1. Clinical picture varies with type of seizure (see Table 5.3 below)
2. Diagnostic tests
1. Blood studies to rule out lead poisoning, hypoglycemia, infection, or electrolyte imbalances
2. Lumbar puncture to rule out infection or trauma
3. Skull x-rays, CT scan, or ultrasound of the head, brain scan, arteriogram, or pneumoencephalogram to detect any pathologic defects
4. EEG may detect abnormal wave patterns characteristic of different types of seizures
1. child may be awake or asleep; sedation is ordered and child may be sleep deprived the night before the test
2. evocative stimulation: flashing strobe light, clicking sounds, hyperventilation
4. Nursing interventions
1. During seizure activity
1. Protect from injury.
1. prevent falling, gently support head.
2. decrease external stimuli; do not restrain.
3. do not use tongue blades (they add additional stimuli).
4. loosen tight clothing.
2. Keep airway open.
1. place in side-lying position.
2. suction excess mucous.
3. Observe and record seizure.
1. note any preictal aura.
1. affective signs: fear, anxiety
2. psychosensory signs: hallucinations
3. cognitive signs: "déjà-vu" symptoms
2. note nature of the ictal phase.
1. symmetry of movement
2. response to stimuli; LOC
3. respiratory pattern
3. note postictal response: amount of time it takes child to orient to time and place; sleepiness.
2. Provide client teaching and discharge planning concerning
1. Care during a seizure
2. Need to continue drug therapy
3. Safety precautions/activity limitations
4. Need to wear Medic-Alert identification bracelet or carry identification card
5. Potential behavioral changes and school problems
6. Availability of support groups/community agencies
7. How to assist the child in explaining disorder to peers

TABLE 5.3 Types of Seizures