1 Care of the Patient with Seizures At the end of this session the participant will: • Describe convulsive seizures • Describe non-convulsive seizures • List 3 nursing actions for a patient having a convulsive seizure • Describe nursing considerations for select anti-seizure medications.
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1 Care of the Patient with Seizures At the end of this session the participant will: Describe convulsive seizures Describe non-convulsive seizures List.
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Care of the Patient with Seizures
At the end of this session the participant will:
• Describe convulsive seizures
• Describe non-convulsive seizures
• List 3 nursing actions for a patient having a convulsive seizure
• Describe nursing considerations for select anti-seizure medications.
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SEIZURES• Definition
• An abnormal electro-physiologic phenomenon of the brain resulting in abnormal synchronization of neuronal activity manifested as altered mental state, tonic or clonic movements, convulsions, or various psychic symptoms.
• Incidence• <20 >60 yrs old, occurs before age 20 in >75% of cases.
• Epilepsy versus Seizure Disorder
• Seizure Disorder-usually an underlying cause• Epilepsy-multiple, recurrent unprovoked
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SeizuresTerms:
Aura-occurs before seizure activity, may be depression, irritability, or unusual sensations.
Ictus-the period of seizure activity.
Postictus (post-ictal)-period after the seizure, pt. may or may not be conscious. If conscious, may be confused, disoriented, tired, lethargic, nauseated.
• starts with blank stare, progresses to chewing, then other random activity
• Patient is unaware of surroundings
EEG during seizure
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SEIZURES
• Treatment• Airway Protection• PREVENT INJURY• Medical Management
• Evaluate for Cause • Describe/document
what is seen including duration
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Nursing ManagementConsiderConsider• IV access, oxygen readiness, available suction• Pad siderails (not a restraint if patient has a convulsive
disorder)• If convulsive seizure occurs
• Protect from harm - pt and staff• Do not restrain patient during seizure• Be prepared to intubate• Don’t put anything in mouth• Evaluate for underlying cause
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Medication ManagementFosphenytoin (Cerebryx)-Dosage: Load 20mg PE/kg at a rate up to 150mg
PE/minute. Converts to phenytoin in the body.Therapeutic Level: Monitored with phenytoin level and
should be 10-20mg/dl. Level to be drawn 2 hours after infusion is completed.
Side Effects: Hypotension.Instructions: May be diluted with equal volume of D5W
or NS and given on a syringe pump or mixed in a bag and given as an infusion at 150mgPE/minute. After mixing, must be refrigerated (max 7days), but can be kept at room temp. for 24 hours.
Subarachnoid Hemorrhage: 500mg IV/PO x 3 days then discontinue.Traumatic Brain Injury: 500mg IV/PO x 7 days then discontinue.
Therapeutic Level: 5-65mg/dl, how to clinically interpret this data is unknown yet.
Side Effects: Agitation, fatigue, GI.Instructions: Must be diluted with NS, D5W, or LR.
Infuse over 15 minutes. Oral and IV doses are equivalent. Use IV ONLY for patients who cannot tolerate PO for first dose.
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Status Epilepticus
Definition: one continuous unremitting seizure lasting longer than 30 minutes or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes.
• Emergency!• Monitor airway, prepare to intubate• Medical treatment includes benzodiazepines,
primarily Lorazepam (Ativan®)
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Seizure Mapping
• For patients with medically intractable seizures (unresponsive to medications)
• Small electrodes, are placed over the surface of the brain or skull/face
• Goal: identify areas causing seizures for possible surgical removal