Seizure (Epilepsy) | Nursing Prep India

Seizure ( Epilepsy)

A seizure occurs when the nerve cells in the brain send out sudden, excessive, uncontrolled electrical signals. All brain functions including feeling, seeing, thinking and moving muscl. depend on electrical signals present between nerve cells in the brain.

Convulsions: The term convulsion is sometimes used as a synonym for seizure but not seizures are characterized by convulsions. Convulsions or fits are abnormal, involunta contraction of muscles seen in seizure disorder.

Epilepsy is a disorder characterized by recurring seizures. Means a pattern of repeat seizures is referred to as epilepsy.

CAUSES

Unknown

Hypoxemia
Vascular insufficiency
Fever
Hyperglycemia
Hypocalcemia
Toxemia in pregnancy
CVA (Thrombosis, embolism, Hemorrhage)
Hypertension
Infection of CNS
Metabolic change
Brain tumour
Drug withdrawal
Allergy
Degenerative brain disorder
Head injury/Head trauma (conclusion, brain contusion)
Meningitis, encephalitis, brain abscess etc.

CLASSIFICATION OF SEIZURES

Generalized Seizure
- Tonic clonic seizure (grand mal)
- Absence (petit mal)
- Minor, Motor Seizures (Akinetic, Myoclonic, Atonic)
Partial (Focal)
- Simple partial
- Complex partial

3. Status Epileptics: It is a state in which a client has continuous seizures or seizures lasting at least 30 minutes. It is a medical emergency:

( a) Tonic-clonic (grand mal):

It is a common type of epilepsy. A grand mal fit may pass through three stages are:

i). Aura (Onset of fits):

This is an initial warning stage before the fit. Symptoms are:

Visual disturbances
Hallucination
Epigastric discomfort
Psychogenic changes
Abnormal sensation of smell, taste, nausea

ii). Tonic: 30 sec. duration

Synaptoms are

Flexion of arms
Loss of consciousness
Extension of legs
Tonic contraction of muscles
A cry sound due to spasm of respiratory muscles

iii). Clonic: Duration (1-5 min)

It is immediately followed by a clonic phase during which there is a violent jerking of face and limbs biting of tongue, incontinence of urine and faeces

iv). Postictal phase:

Unconsciousness (coma)
It lasts for few minutes to several hours. There may be headache, confusion, sleepiness, automatic behaviour.

(b) Petit mal seizures (absence fits):

It is typically seen in children during an absence attack. Symptoms are

Child stops working
Looks confused
May blink or roll up the eyeball
Not responds to verbal commands.

CLINICAL MANIFESTATIONS

Impaired consciousness.
Excess or loss of muscle tone or movement.
Cyanosis.
Fixed jaw.
Dilated and fixed pupils.
Body stiffness.
Disturbance of behaviour, mood sensation and perception.
Disturbance of autonomic functions of the body.
Incontinence of urine.

DIAGNOSTIC EVALUATIONS

History of seizures.
CT scan
MRI
Electroencephalograph
Neuropsychological tests for epilepsy

MANAGEMENT

Medical Management (Pharmacological Therapy)

Anticonvulsant or Antiepileptic, eg,

Phenytoin
Carbamazepine
Phenobarbital
Valproate
Primidone

Surgical Management

By destroying minute areas of the brain.

Nursing Management

Nursing care before seizures

To maintain airway
To prevent injury
To observe seizure
To administer drug

Nursing care after seizures

To assist behavioural and conditions of patient after seizure
Instruct to patient that treatment of seizure will be long duration.
To give instruction to family member's of patient about care giving during seizure
Drugs should not be discontinuing without permission of doctor
Do not drive alone, avoid swimming, horse riding
Patient should sit on floor when he/she feels Aura signs

Nursing Diagnosis

Risk for injury related to seizures and cerebral edema.
Hyperthermia related to infectious process
Ineffective tissue perfusion related to disease condition
Disturbed thought process related to personality changes
Risk for chronic low self-esteem related to seizure, social isolation, misperceptions
Deficient knowledge related to lack of exposure Information misinterpretation, treatment and safety measures