Epilepsy (NEUROLOGICAL CONDITION) presentation

complete information for the management and care of patient suffering from epilepsy definition ,classification, types, pathophysiology ,clinical manifestation, diagnostic evaluation, medical management, nursing management, care provided to the patient suffering from epilepsy .

1. EPILEPSY Submitted To: Mrs. Mamta Toppo Associate professor College of Nursing RIMS Ranchi Submitted By: Sachita Tiu Roll No. 30 Basic Bsc nursing 3 rd year RIMS ,Ranchi

2. Introduction Definition Causes and risk factors Aura Classification Pathophysiology Clinical manifestation Diagnostic evaluation Medical management Surgical management Complication Prevention Diet Nursing responsibility Seizure first aid Health education Nursing diagnosis Nursing inetervention Summary New research Bibliography CONTENT

3. INTRODUCTION Epilepsy is derived from the Greek word Epilepsy which means take hold of or to seize . In 400BC Hippocrates described that EPILEPSY is disease of brain. It is a brain disorder in which a person has repeated seizure over time (epilepsy = 2-3 seizure). It is caused due to electrical disturbance in the nerve cell which results in emit abnormal reoccurring uncontrolled electric discharge. It is followed by loss of consciousness, excess muscle movement, disturbance of behavior,mood,sensation etc.

4. DEFINITION A neurological disorder marked by sudden recurrent episode of sensory disturbance,loss of consciousness or convulsions associated with abnormal electrical activity in the brain. Or Epilepsy is the two or more unprovoked seizure.A chronic non-communicable disease of the brain that affect people of all ages. - World health organization

5. Causes and risk factors Traumatic brain injury Abnormal brain development Disturbance in nerve signal Genetic influence
Infection such as meningitis,encephalitis, AIDS . Brain tumor Exposures to lead carbon monoxide and other poison. Overdose of antidepressants and other drugs.

6. AURA An  aura  is a feeling, experience, or movement that just seems different. It can also be a warning that a  seizure  is going to happen.

7. CLASSIFICATION Focal/ partial seizure Distributed/ generalized seizure

8. When an epileptic seizure starts in one side of the brain, it’s called a focal onset seizure or a focal seizure. During a focal seizure , you stay fully aware of what’s happening around you, even if you can’t move or respond.  1. FOCAL SEIZURE

9. Simple Complex Type

10. SIMPLE PARTIAL SEIZURE A  simple  partial  seizure  is a type of  seizure  associated with epilepsy. It may also be referred to as a focal  seizure During a simple partial seizure, formerly known as a focal seizure, the individual remains aware . A simple partial seizure may involve sensory, motor, psychic, or autonomic symptoms .

11. Complex partial seizure The persoon may loss consciousness for a period of time. It may result in altered consciousness,non purposeful movement eg.walking in circulation, hand tubing etc.

12. 2.Generalized seizure Generalized seizures are characterized by the sudden onset of abnormal electrical activity involving both sides of the brain. There are six different types of generalized seizure. 

13. Type of generalized seizure

14. Absence seizures:  Historically known as petit mal seizures, absence seizures involve a short period of time in which you lose a sense of awareness or "space out." This type is most common in children between the ages of 4 and 14 and usually lasts 20 to 30 seconds

15. Tonic seizures:  These seizures cause your muscles to suddenly stiffen, which can prompt you to fall if you're standing up. Tonic seizures often happen during sleep and usually involve a loss of consciousness

16. Atonic seizures:   When you have an  atonic seizure , your muscles lose tone and control, becoming limp, and you may collapse. These are often referred to as "drop seizures."

17. Myoclonic seizures:  If you've ever been asleep and suddenly woken up because one of your muscles suddenly jerked, you know what a myoclonic seizure feels like. These seizures involve sudden, quick jerks in your arms or legs. You may have a number in a row or just one on occasion .

18. Clonic seizures:   Similar to myoclonic seizures, clonic seizures involve sudden, jerky muscle movement, only in this case, it's repetitive. Usually, clonic seizures are involved in a tonic-clonic seizure.

19. Tonic-clonic seizures:   Previously called grand mal seizures, these seizures are the type that most people associate with epilepsy. First, in the tonic stage, your muscles stiffen, then you lose consciousness and fall to the ground. Next is the clonic stage, in which your arms and sometimes your legs begin jerking or twitching quickly and repeatedly. These seizures typically last for a few minutes.

20. What is this seizure called?

21. PATHOPHYSIOLOGY

22. Clinical manifestation Partial seizure Consciousness is fully preserved. Motor disturbance in any part of body. Electric shock like feeling,tingling Hallucinations Change in skin colour, BP, heart rate, pupil size Memory disturbance. Illusion of size , structured hallucinations, fear, , irritability,depression. Aura may be present for short time. Generalized seizure Temporary confusion Uncontrollable jerking movement of arms and legs
Loss of consciousness and awareness. Involuntary changes in body movement,function , sensation or behavior. Dizziness, tightening of chest.

23. DIAGNOSTIC EVALUATION Physical examination Neurological and behavioral examination Blood test Lumber puncher EEG CT MRI PET Neuropsychological test

24. MEDICAL MANAGEMENT Carbamazepine 1600mg/day Phenytoin Clonazepam 20mg/day Valporic acid 15mg/kg/day Ethosuximide1000mg/day

25. SURGICAL MANAGEMENT Temporal Lobectomy Extra temporal resection Corpus callostomy Hemispherectomy Vagus nerve stimulation.

26. COMPLICATION Hematoma Hemorrhage Aseptic meningitis Infection Deep vein thrombosis Dysphasia Death

27. PREVENTION Prevent traumatic brain injury (wear helmet & seat belt. Get adequate sleep at night. Stay away from alcohol and drugs. Minimize screen timing (TV /phone/computer). Manage stress Practice meditation,relaxation technique,yoga and deep breathing exercise to decrease anxiety and depression. Keep away from bright light and other visual stimuli.

28. DIET MANAGEMENT Ketogenic diet is preferred. It means food rich in:- Fat Low carbohydrates Normal protein Vitamin Calcium reach food

29. NURSING RESPONSIBILITY Move harmful object out of the way,cushion the head and protect the person from falling. Side rails should be padded to prevent injury. Lossen ties , scarves and other neckware. Don’t put anything in person mouth. The individual should not be restrained because this may increase the risk of injury. Oral airway and suction should be redily available. Make sure the airway is clear and the person is breathing.

30. NURSING DIAGNOSIS Risk for injury related to loss of consciousness during seizure activity and post physical weakness. Ineffective airway clearance related to blockage of the tongue,enditrachial, increase secration of saliva. Ineffective breathing pattern related to neuromuscular impairment, dyspea and apnea Risk for ineffective cerebral tissue perfusion related to decreased oxygen supply to the brain. Ineffective self -health management related to drug therapy and life style adjustment.

31. NURSING INTERVENTION

32. Risk for injury releated to loss of consciousness during seizure activity and post physical weakness. Remove potentially harmful object from the environment. Keep sucction, ambulance bag ,oral or nasopharyngeal airway and oxygenation if needed. Use padded side rails to prevent injury during a seizure. Instruct patient to carry medic ID card to provide information in case of emergency. Remain with the patient during seizure to protect from injury. Monitor neurological status to identify any deficits resulting from seizure. Record seizure characteristics: body part involved,motor activity and seizure progression.

33. Ineffective airway clearance related to blockage of the tongue, endotracheal,incresed secretion of saliva. Auscultate breathing sound every 1 to 4 hours. Monitor respiratory pattern including :rate ,depth, and efforts. Monitor blood gas values and pulse oxygen saturation levels as available. Provide proper position ,elevate head of the bed up to 30-45degree.

34. Ineffective breathing pattern releated to neuromuscular impairment,dyspnea and apnea . Monitor respiratory and oxygenation status to determine presence and extent of breathing problem and to initiate appreciate intervention. Provide side line position to maximize ventilation potential and decrease risk of aspiration. Perform endotracheal or nasotracheal suctioning to maintain airway. Loosen clothing to prevent restricted breathing. Maintain oxygenation and prevent hypoxia.

35. Risk for ineffective cerebral tissue perfusion releated to decrease oxygen supply to the brain Maintain head of the bed flat or less than 30 degree.

36. Inefficient self health management releated to drug therapy and lifestyle adjustment. Assess the patient’s current level of knowledge related to specific disease process to establish learning needs. Discuss life style changes. Discussion therapy/ treatment option and describe rationale behind management so that the patient and family can make lifestyle modification to manage a chronic disease.

37. HEALTH EDUCATION Safty education and first aid training Medication information and seizure reduction plan Social and mental health education. Counselling to patient and family members. Take mediation exactly as directed,skipPing dozes can affect the way your body handles the mediation which would cause to have a seizure
Don’t drink alcohol or use any mediation without talking with your health care first. Wear a medic alert identity card

38. Summary Epilepsy is a neurological disorder caused by the electrical disturbance in the brain.This electrical disturbance causes episode called as seizure.It can occurred in any age group.I t is classified into two parts : Focal and generalized seizure.

39. NEW RESEARCH

40. BIBLIOGRAPHY PV A Textbooks of medical surgical nursing Page no 353-356. Brunnars And suddarth Text book of medical surgical nursing.twelve edition page no.290-295 www.Wikipedia.org www.Slideshare.net.in www.Healthline.com www.researchgate.com

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