SEIZURE (AutoRecovered).pptx epilepsy nursing management

seizure and epilepsy

1. SUBMITTED TO : DR. MEENA PAGARWAR AP CHILD HEALTH NURSING SUBMITTED BY: COLLEGE OF NURSING, GMC, NAGPUR. MS.JYOTI V MADANE MSC NURSING 1 ST YEAR CON,GMC,NAGPUR. SEIZURE AND EPILEPSY

2. GENERAL OBJECTIVE: At the end of teaching learning activity, class will be able to define seizure and epilepsy, enlist the types and clinical manifestations of epilepsy, able to know diagnostic methods in epilepsy, medical, surgical and nursing management along with preventive measures to be taken in epilepsy. SPECIFIC OBJECTIVE : At the end of this teaching learning activity class will be able, To define seizure and epilepsy. To explain pathophysiology of epilepsy. To enlist the types of epilepsy. To be aware of causes of epilepsy. To understand the clinical manifestations of epilepsy. To know the diagnostic methods in epilepsy. To discuss medical, surgical and nursing management of epilepsy. To acquire in depth knowledge to handle client of epilepsy and its preventive measures .

3. INTRODUCTION Seizure episodes are a result of excessive electrical s discharges in a group of brain cells. Different parts of the brain can be the site of such discharges. Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. Seizures can also vary in frequency, from less than one per year to several per day. One seizure does not signify epilepsy (up to 10% of people worldwide have one seizure during their lifetime) Epilepsy is a chronic noncommunicable disease of the brain that affects around 50 million people worldwide. It is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized) and are sometimes accompanied by loss of consciousness and control of bowel or bladder function .

4. Define: Seizures consist of abnormal motor and sensory activity, and are due to a sudden, excessive discharge from cerebral neurons. Seizures are symptoms of underlying neurological brain disorder. Can involve part or all of brain Seizures, generally sudden and transient, should be viewed as a symptom and not a disease. TWO CATEGORIES OF SEIZURES Idiopathic: Attributed to a genetic or developmental defect. The definite cause for the seizure cannot be identified. Acquired Cause for seizure can be identified. Brain tumors, stroke, hypoxemia (anything that decreases 02 to the brain), head injury, infections, toxic, drug withdrawal, medications , Infants: Fever Leading cause in elderly: Stroke and cerebral metastasis

5. Definition of EPILEPSY: Epilepsy is a common condition that affects the brain and causes frequent seizures . Epilepsy is defined as having two or more unprovoked seizures .

6. PATHOPHYSIOLOGY

7. TYPES OF EPILEPSY

8. ETIOLOGICAL FACTORS

9. Though there is no one identifiable cause found in half of the people suffering from the condition, several factors have been found to be responsible for epilepsy due to various factors such as: Genetic Influence : Some common types of epilepsy are characterized by genetic influence. There are certain genes that run in families that may be responsible for seizures in a person. Head injury : Traumatic brain injury in car accidents or other trauma can also cause epilepsy in a person. Abnormalities in the brain: Certain brain abnormalities like tumors , stroke, cavernous malformations or vascular malformations can also cause epilepsy. Infections: Certain infections like HIV, meningitis, viral encephalitis and other parasitic infections can also cause epileptic seizures in a person. Prenatal injury before birth Developmental disorders like autism

10. CLINICAL MANIFESTATIONS

11. The following are general symptoms of epilepsy : Staring Jerking movements of the arms and legs. Stiffening of the body. Loss of consciousness. Breathing problems or breathing stops. Loss of bowel or bladder control. Falling suddenly for no apparent reason, especially when associated with loss of consciousness. Not responding to noise or words for brief periods. Appearing confused or in a haze. Nodding the head rhythmically, when associated with loss of awareness or even loss of consciousness. Periods of rapid eye blinking and staring

12. Diagnostic tests may include: History past and present illness Physical and neurological examination Blood tests Electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp. Magnetic resonance imaging (MRI) Computed tomography Lumbar puncture (spinal tap).

13. The goal of seizure management is to control, stop, or decrease the frequency of the seizures. The major goals of seizure management include the following: Proper identification of the type of seizure. Using medication specific to the type of seizure. Using the least amount of medication to achieve adequate control. Maintaining good medicating levels. Treatment may include : Medications :- There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, side effects, the cost of the medication, and the adherence with the use of the medication. MEDICAL AND SURGICAL MANAGEMENT

14. Common epilepsy medications include: levetiracetam (Keppra) lamotrigine (Lamictal) topiramate (Topamax) valproic acid (Depakote) carbamazepine (Tegretol) ethosuximide ( Zarontin ) Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles, or syrup), It is important to give your child his/her medication on time and as prescribed by your physician. All medications can have side effects, although some children may not experience side effects Ketogenic diet - whose seizures are not being well controlled, may be placed on a special diet called the ketogenic diet. This type of diet is low in carbohydrates and high in protein and fat.

15. SURGICAL MANAGEMENT If medication can’t decrease your number of seizures, another option is brain surgery . Resection The most common surgery is resection. This involves removing the part of your brain where the seizures start. Most often, the temporal lobe is removed in a procedure known as temporal lobectomy. In some cases, this can stop seizure activity. In some cases, you’ll be kept awake during this surgery so doctors can talk with you and avoid removing part of the brain that controls important functions such as vision, hearing, speech, or movement. Multiple subpial transection If the area of the brain is too big or important to remove, surgeons may perform another procedure called a multiple subpial transection, or disconnection. During this procedure, the surgeon makes cuts in your brain to interrupt the nerve pathway. This cut keeps seizures from spreading to other areas of your brain.

16. After surgery, some people are able to cut down on antiseizure medications or even stop taking them, their doctor’s oversight. There are risks to any surgery, including a negative reaction to anesthesia, bleeding, and infection. Surgery of the brain can sometimes result in cognitive changes. Neurosurgery has been aided by several advances, including microsurgical techniques, EEGs with depth electrodes, improved illumination and homeostasis, and the introduction of neuro- leptanalgesic agents ( droperi-dol and fentanyl). These techniques, combined with use of local anesthetic agents, enable the neurosurgeon to perform surgery on an alert and cooperative patient.

17. Using special testing devices, electrocortical mapping, and the patient's responses to stimulation, the boundaries of the epileptogenic focus ( ie , abnormal area of the brain) are determined. Any abnormal epileptogenic focus is then excise. Vagus nerve stimuation As an adjunct to medication and surgery in adolescents and adults with partial seizures, a generator may be implanted under the clavicle. The device is connected to the vagus nerve in the cervical area, where it delivers electrical signals to the brain to control and reduce seizure activity. External programming system is used by the physician to change stimulator settings. Patients can turn the stimulator on and off with a magnet. Resection surgery significantly reduces the incidence of seizures in patients with refractory epilepsy, however, more research is needed to determine the effect of surgery on quality of life, anxiety, and depression, all issues for these patients

18. NURSING MANAGEMENT Assessment The nurse elicits information about the patient's seizure history. The patient is asked about the factors or events that may precipitate the seizures. Alcohol intake is documented. The nurse determines whether the patient has an aura before an epileptic seizure, which may indicate the origin of the seizure ( eg , seeing a flashing light may indicate that the seizure originated in the occipital lobe). Observation and assessment during and after a seizure assist in identifying the type of seizure and its management.

19. NURSING DIAGNOSIS: Risk for injury related to seizure activity. Fear related to the possibility of seizures. 3. Ineffective individual coping related to stresses imposed by epilepsy. 4. Deficient knowledge related to epilepsy and its control.

20. NURSING INTERVENTIONS Preventing Injury Injury prevention for the patient with seizures is a priority. If the type of seizure the patient is having places him or her at risk for injury, the patient should be lowered gently to the floor (if not in bed), and any potentially harmful items nearby ( eg , furniture) should be removed. The patient should never be restrained or forced into a position, nor should anyone attempt to insert anything into the patient's mouth once a seizure has begun. Patients for whom seizure precautions are instituted should have pads applied to the side rails while in bed.

21. Reducing Fear of Seizures:- Fear that a seizure may occur unexpectedly can be reduced by the patient's adherence to the prescribed treatment regimen. Cooperation of the patient and family and their trust in the prescribed regimen are essential for control of seizures. The nurse emphasizes that the prescribed antiseizure medication must be taken on a continuing basis and that drug dependence or addiction does not occur. Periodic monitoring is necessary to ensure the adequacy of the treatment regimen, to prevent side effects, and to monitor for drug resistance. In an effort to control seizures, factors that may precipitate them are identified, such as emotional disturbances, new environmental stressors, onset of menstruation in female patients, or fever.

22. The patient is encouraged to follow a regular and moderate routine in lifestyle, diet (avoiding excessive stimulants), exercise, and rest (sleep deprivation may lower the seizure threshold). Moderate activity is therapeutic, but excessive exercise should be avoided. An additional dietary intervention, referred to as the ketogenic diet, may be helpful for control of seizures in some patients .This high- protein, low- carbohydrate diet is most effective in children Photic stimulation (bright flickering lights, tele vision viewing) may precipitate seizures, wearing dark glasses or covering one eye may be preventive. Tension states (anxiety, frustration) induce seizures in some patients. Classes in stress management may be of value. Because seizures are known to occur with alcohol intake, alcoholic beverages should be avoided.

23. Improving Coping Mechanisms The social, psychological, and behavioral problems that frequently accompany epilepsy can be more of a disability than the actual seizures. Epilepsy may be accompanied by feelings of stigmatization, alienation, depression, and uncertainty. The patient must cope with the constant fear of a seizure and the psychological consequences these problems are compounded during adolescence and add to the challenges of dating, not being able to drive, and feeling different from other people.

24. Adults face these problems in addition to the burden of finding employment, concerns about relationships and childbearing, insurance problems. and legal barriers. Alcohol abuse may complicate matters. Family reactions may vary from outright rejection of the person with epilepsy to overprotection. As a result, many people with epilepsy have psychological and behavioral problems Counselling assists the patient and family to under- stand the condition and the limitations it imposes. Social and recreational opportunities are necessary for good mental health. Nurses can improve the quality of life for patients with epilepsy by teaching them and their families about symptoms and their management.

25. Providing Patient and Family Education Perhaps the most valuable facets of care contributed by the nurse to the person with epilepsy are education and efforts to modify the attitudes of the patient and family toward the disorder. The person who experiences seizures may consider every seizure a potential source of humiliation and shame. This may result in anxiety, depression, hostility, and secrecy on the part of the patient and family. Ongoing education and encouragement should be given to patients to enable them to overcome these reactions. The patient with epilepsy should carry an emergency medical identification card or wear a medical information bracelet. The patient and family need to be educated about medications as well as care during a seizure.

26. It’s important to note that most seizures don’t require emergency medical attention, and you can’t stop a seizure once it’s in progress. When you’re with somebody having a mild seizure: Stay with the person until their seizure ends and they’re awake. Once they’re awake, guide them to a safe place and tell them what happen. Stay calm and try to keep other people calm. Speak calmly. Check for a medical bracelet. Offer to help the person get home safely.

27. If the person is having a tonic- clonic seizure, which causes uncontrolled shaking or jerking: Ease the person to the ground. Turn them gently onto their side to help them breathe. Clear any dangerous objects away from them. Put something soft under their head. If they wear glasses, remove them. Loosen any clothing, such as a tie, that may affect breathing. Time the seizure and call 108 if it lasts longer than 5 minutes. When someone is having a seizure, it’s critical to never : Hold the person down or try to stop their movements Put anything in their mouth Give them mouth to mouth Offer the person food or water until they’re fully alert.

28. RESEARCH EVIDENCES: Psychological treatments for people with epilepsy Rosa Michaelis , Venus Tang , Janelle L Wagner , Avani C Modi , William Curt LaFrance Jr , Laura H Goldstein , Tobias Lundgren , and Markus Reuber . Abstract Background Given the significant impact epilepsy can have on the health‐related quality of life ( HRQoL ) of individuals with epilepsy and their families, there is great clinical interest in evidence‐based psychological treatments, aimed at enhancing psychological well‐being in people with epilepsy. A review of the current evidence was needed to assess the effects of psychological treatments for people with epilepsy on HRQoL outcomes, in order to inform future therapeutic recommendations and research designs. Objectives: To assess the effects of psychological treatments for people with epilepsy on HRQoL outcomes. Authors' conclusions Implications for practice: Psychological interventions and self‐management interventions improved QoL, and emotional well‐being, and reduced fatigue in adults and adolescents with epilepsy. Adjunctive use of psychological treatments for adults and adolescents with epilepsy may provide additional benefits to QoL in those who incorporate patient‐centered management. Implications for research: Authors should strictly adhere to the CONSORT guidelines to improve the quality of reporting on their interventions. A thorough description of the intervention protocol is necessary to ensure reproducibility.

29. Summary: At the end of the class the student have gain knowledge abo Epilepsy and Seizure and its types, risk factors, clinical features, diagnostic evaluation, and its medical, surgical and nursing management.

30. Conclusion: Epilepsy is a group of syndromes characterized by recurring seizures. A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function. Seizure are sudden, abnormal electrical discharges from the brain that results changes in sensation behavior movements, perceptions, or consciousness

31. BIBILIOGRAPHY Brunner and suddarths , TEXT BOOK OF MEDICAL SURGICAL NURSING, 10TH edition, Lippincott Williams and Wilkins page 2105- 2109. Lippincott, "MANNUAL OF NURSING PRACTICE", 8th edition, Lippincott Williams and Willkins page 1904- 1908. https://www.ninds.nih.gov/health- information/disorders/epilepsy- and- seizures#:~:text=Epilepsy%20is%20a%20chr onic%20brain,thoughts%2C%20feelings%2C %20and% https://www.who.int/news-room/fact- sheets/detail/epilepsy . https://www.cdc.gov/epilepsy/index.html . https://www.ncbi.nlm.nih.gov/pmc/articles/P MC6485515/