seizures and nursing management .pptx

seizures

1. Seizure disorder Presented by : Preeti Roll no 36 BSc {n} 3 rd year

2. Check your knowledge ? Difference between epilepsy, seizures and convulsions? Etiology ? Pathophysiology ?

3. Are you ready ? https://www.youtube.com/watch?v=MBfJozL7qHM

4. Classification

5. Understand the main difference

6. 1) FOCAL/partial SEIZURES Already discussed

7. 2) Generalized seizures Generalized seizures involve abnormal electrical discharge from the both cerebral hemispheres. Also called as grand mal seizures. Consciousness is always impaired There are two major types:- Absence seizures Tonic clonic seizures

8. Absence seizures Petit mal seizure is the term used for the absence seizures. Usually last for 15 seconds . Most commonly occur in the children below the 20 years , usually occur in the childrenn of ages 6-12 years. It commonly involve the starring episode change in alertness (consciousness) The child may show a temporary blackout that lasts for a short duration.

9. Tonic clonic seizures The patient may experience a premonition just before the seizure (aura). This is followed by the stiffening of limbs in the tonic phase. The tonic phase is followed by the clonic phase in which the person starts shaking and jerking. The patient may bite his/her tongue. This stage is followed by  deep sleep (loss of consciousness) . Loss of bladder and bowel control may be seen during the seizure.

10. Phases of tonic clonic seizures Initial phase : (tonic phase) Intense muscle contraction Jaw clenches legs and arms flexed or contracted The pupil dilates chest become rigid, pallor or cyanosis Next phase : ( clonic phase) Jerking movements Last from 30 sec to 30 min

11. Diagnostic evaluation History EEG Lumbar puncture Other test : Roentgenogram Computed axial tomography positron emission tomography Magnetic resonance imaging

12. Management

13. Medical management Anticonvulsant of choice : phenobarbitone with initial dose of 20mg/kg IV slowly over 10 min If no response additional dosage of 10mg/kg over 15 min If still not controlled phenytoin is added of 20mg/kg, IV over 20 min DIAZEPAM is generally avoided in neonates Status epilepticus DOC is phenytoin

14. Surgical management Neurosurgery with uncontrolled seizures Removal of tumors , hematomas, malformations and other brain lesions. Corpus callostomy

15. Nursing management

16. Nursing assesment History.  The diagnosis of epileptic seizures is made by analyzing the patient’s detailed clinical history. Physical exam.  A physical examination helps in the diagnosis of specific epileptic syndromes that cause abnormal findings

17. Nursing diagnosis Risk for trauma or suffocation   related to loss of large or small  muscle coordination. Risk for  ineffective airway clearance related to neuromuscular impairment. Situational low self-esteem  related to stigma associated with the condition. Deficient knowledge  related to information misinterpretation. Risk for injury   related to weakness, balancing difficulties, cognitive limitations or altered consciousness.

18. Nursing interventions Prevent trauma/injury Promote airway clearance.   Improve self-esteem. Enforce education about the disease.

19. Emergency care during seizures Assist the child to a lying position. Take off eye glasses, if the child wears and loosen tight clothes. Remove dangerous objects from the vicinity of the child. Maintain patent airway and adequate oxygenation must be ensured. Administer the prescribed medications on time. Do not restrain the child during seizures. The side rails of bed should be padded. Do not force anything into the child's mouth during seizures.

20. Emergency care after seizure After the seizures are over, the child should be provided complete bed rest. Change the clothes and bed sheet, if soiled. Suction the airway, if excessive secretions are present. Turn the face of the child to one side, to avoid aspiration of secretions. Give CPR if breathing is not re-established after the attack. Observe the child until fully conscious. Treat any injury that may have occurred during convulsions. Continuously monitor the vital signs of the child. After the child is awake and fully conscious, give oral fluids like fruit juice, lemonade, etc. Administer intravenous fluids if oral intake is less. Maintain intake and output chart. Provide a non-stimulating, calm and quiet environment to the child. Parents need to be counseled regarding the disease and its prognosis. Parents should be taught how to take care of the child at home. The child should not be left alone and should not be allowed to perform activities which involve risk of injury. The child who is a known case of epilepsy should wear a medical identification card.

21. Does and dont’s https://www.youtube.com/watch?v=jJWfHHqfSbk

22. Any doubts ?

23. Let’s have a practice test

24. Practice test  In diagnosing seizure disorder, which of the following is the most beneficial? A. Brain scan B.  Skull radiographs C. Lumbar puncture D. Electroencephalogram  Tatiana has a seizure disorder; which of the following would be the lowest priority when caring for her? A. Assessing for signs and symptoms of increased intracranial pressure (ICP). B. Educating the family about anticonvulsant therapy. C. Observing and taking down data on all seizures. D. Assuring safety and protection from injury.

25. 3.The drug of choice in status epileptics is ? Phenytoin Phenobarbiton Diazepam sodium valporate 4. . Which is the most common treatment for epilepsy? A. Surgery B. Special diet C. Medication D. An implanted electrical device 5. What is the most common type of seizure? The grand mal seizure Petit mal seizure Absence seizure Both 2 and 3