Transcript Review of Seizures and Nursing Care

A Review of Seizures
& Nursing Care
Emily Booth RN(EC) BScN MN
[email protected]
Goals:
To understand the signs and
symptoms of a seizure
 To understand the nursing care that
can be offered pre, during and post
seizure activity
 To understand how to use the
suctioning machine
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What is a Seizure?
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A sudden, abnormal, excessive
electrical discharge from the brain that
can change motor and/or autonomic
function, consciousness or sensation
Epileptic vs Non-Epileptic
Epileptic
An abnormal excessive amount of neural
activity in the brain that originates in the
central nervous system
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Non-Epileptic
A response to stimulus that does not originate
in the central nervous system
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What are some causes of non-epileptic seizures?
Alcohol withdrawal
 Fever
 Hypoxia
 Drug Intoxication
 Poisoning
 Cardiopulmonary
 Blood Loss
 Metabolic
 Tumours
 Head Injury
 Hyperthermia
…and many more
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2 Basic Types of Seizures
Partial
Start in a specific part of the brain
Simple – no loss of consciousness
Complex – loss of consciousness
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Generalized
Affect the whole brain
(Absence/petit mal and tonic-clonic/grand mal)
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If a partial becomes a generalized, called a secondary generalized seizure
Signs and Symptoms of
Impending Seizure Activity
The person reports unusual symptoms
including:
 Smelling burnt toast
 Feeling of spiders crawling on arms
 Other odd odours, tastes or
sensations
 Auras
Terminology
Ictus
The actual seizure activity
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Postictal phase
Post seizure
Partial Seizure - Simple
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Confined to 1 brain lobe
Person is fully aware but unable to control
what is happening
May have sudden intense feelings of fear,
bliss or déjà vu
May have aura, tingling/numbing sensation,
see flashing lights
Ictus phase usually short, which can make it
difficult to identify true seizure activity
Symptoms correspond to brain lobe involved…
Frontal: movement
of extremity or
change in speech
Temporal: memory,
sound, smell,
emotions*
Parietal: tingling or
feeling of warmth
down one side of
body
Occipital: see
flashing lights,
fireballs, bright
colours shooting
across half visual
field
Nursing Management of a
Partial Seizure
Symptoms can be frightening to the
conscious person
 Offer reassurance this will pass
 Assess immediate environment
 Remember – a partial can be a
warning sign for a stronger seizure
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Partial Seizures - Complex
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Affects an entire hemisphere; does not spread
Person can not respond to commands and will not
remember event
May appear to be fully awake but with a blank stare
Automatisms – involuntary automatic behaviours such
as chewing, lip smacking, hallucinations, odd
behaviour (undressing or laughing uncontrollably)
Postictal phase may be minimal or nonexistent
Without warning, mall fall to the ground
Nursing Management
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Same as partial seizures
If person falls to the ground, assess for
injury, limb displacement
Behaviour may change if person thinks he
is being restrained – do not restrain!
Use a calm and reassuring voice
If the person gets up and starts walking
away, be prepared to follow
Generalized Seizures – Non
Convulsive
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Also called Absence or Petit Mal
May stop speak mid sentence, blank stare
Repeated lip smacking/eye blinking
Sudden brief lapse of consciousness
Will not remember event
Can be frequent but very short duration
Can normally continue with activities they
were doing before seizure
Generalized – Atypical
Absence/Petit Mal
Longer than generalized non
convulsive
 Up to 45 minutes
 Longer recovery time
 Loss of awareness not always
complete
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Generalized – Myoclonic
Seizures
Sudden brief jerking of muscle
group(s) lasting a few seconds
 Affected areas can range from pinky
finger to entire torso
 Person may report soreness or
cramping in area that was affected
 Can affect bowel/bladder control
 May lead to a tonic clonic seizure
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Generalized – Atonic
Seizures
Occurs as result of sudden loss of
tone in postural muscles
 Will drop to ground if standing/slump if
in chair
 Consciousness will be lost for a split
second
 Common injuries include ankles,
knees, chin (site of impact)
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Generalized – Convulsive
Seziures
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Tonic-Clonic/Grand Mal
Muscle spasm in which arms and legs flex
Alternates between contraction and
relaxation
Can strike without warning
Initial tonic phase – falls, brief flexion of
back followed by staring
Arms may be up in air, signalling tonic
phase is about to start
Generalized – Convulsive
Seizures Continued
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May scream or moan as air is pushed from
lungs in a tight spasm
Breathing could be impaired during this
time/become cyanotic
May lose bladder/bowel control
Pupils may become dilated
Muscular contractions start at 8 spasms per
second and intensify
Can appear very violent
Generalized – Convulsive
Transition from Tonic to Clonic
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As tonic evolves, periods of muscle
relaxation will occur/lengthen until end of
seizure
Postictal phase – will be very still with
flaccid muscles
Excessive salvation can obstruct airway
Minutes to hours to regain consciousness
Exhaustion – may sleep for hours
Will not remember the episode
May have head ache, muscle aches,
injuries
Nursing Management of a
Generalized Seizure
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Communicate throughout the episode, give
reassurance it will be stopped and he won’t
be left along
Protect ehad from banging on floor while
convulsive movements occur
Loosen tight clothing
Try to turn into recovery position
Do not force anything in mouth
Check frequently after all seziure activity
ends
Status epileptics – lasts longer than 30 minutes – an emergency!
Suctioning Equipment
Suction machine
 Suction tubing and oral
sucker/younker
 Sterile water
 Personal protective equipment as
needed
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Suctioning Procedure
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Attach tubing and younker, ensure good fit;
turn on machine
Gently insert younker into mouth
Move to all parts of mouth as necessary
Clean suction tubing/younker by suctioning
sterile water
Oral younker may be used on same person
for 24hrs
Collection container good for 24hrs
Document – Amount, appearance, any
trauma
Suctioning Reminders
Never use the younker to ‘pry’ open
the mouth/teeth
 Never use fingers to pry open
mouth/teeth
 If person starts biting, do not use the
younker as a bit block
 Talk to the person during the entire
procedure
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