1
Q
Seizures
A
are abnormal, excessive electrical discharges of neurons within the brain caused by a disease process.
Classified according to their type and etiology
2
Q
Epilepsy
A
is chronic, recurring, and diagnosed after 2 or more unprovoked seizures and all other possible etiologies for the seizures have been ruled out
3
Q
Risk Factors for Seizures
A
- some seizures have no known etiology
- febrile seizures
- cerebral edema
- intracranial infection or hemorrhage
- brain tumors of cysts
- anoxia
- toxins or drugs
- lead poisoning
- tetanus, shigella, or salmonella
- hypoglycemia, hypocalcemia, alkalosis, hyponatremia, hypernatremia, or hypomagnesemia
4
Q
Risk Factors for Epilepsy
A
- trauma
- hemorrhage
- congenital defects
- anoxia
- infection
- toxins
- hypoglycemia injury
- uremia
- migraine
- cardiovascular dysfunction
5
Q
Expected findings: Tonic-Clonic seizure
A
Generalized
- onset without warning
- TONIC PHASE (10-30 seconds)
- eyes roll upward
- LOC
- tonic contraction of entire body, with arms flexed and legs, head, and neck extended
- mouth snaps shut and tongue can be bitten
- thoracic and abdominal muscles contract
- possible piercing cry
- increased salivation
- flushing
- blood pressure and heart rate increases
- loss of swallowing reflex
- apnea leading to cyanosis
- CLONIC PHASE (30-50 seconds)
- violent jerking movements of the body
- trunk and extremities experience rhythmic contraction and relaxation
- can have foaming in the mouth
- can be incontinent of urine and feces
- gradual slowing of movements until cessation
- POSTICTAL STATE (30 minutes)
- remains semiconscious but arouses with difficulty
- confused for several hours
- impairment of fine motor movements
- lack of coordination
- possible vomiting, headache, visual or speech difficulties
- sleeps for several hours
- feel tires and can complain of sore muscles
- no recollection of the seizure
6
Q
Expected Findings: Absence Seizures
A
Generalized
- onset between ages 5-8 years old and ceases by the teenage years
- loss of consciousness lasting 5-10 seconds
- minimal or no change in behavior
- resembles daydreaming in behavior or inattentiveness
- can drop items being held, but the child seldom falls
- lip smacking, twitching of eyelids and face or slight hand movements
- unable to recall episode, but can be momentarily confused
- can immediately resume previous activities
7
Q
Expected Findings: Myoclonic Seizure
A
Generalized
- variety of seizure episodes
- symmetric or asymmetric involvement
- brief contractions of muscle of groups of muscles
- can involve only the face and trunk or one or more extremities
- no postictal state
- might not lose consciousness
8
Q
Expecting Findings: Atonic or akinetic seizure
A
Generalized
- onset between 2 and 5 years
- muscle tone is lost for a few seconds
- a period of confusion follows
- loss of muscle tone frequently resulting in falling
- if seizures are frequent, child should wear a helmet to prevent injury
9
Q
Expected Findings: West Syndrome ( infantile spasms)
A
Rare disorder with a peak onset between 3-7 months of age. Rarely occurs after 18 months of age.
- twice as common in boys
- sudden, brief, symmetric muscle contractions
- flexed head, extended arms with legs drawn up
- possible eye deviation or nystagmus
- possible LOC
- possible flushing, pallor, or cyanosis
- possible cry or giggle before or after
- can occur as a single event or in a cluster of up to 150 seizures
10
Q
Expected Findings: simple partial seizures with motor signs
A
Partial
- aversive seizure ( most common ): eyes and head turn away from side of focus, with to without LOC
- Rolandic (sylvan) seizure: Tonic-Clonic movements involving the fave, salivation, arrested sleep, and most common during sleep
11
Q
Expected Findings: simple partial with sensory sings
A
Partial
- tingling, numbness or pain in one area of the body then spreading to other parts, with visual sensations
- motor development such as hypertonia or posturing
12
Q
Expected Findings: complex partial seizures (psychomotor seizures)
A
Partial
- altered behavior
- inability to respond to environment
- impaired consciousness
- confusion and unable to recall event
- complex sensory aura: strange feeling in stomach that rises to the throat, auditory or visual hallucination, feelings of fear, distorted sense or time and self
13
Q
Lab Tests: Seizures
A
depend on age, history, and physical condition
- lead level
- WBC
- blood glucose
- serum electrolytes
- metabolic panel
- chromosomal analysis
- toxicology screen
14
Q
Diagnostic: Seizures
A
EEG
MRI
LP
CT
15
Q
Diagnostic: Seizure: EEG
A
records electrical activity and can identify the origin of seizure activity
- can be monitored during sleep, when awake, and with stimulation and hyperventilation
- test can last 1 hour to multiple periods and days
- can be preformed with video monitoring
- abstain from caffeine for several hours prior to the procedure
- wash hair before and after the procedure to remove electrode gel
- inform the child that he can be asked to take deep breaths and exposed to flawed of light during the procedure
- if prescribed, instruct the parent to withhold sleep from the child prior to the test
- inform the child that he may be allowed to sleep during the test. sleep may be withheld prior to test and may be induced during the test.
- inform the child that the test will not be painful
16
Q
Diagnostic: Seizures: MRI
A
use to detect malformations, cortical dysplasia, or tumors
17
Q
Diagnostic: Seizures: LP
A
measures spinal fluid pressure and detects infection
18
Q
Diagnostic: Seizure: CT
A
detects hemorrhage, infarction or malformation
19
Q
RN Care: Seizure
A
Initiate Seizure Precautions for any child at risk
- pad side rails of bed, crib, and wheelchair
- keep bed free of objects that would cause injury
- have suction and oxygenation ready
20
Q
RN Care: During a Seizure
A
- protect from injury ( move furniture away, hold head in lap if on the floor)
- maintain position to provide patent airway
- be prepared to suction oral secretions
- turn child to side-lying position (decreases risk of aspiration)
- loosen restrictive clothing
- do not attempt to restrain the child
- loosen restrictive clothing
- do not attempt to open the jaw or insert an airway during seizure activity. Do not put anything in the child’s mouth.
- Remove the child’s glasses
- Administer oxygen
- remain with the child
- note onset, time, and characteristic of seizure
- allow for seizure to end spontaneously
21
Q
RN Care: Postseizure
A
- maintain the child in side-lying position to prevent aspiration and facilitate drainage of oral secretions
- check for breathing, check vital signs, and check position of head and tongue
- assess for injuries, including the mouth (tongue, teeth)
- preform neurologic assessment
- allow for rest if necessary
- reorient and calm the client
- maintain seizure precautions, including placing the bed in the lowest position and padding the side rails to prevent future injury.
- check inside of mouth to see if tongue or lips have been bitten
- note the time of the postictal period
- remain with the client
- do not offer food or liquids until completely awake and swallowing reflex has returned
- encourage client to describe the period before, during, and after the seizure activity
- determine if the client experienced an aura, which can indicate the origin of the seizure in the brain
- try to determine the possible trigger, such as fatigue or stress
- document the onset and duration of seizure and client findings/observation prior to, during, and following the seizure (LOC, arena, cyanosis, motor activity, incontinence.)
22
Q
Antiepileptic Drugs (AEDs)
A
Diazepam, phenytoin, carbamazepine, valproic acid, and fosphenytoin sodium, topiramate, lamotrigine, clonazepam
- medication selection is based on the clients age, type of seizure, and other medical factors.
- a single medication is initiated at low dosage and gradually increased until seizures are controlled
- a second medication can be added to achieve seizure control
- monitor for seizure control
- assess for allergies
- monitor for adverse effects
- monitor therapeutic serum medication levels for required medications
- medications should be taken at the same time every day to enhance effectiveness
- be aware of medication and food interactions that are specific to each medication
- teach the child and family about adverse effects of the medications
- dosage can be increased as the child grows
- blood cell counts, urinalysis, and liver functions tests will be need to be obtained at frequent intervals to determine effect on organ function.
23
Q
Interpersonal care
A
- the school nurse should be involved in providing for the child’s safety in the school setting. This can include implementation of an individualized education plan or another specialized program
- referral to nutrition services if ketogenic diet. (high fat, low carb)
24
Q
Therapeutic Procedures
A
Surgical Removal and Separation
Vagal Nerve Stimulator
25
Therapeutic Procedures: Surgical Removal and Separation
- removal of a tumor, lesion, or hematoma
- Focal Resection: of an area of the brain to remove epileptogenic zone
- Hemispherectomy: removal of one hemisphere of the brain
- Corpus Callostomy: separation of the two hemisphere in the brain
26
Therapeutic Procedures: Vagal Nerve Stimulator
- under general anesthesia, the stimulator is implanted into the left chest wall and connected to an electrode that is places at the left vagus nerve. The device is then programmed to administer intermittent vagal nerve stimulation at a rate specific to the clients needs.
- treatment is adjunctive therapy for clients 12 years and older with partial onset seizures which are unmanageable with anti epileptic medications
- in addition to routine stimulation, the client can initiate vagal nerve stimulation by holding a magnet over the implantable device at the onset of seizure activity. This will either abort the seizure or lessen its severity.
27
Client Education
- educate the client and family about the importance of periodic lab testing to monitor AED levels
- do not stop medications without provider authorization
- encourage medication adherence
- inform the client about possible medication interactions
- encourage wearing a medical alert bracelet or necklace at all times
- refer the family to the states DMV to determine laws regarding driving for clients who have seizure disorders
- teach the child how to wear safety devices, such as helmets, while participating in activities
- teach the family not to leave the child unattended in water
- older children should be encouraged to use a shower, rather than a bathtub, and leave the bathroom door unlocked while showering
- avoid triggering factors such as emotional stress, sleep deprivation, fatigue, and physical abuse
28
Complications
Status Epilepticus
| Developmental Delays
29
Complications: Status Epilepticus
status epileptics is prolonged seizure activity that lasts longer than 30 minutes or continuous seizure activity in which the client does not enter a postictal phase. This acute condition requires immediate treatment to prevent loss of brain function, which can become permanent
- maintain airway, administer oxygen, establish IV, preform ECG monitoring, and monitor pulse O2 and ABG results
- administer a loading dose of diazepam or lorazepam. If seizures continue after the loading dose if given, fosphenytoin followed by phenobarbital should be administered
- provide support for the client and family
30
Complications: Developmental Delay
- promote optimal development
- make appropriate referrals
- provide support to family
Pediatric
flashcards
Decks in class (16)
# Cards
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Family Centered Nursing Care29
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Physical Assessment Findings118
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Health Promotion of Infants64
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Health Promotion for Toddlers (1-3 years)36
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Health Promotion of Preschoolers (3-6years)28
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Health Promotion of School-Aged Children (6-12 years)24
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Health Promotion of Adolescents (12-20 years)26
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Safe Administration of Medication17
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Pain Management31
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Hospitalization, Illness, and Play42
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Death and Dying16
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Acute Neurologic Disorders40
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Seizures30
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Head Injury20
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Cognitive and Sensory Impairments45
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Oxygen and Inhalation Therapy34
