Lecture on Seizures and Status Epilepticus

Jun 30, 2024

Lecture on Seizures and Status Epilepticus

Introduction

  • Presenter: Cathy from LevelUpRN
  • Topics: Seizures, Status Epilepticus
  • Quiz: 3 questions at the end
  • Resources: LevelUpRN medical-surgical nursing flashcards

Seizures

  • Definition: Uncontrolled electrical discharge of neurons in the brain
  • Epilepsy: Diagnosed if a patient has two or more episodes of unprovoked seizures
  • Pathophysiology:
    • Disease, injury, or unknown cause leads to hyper excitability and decreased inhibition of neuron activity
  • Risk Factors:
    • Fever (common in children: febrile seizures)
    • Cerebral edema
    • Infection (e.g., meningitis)
    • Fluid and electrolyte imbalances (especially hyponatremia)
    • Drug or alcohol withdrawal
  • Triggers:
    • Fatigue, stress, flashing lights, caffeine

Types of Seizures

  1. Tonic-Clonic Seizure (formerly grand mal)
    • Tonic Episode: Stiffening of muscles, loss of consciousness
    • Clonic Episode: 1-2 minutes of rhythmic jerking of extremities
    • Postictal Phase: Confusion, sleepiness, possible agitation
  2. Absence Seizure
    • Symptoms: Loss of consciousness for a few seconds, resembles daydreaming
    • Other Symptoms: Picking at clothes, lip smacking, eye fluttering
  3. Myoclonic Seizure
    • Symptoms: Brief jerking of extremities, usually no loss of consciousness
  4. Atonic Seizure
    • Symptoms: Loss of muscle tone, risk of falling

Diagnosis and Treatment

  • Diagnosis: EEG (electroencephalogram)
  • Medications: Antiepileptics/anticonvulsants (e.g., valproic acid, carbamazepine, phenytoin)
    • Details available in pharmacology playlist
  • Procedures:
    • Vagal Nerve Stimulator: Surgically implanted, sends electrical pulses to vagus nerve
    • Craniotomy: Remove brain tissue responsible for seizures

Nursing Care During a Seizure

  • Actions:
    • Lower patient to the floor or bed if standing or sitting
    • Turn patient to their side
    • Loosen restrictive clothing
    • Do not place anything in the mouth or restrain the patient
    • Note onset and duration of the seizure
  • Post-Seizure:
    • Check vital signs and neurological status
    • Reorient the patient
    • Implement seizure precautions (e.g., pad side rails)
    • Identify possible triggers

Status Epilepticus

  • Definition: Prolonged seizure (> 5 minutes) or failure to regain consciousness between seizures
  • Risk Factors: CNS infection, head trauma, drug withdrawal/toxicity
  • Treatment:
    • Antiepileptic agents (e.g., phenytoin)
    • Benzodiazepines (e.g., lorazepam)
    • Anesthetic agents (e.g., propofol)
    • Barbiturates (e.g., phenobarbital)
  • Nursing Care:
    • Maintain patent airway
    • Administer oxygen as prescribed
    • Assist with intubation

Quiz Questions

  1. Question: What type of seizure is characterized by blank staring, eye fluttering, and picking at clothes?
    • Answer: Absence seizure
  2. Question: What phase of a tonic-clonic seizure is characterized by confusion and sleepiness?
    • Answer: Postictal phase
  3. Question: What life-threatening disorder is characterized by a prolonged seizure or failure to regain consciousness between seizures?
    • Answer: Status epilepticus

Conclusion

  • Next Topic: Meningitis
  • Stay tuned for more videos from LevelUpRN