Fion Kung
 Define
seizure
 Types of seizure
 Understand current treatment and prevention
 Understand the diagnostic test
 Nursing diagnosis, outcome and intervention
 NCLEX style questions
 According
to the Centers for Disease
Control and Prevention
Epilepsy is the fourth most common
neurological disorder in the U.S. after
migraine, stroke, and Alzheimer's disease.
 Ten percent of the American population will
experience a seizure in their lifetime.
 Epilepsy affects 2.2 million Americans
 Epilepsy affects 65 million people worldwide.

50-70% of all cases of epilepsy is of unknown origin
 Some known causes:
 Birth trauma
 Infectious diseases
 Ingestion of toxins
 Brain tumors
 Inherited disorders
 Cerebrovascular accident

A
single sudden temporary event that consists
of uncontrolled, electrical neuronal discharge
in the brain
 It interrupts the normal function in the brain
 When a person has recurrent seizures, they
are called epilepsy

Affect variety of mental and physical functions
 Two


categorized
Partial (Focal)
Generalized
 Absence




seizures
Brief alteration in consciousness
Mild increase or decrease in muscular tone
Blinking or rolling eyes, a blank stare, slight mouth
movements
Usually last 5-30 seconds
 Tonic-clonic





seizures
Loss of
consciousness
Stertorous
respirations
Dilated pupils,
hypertension, fast
heart rate
Tonic phase
Clonic phase
Severe seizure activity known as
“status epilepticus” and is a medical
emergency characterized by either
continuous seizures lasting at least 5
minutes or 2 or more separate seizures
where recovery is incomplete.
 Epilepticus can culminate in severe
neurological injury due to cerebral
hypoxia and death can occur from
respiratory and/or cardiovascular
failure.

 Electroencephalography
(EEG)
 Computed tomography scan (CT)
 Magnetic resonance spectroscopy (MRS)
 Magnetic resonance imaging (MRI)
 Antiepileptic



Drugs (AEDs)
Dilantin (phenytoin)
Phenobarbital
Tegretol (carbamazepine)
 Surgery
 Ketogenic
diet
 Vagus nerve stimulation therapy
 Acute
confusion related to postseizure state
 Social isolation related to unpredictability of
seizures, community-imposed stigma
 Risk for ineffective airway clearance
 Risk for falls
 Risk for powerlessness
 Risk for trauma
 Readiness for enhanced knowledge
 Readiness for enhanced self-care





Rest and maintain functional capacity
Remain free of falls
Remain free of injuries
Prevent seizure
Monitor level of self-care
 Keep
the bed in low position with siderails up,
and use the padded siderails
 Monitor the vital signs, behaviors,
consciousness
 Give the antiepileptic drugs as ordered
 Reinforce learning through educational followup
 Use combination of teaching methods
 Show respect for the person and support the
person’s awareness.
 Getting
enough sleep
 Controlling stress
 Take the anticonvulsant medications daily. Do
not stop suddenly
 Avoid brain injury
 Avoid fall





Move things out of the
way so patient won't
injure him or herself.
Loosen any tight
clothing around the
neck.
Put a pillow or
something soft under
the head.
Lay him or her on one
side.
Time the seizure



Don't put anything in the
mouth.
Don't try to hold the child
down.
Don't give mouth-tomouth resuscitation until
the seizure is over
 Allow
the patient to rest
 Check for the vital signs, consciousness
 Conduct post seizure evaluation
 Check if it was the first seizure
 Check what was the patient doing prior to the
seizure
 Check for other illness
 Review current medications
 CC:
“Patient admitted to ER with loss of
consciousness related to seizure”
 PMH:
hypertension
 FMH: Father has stroke and died on his 68.
mother is healthy.
 Allergies: aspirin
 Phenytoin
(Dilantin) 3 times per day
 Therapeutic effect: reduction of seizure
activity.
 Side effects: suicidal thoughts, StevensJohnson Syndromes, diplopia, dizziness,
headache, confusion, hypotension
(Davis’s Drug Guide (2012)
 Nursing



Diagnosis:
Risk for falls
Risk for trauma
Acute confusion related to postseizure state
 Goal/Outcome:



Remain free of falls
Remain free of injuries
Rest and maintain functional capacity






Keep the bed in very low position with siderails up,
and use the padded siderails
Monitor the vital signs, behaviors, consciousness
Give the antiepileptic drugs as ordered
Call light/personal assistance systems in reach
Provide quiet place for patient to rest
Assess the patient’s behavior and cognition
systematically and continually throughout the day ad
night
 Generalized
seizure is happening in only one
part of the brain.
A. True
B. False
 What
of the following does not prevent
seizures?
A. Get enough sleep
B. Controlling stress
C. stop the anticonvulsant medications when
there is no seizure symptom present
D. prevent fall
 The
nurse answers a call bell and finds a
frightened mother whose child, the patient, is
having a seizure. Which of these actions should
the nurse take?
A. The nurse should insert a padded tongue blade
in the patient’s mouth to prevent the child from
swallowing or choking on his tongue.
B. The nurse should help the mother restrain the
child to prevent him from injuring himself.
C. The nurse should call the operator to page for
seizure assistance.
D. The nurse should clear the area and position
the client safely.
 The
nurse is caring for the male client who
begins to experience seizure activity while in
bed. Which of the following actions by the
nurse would be contraindicated?
A. Loosening restrictive clothing
B. Restraining the client’s limbs
C. Removing the pillow and raising padded
side rails
D. Positioning the client to side, if possible,
with the head flexed forward
 The
most important responsibility of the nurse
when a patient has a seizure is to:
A. Maintain the head-tilt-chin lift method.
B. Provide oxygen immediately
C. Prevent injury of the patient
D. Prevent status epilepticus

Silvestri, L. A. (2008). Comprehensive review for the nclex-rn examination
. (4 ed.). St. Louis, MO: Saunders Elsevier. (Silvestri, 2008)

Leone, M. (2011). Treatment of first tonic-clonic seizure does not affect
mortality: long-term
following a randomised clinical trial. J Neurol
Neurosurg Psychiatry. (Leone, 2011)

Faught , E., Duh, M., Weiner, J., Guerin, A., & Cunnington, M. (2008).
Nonadherence to antiepileptic drugs and increased mortality: findings
from the ransom study Neurology, 11(71(20):1572), (Faught , Duh, Weiner,
Guerin & Cunnington, 2008)

Ackley, B. J., & Ladwig, G. B. (2010). Mosb'ys guide to nursing diagnosis .
(5th ed.). Mosby. (Ackley & Ladwig, 2010)

Mary, F., (n.d). Review Article: Evidence-based models of care for
people with epilepsy. Epilepsy And Behavior, 231-6.
doi:10.1016/j.yebeh.2011.10.019

Rebecca, E., Review Article: care plan for people with
epilepsy. Epilepsy, 211-1. doi:8.1621/j.yebeh.2009.10.019

Ackley K, S., Epilepsy data. About Epilepsy. N.p., n.d. Web. 13 Nov. 2012.

Davis’s Drug Guide (2012) In nursing central [software] retrieved from PDA