Epilepsy.pdf

Adult Nursing Hinkle, J. L., & Cheever, K. H. (2022). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd. Epilepsy Lecturer: Dr. Mohammad Mahdi Saeed Learning Outcomes: Define seizures and epilepsy Enumerate types and clinical manifestations Identify risk facto...

Adult Nursing Hinkle, J. L., & Cheever, K. H. (2022). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd. Epilepsy Lecturer: Dr. Mohammad Mahdi Saeed Learning Outcomes: Define seizures and epilepsy Enumerate types and clinical manifestations Identify risk factors and causes and common complications Nursing care during and after epilepsy Medical managements and medications 1 Epilepsy Define o Seizures are episodes of abnormal motor, sensory, autonomic, or psychic activity (or a combination of these) that result from sudden excessive discharge from cerebral neurons. o Epilepsy is more than one unprovoked seizure. o Three main seizure types: focal onset, generalized onset, and unknown onset seizures Pathophysiology The underlying cause is an electrical disturbance (arrhythmia) in the nerve cells in one section of the brain; these cells emit abnormal, recurring, uncontrolled electrical discharges. The characteristic seizure is a manifestation of this excessive neuronal discharge. Associated loss of consciousness, excess movement or loss of muscle tone or movement, and disturbances of behavior, mood, sensation, and perception may also occur. Causes of Seizure The specific causes of seizures are varied and can be categorized as genetic, due to a structural or metabolic condition, or the cause may be yet unknown etiologies (Fisher et al., 2017). Causes of seizures include: Allergies Brain tumor Cerebrovascular disease CNS infections Drug and alcohol withdrawal Fever (childhood) Head injury Hypertension Hypoxemia of any cause, including vascular insufficiency Metabolic and toxic conditions (e.g., kidney injury, hyponatremia, hypocalcemia, hypoglycemia, pesticide exposure) 2 Clinical Manifestation The initial pattern of the seizures indicates the region of the brain in which the seizure originates. Only a finger or hand may shake, or the mouth may jerk uncontrollably. The person may talk unintelligibly; may be dizzy; and may experience unusual or unpleasant sights, sounds, odors, or tastes, but without loss of consciousness. Generalized seizures often involve both hemispheres of the brain, causing both sides of the body to react. Intense rigidity of the entire body may occur, followed by alternating muscle relaxation and contraction (generalized tonic–clonic contraction). The simultaneous contractions of the diaphragm and chest muscles may produce a characteristic epileptic cry. The tongue is often chewed, and the patient can be incontinent of urine and feces. After 1 or 2 minutes, the convulsive movements begin to subside; the patient relaxes and lies in deep coma, breathing noisily. The respirations at this point are chiefly abdominal. In the postictal state (after the seizure), the patient is often confused and hard to arouse and may sleep for hours. Many patients report headache, sore muscles, fatigue, and depression. Other generalized seizures may be absence types of seizures. Focal seizures are subdivided into events characterized by both motor and non-motor symptoms. There may be an impairment of consciousness or awareness or other dyscognitive features, localization, and progression of symptoms. Diagnostic Studies MRI is used to detect structural lesions such as focal abnormalities, cerebrovascular abnormalities, and cerebral degenerative changes. The EEG furnishes diagnostic evidence for a substantial proportion of patients with epilepsy and assists in classifying the type of seizure. SPECT is an additional tool that is sometimes used in the diagnostic workup. It is useful for identifying the epileptogenic zone so that the area in the brain giving rise to seizures. Occurrence of an aura (a premonitory or warning sensation, which can be visual, auditory, or olfactory) 3 The Epilepsies Epilepsy is a group of syndromes characterized by unprovoked, recurring seizures. Epileptic syndromes are classified by specific patterns of clinical features, including age at onset, family history, and seizure type. Epilepsy can be primary (idiopathic) or secondary (when the cause is known and the epilepsy is a symptom of another underlying condition, such as a brain tumor). Nursing Care during a Seizure  Provide privacy, and protect the patient from curious onlookers. (The patient who has an aura may have time to seek a safe, private place.)  Ease the patient to the floor, if possible.  Protect the head with a pad to prevent injury (from striking a hard surface).  Loosen constrictive clothing and remove eyeglasses.  Push aside any furniture that may injure the patient during the seizure.  If the patient is in bed, remove pillows and raise side rails.  Do not attempt to pry open jaws that are clenched in a spasm or attempt to insert anything in the mouth during a seizure. Broken teeth and injury to the lips and tongue may result from such an action.  Do not attempt to restrain the patient during the seizure, because muscular contractions are strong and restraint can produce injury.  If possible, place the patient on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mucus. If suction is available, use it if necessary to clear secretions. Nursing Care after the Seizure  Keep the patient on one side to prevent aspiration. Make sure the airway is patent.  On awakening, reorient the patient to the environment.  If the patient is confused or wandering, guide the patient gently to a bed or chair.  If the patient becomes agitated after a seizure (postictal), stay a distance away, but close enough to prevent injury until the patient is fully aware. 4 Patients with epilepsy, particularly those with generalized events that are medically refractory, are at serious risk for Sudden Unexpected Death in Epilepsy (SUDEP), defined as nontraumatic, nondrowning unexpected death of a patient with epilepsy. Woman epilepsy  Women with epilepsy often note an increase in seizure frequency during menses.  Women of childbearing age who have epilepsy require special care and guidance before, during, and after pregnancy.  The risk of congenital fetal anomaly is two to three times higher in women with epilepsy. Maternal seizures, anticonvulsant medications, and genetic predisposition all contribute to possible malformations.  Mothers who are at high risk (teenagers, women with histories of difficult deliveries, women who use illicit drugs [e.g., “crack” cocaine, heroin], and women with diabetes or hypertension) should be identified and monitored closely during pregnancy, because damage to the fetus during pregnancy and delivery can increase the risk of epilepsy.  Anticonvulsant = osteoporosis 5 Risk Factors  Older adults have a high incidence of new-onset epilepsy  Cerebrovascular disease is the leading cause of seizures in the older adult  Head injury is one of the main causes of epilepsy that can be prevented. Medications Medications control seizures in 70% to 80% of patients with seizures. Side effects are: idiosyncratic or allergic disorders, which manifest primarily as skin reactions; acute toxicity, which may occur when the medication is initially prescribed; and chronic toxicity, which occurs late in the course of therapy. Drug toxicity = phenytoin = gingival hyperplasia Nursing diagnosis  Risk for injury associated with seizure activity  Fear associated with the possibility of seizures  Difficulty coping associated with stresses imposed by epilepsy  Lack of knowledge associated with epilepsy and anticonvulsant medications Complications The major potential complications for patients with epilepsy are status epilepticus and medication side effects (toxicity). 6