Status Epilepticus PDF

10/24/23, 3:47 PM Realizeit for Student Status Epilepticus Status epilepticus (acute prolonged seizure activity) can be defined as a seizure lasting 5 minutes or longer or serial seizures occurring without full recovery of consciousness between attacks (Hickey & Strayer, 2020). The term has been b...

10/24/23, 3:47 PM Realizeit for Student Status Epilepticus Status epilepticus (acute prolonged seizure activity) can be defined as a seizure lasting 5 minutes or longer or serial seizures occurring without full recovery of consciousness between attacks (Hickey & Strayer, 2020). The term has been broadened to include continuous clinical or electrical seizures (on EEG) lasting at least 30 minutes, even without impairment of consciousness. It is considered a medical emergency. Status epilepticus produces cumulative effects. Vigorous muscular contractions impose a heavy metabolic demand and can interfere with respirations. Some respiratory arrest at the height of each seizure produces venous congestion and hypoxia of the brain. Repeated episodes of cerebral anoxia and edema may lead to irreversible and fatal brain damage. Factors that precipitate status epilepticus include interruption of anticonvulsant medication, fever, concurrent infection, or other illness. Medical Management The goals of treatment are to stop the seizures as quickly as possible, to ensure adequate cerebral oxygenation, and to maintain the patient in a seizure-free state. An airway and adequate oxygenation are established. If the patient remains unconscious and unresponsive, an endotracheal tube is inserted. IV diazepam, lorazepam, or fosphenytoin is given slowly in an attempt to halt seizures immediately. Other medications (phenytoin, phenobarbital) are given later to maintain a seizure-free state. An IV line is established, and blood samples are obtained to monitor serum electrolytes, glucose, and phenytoin levels. EEG monitoring may be useful in determining the nature of the seizure activity. Vital signs and neurologic signs are monitored on a continuing basis. An IV infusion of dextrose is given if the seizure is caused by hypoglycemia. If initial treatment is unsuccessful, general anesthesia with a short-acting barbiturate may be used. The serum concentration of the anticonvulsant medication is measured, because a low level suggests that the patient was not taking the medication or that the dosage was too low. Cardiac involvement or respiratory depression may be life-threatening. The potential for postictal cerebral edema also exists. Nursing Management The nurse initiates ongoing assessment and monitoring of respiratory and cardiac function because of the risk for delayed depression of respiration and blood pressure secondary to administration of anticonvulsant medications and sedatives to halt the seizures. Nursing assessment also includes monitoring and documenting the seizure activity and the patient’s responsiveness. The patient is turned to a side-lying position, if possible, to assist in draining pharyngeal secretions. Suction equipment must be available because of the risk of aspiration. The IV line is closely monitored, because it may become dislodged during seizures. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUAYD8aTcEKqA9iFsBPwk2RFvtNozNlLKTVk0W5HMqg… 1/2 10/24/23, 3:47 PM Realizeit for Student A person who has received long-term anticonvulsant therapy has a significant risk for fractures resulting from bone disease (osteoporosis, osteomalacia, and hyperparathyroidism), which is a side effect of therapy (Comerford & Durkin, 2020). Therefore, during seizures, the patient is protected from injury with the use of seizure precautions and is monitored closely. The patient having seizures can inadvertently injure nearby people, so nurses should protect themselves. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUAYD8aTcEKqA9iFsBPwk2RFvtNozNlLKTVk0W5HMqg… 2/2