2 NCP Seizure Disorders

The Simson in Seizure disorderSeizure Disorder is a brain disorder that involves recurring disruptions called seizures in the electrical activity in the brain. The brain is a complex electrochemical organ and body’s nerves use electric discharges in this electrical network, something like a small storm in the brain.

Experiencing a seizure in not always a symptom of seizure disorder. A Seizure Disorder involves recurring seizures,so that person must experience at least two to be diagnosed. Many people experience a single seizures during their life and never have another. Seizures are not a sign of mental illness and are not contagious. Having seizures in not necessarily linked to cognitive impairments and problems processing information, although some of the underlying cause (such as a brain injury) may involve coexisting cognitive problems.

Nursing Priorities

  1. Prevent/control seizure activity.
  2. Protect patient from injury.
  3. Maintain airway/respiratory function.
  4. Promote positive self-esteem.
  5. Provide information about disease process, prognosis, and treatment needs.

Discharge Goals

  1. Seizures activity controlled.
  2. Complications/injury prevented.
  3. Capable/competent self-image displayed.
  4. Disease process/prognosis, therapeutic regimen, and limitations understood.
  5. Plan in place to meet needs after discharge.

Nursing Diagnosis: Risk for Trauma/Suffocation

Risk factors may include

  • Weakness, balancing difficulties
  • Cognitive limitations/altered consciousness
  • Loss of large or small muscle coordination
  • Emotional difficulties

Evidenced by
[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]

Desired Outcomes

  • Verbalize understanding of factors that contribute to possibility of trauma and/or suffocation and take steps to correct situation.
  • Demonstrate behaviors, lifestyle changes to reduce risk factors and protect self from injury.
  • Modify environment as indicated to enhance safety.
  • Maintain treatment regimen to control/eliminate seizure activity.
  • Identify actions/measures to take when seizure activity occurs.
Nursing actions Rationale
Explore with patient the various stimuli that may precipitate seizure activity. Alcohol, various drugs, and other stimuli (e.g., loss of sleep, flashing lights, prolonged television viewing) may increase brain activity, thereby increasing the potential for seizure activity.
Discuss seizure warning signs (if appropriate) and usual seizure pattern. Teach SO to recognize warning signs and how to care for patient during and after seizure. Enables patient to protect self from injury and recognize changes that require notification of physician/further intervention. Knowing what to do when seizure occurs can prevent injury/complications and decreases SO’s feelings of helplessness.
Keep padded side rails up with bed in lowest position, or place bed up against wall and pad floor if rails not available/appropriate.

 

Minimizes injury should seizures (frequent/generalized) occur while patient is in bed. Note: Most individuals seize in place and if in the middle of the bed, individual is unlikely to fall out of bed.
Encourage patient not to smoke except while supervised. May cause burns if cigarette is accidentally dropped during aura/seizure activity.
Evaluate need for/provide protective headgear Use of  helmet may provide added protection for individuals who suffer recurrent/severe seizures
Use tympanic thermometer when necessary to take temperature. Reduces risk of patient biting and breaking glass thermometer or suffering injury if sudden seizure activity should occur.
Maintain strict bed rest if prodromal signs/aura experienced. Explain necessity for these actions.

 

Patient may feel restless/need to ambulate or even defecate during aural phase, thereby inadvertently removing self from safe environment and easy observation. Understanding importance of providing for own safety needs may enhance patient cooperation
Stay with patient during/after seizure. Promotes patient safety.
Turn head to side/suction airway as indicated. Insert plastic bite block only if jaw relaxed.

 

Helps maintain airway and reduces risk of oral trauma but should not be “forced” or inserted when teeth are clenched because dental and soft-tissue damage may result. Note: Wooden tongue blades should not be used because they may splinter and break in patient’s mouth. (Refer to ND: Airway Clearance/Breathing Pattern, ineffective, risk for
Cradle head, place on soft area, or assist to floor if out of bed. Do not attempt to restrain.

 

Gentle guiding of extremities reduces risk of physical injury when patient lacks voluntary muscle control. Note: If attempt is made to restrain patient during seizure, erratic movements may increase, and patient may injure self or others.

 

Document preseizure activity, presence of aura or unusual behavior, type of seizure activity (e.g., location/duration of motor activity, loss of consciousness, incontinence, eye activity, respiratory impairment/cyanosis), and frequency/recurrence. Note whether patient fell, expressed vocalizations, drooled, or had automatisms (e.g., lip-smacking, chewing, picking at clothes). Helps localize the cerebral area of involvement
Perform neurological/vital sign check after seizure, e.g., level of consciousness, orientation, ability to comply with simple commands, ability to speak; memory of incident; weakness/motor deficits; blood pressure (BP), pulse/respiratory rate. Documents postictal state and time/completeness of recovery to normal state. May identify additional safety concerns to be addressed
Reorient patient following seizure activity. Patient may be confused, disoriented, and possibly amnesic after the seizure and need help to regain control and alleviate anxiety.
Allow postictal “automatic” behavior without interfering while providing environmental protection. May display behavior (of motor or psychic origin) that seems inappropriate/irrelevant for time and place. Attempts to control or prevent activity may result in patient becoming aggressive/combative.
Investigate reports of pain. May be result of repetitive muscle contractions or symptom of injury incurred, requiring further evaluation/intervention.

 

Observe for status epilepticus, i.e., one tonic-clonic seizure after another in rapid succession.

 

 

This is a life-threatening emergency that if left untreated could cause metabolic acidosis, hyperthermia, hypoglycemia, arrhythmias, hypoxia, increased intracranial pressure, airway obstruction, and respiratory arrest. Immediate intervention is required to control seizure activity and prevent permanent injury/death. Note: Although absence seizures may become static, they are not usually life-threatening.
Administer medications as indicated:
Antiepileptic drugs (AEDs), e.g., phenytoin (Dilantin), primidone (Mysoline), carbamazepine (Tegretol), clonazepam (Klonopin), valproic acid (Depakene), divalproex (Depakote), acetazolamide (Diamox), ethotoin (Peganone), methsuximide (Celotin), fosphenytoin (Cerebyx);
Specific drug therapy depends on seizure type, with some patients requiring polytherapy or frequent medication adjustments.AEDs raise the seizure threshold by stabilizing nerve cell membranes, reducing the excitability of the neurons, or through direct action on the limbic system, thalamus, and hypothalamus. Goal is optimal suppression of seizure activity with lowest possible dose of drug and with fewest side effects. Cerebyx reaches therapeutic levels within 24 hr and can be used for nonemergent loading while waiting for other agents to become effective. Note: Some patients require polytherapy or frequent medication adjustments to control seizure activity. This increases the risk of adverse reactions and problems with adheren

Nursing Diagnosis: Risk for ineffective Airway Clearance/Breathing Pattern

Risk factors may include

  • Neuromuscular impairment
  • Tracheobronchial obstruction
  • Perceptual/cognitive impairment

Evidenced by
[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]

Desired Outcomes

  • Respiratory Status: Ventilation
  • Maintain effective respiratory pattern with airway patent/aspiration prevented.
Nursing actions

Rationale

Encourage patient to empty mouth of dentures/foreign objects if aura occurs and to avoid chewing gum/sucking lozenges if seizures occur without warning. Reduces risk of aspiration/foreign bodies lodging in pharynx.
Place in lying position, flat surface; turn head to side during seizure activity. Promotes drainage of secretions; prevents tongue from obstructing airway.
Loosen clothing from neck/chest and abdominal areas. Facilitates breathing/chest expansion.
Insert plastic airway or soft roll as indicated and only if jaw is relaxed. If inserted before jaw is tightened, these devices may prevent biting of tongue and facilitate suctioning/respiratory support if required. Airway adjunct may be indicated after cessation of seizure activity if patient is unconscious and unable to maintain safe position of tongue.
Suction as needed. Reduces risk of aspiration/asphyxiation. Note: Risk of aspiration is low unless individual has eaten within the last 40 min.
Administer supplemental oxygen/bag ventilation as needed postictally. May reduce cerebral hypoxia resulting from decreased circulation/oxygenation secondary to vascular spasm during seizure. Note: Artificial ventilation during general seizure activity is of limited or no benefit because it is not possible to move air in/out of lungs during sustained contraction of respiratory musculature. As seizure abates, respiratory function will return unless a secondary problem exists (e.g., foreign body/aspiration).
Prepare for/assist with intubation, if indicated. Presence of prolonged apnea postictally may require ventilatory support.

Credits:Curators of the University of Missouri and RCEP7 Handbook of Disabilities

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