SEIZURES II.

GENERALIZED
a. Absence (Petit mal)
Abnormal episodes of motor, sensory, autonomic, or psychic activity (or a Blinking or rolling of the eyes
combination of these) resulting from a sudden, abnormal, uncontrolled electrical Slight mouth movement (grin-like)
discharge from cerebral neurons. 1-10 seconds duration
Classification of Seizures: Can recur as often as 100 times a day
1. Partial seizures – begin in one part of the bran b. Generalized tonic-clonic (Grand mal)
a. Simple – consciousness remains intact Begins with a loud cry
b. Complex – impairment of consciousness Loss of consciousness
2. Generalized seizures – involves the whole brain Body stiffness (tonic) then relaxes (clonic)
Tongue biting
Incontinence
Labored breathing – turn client to the side(?) Safety
SPECIFIC CAUSES OF SEIZURES
Apnea – lips turned blue-violet
Airway
Cerebrovascular disease Cyanosis
Hypoxemia 2-5 mins duration Time of seizure
Fever (childhood) Drooling of the saliva
Head injury Confused or deep sleep (post-ictal period)
Hypertension
CNS infections Medications: lifetime Complications:
Health Teaching:
Metabolic and toxic conditions – endocrine disorders
Brain tumor – bc of compression Phenytoin Fall
Avoid trigger
Drug and alcohol withdrawal factors such as Carbamazepine Anoxia due to
Allergies flashing lights,
noise, hunger aspiration of vomitus
Phenobarbital

MANIFESTATIONS

I. PARTIAL GUIDELINES FOR SEIZURE CARE

a. Simple (Jacksonian motor type)
Stiffening or jerking in one extremity
Start in the thumb and spread to the entire hand and arm

b. Simple (Sensory type)

Perception is distorted
Hallucinations, flashing lights – hallucinations as a form of seizure
Foul odor, vertigo, déjà vu

c. Complex
Purposeless behavior
Aura (premonition)
Automatisms
Picking at his clothes
Aimless wandering
Lip smacking or chewing motion
 CEREBROVASCULAR DISORDERS FIVE A’s OF HEMIPLEGIA

Functional abnormality of the CNS that occurs when the blood supply is disrupted 1. Aphasia – defect in comprehending speech or written language
2. Agnosia – inability to recognize the meaning of sensory stimuli
Blood flow in the brain: 60-70 ml/100g of brain tissue/min 3. Apraxia – inability to perform correct movement
4. Agraphia – inability to express oneself in writing
PREVENTION
5. Alexia – word blindness or inability to read
A. Non-modifiable risk factors
Age (over 55), male gender
B. Modifiable risk factors A. TRANSIENT ISCHEMIC ATTACK (TIA)
Hypertension – the primary RF Temporary neurologic deficit resulting from a temporary impairment of blood
Cardiovascular disease flow
Elevated cholesterol or elevated hematocrit “Warning of an impending stroke”
Obesity – additional stress
Diabetes PREVENTIVE TREATMENT AND
Oral contraceptive use SECONDARY PREVENTION
Smoking and drug and alcohol abuse
a. Health maintenance
STROKE or “BRAIN ATTACK” measures including a
healthy diet, exercise, and
Sudden loss of function resulting from a disruption of the blood supply to a part of the the prevention and
bran treatment of periodontal
Types of Stroke: disease
a. Ischemic (80% to 85%) b. Carotid endarterectomy
b. Hemorrhagic (15% to 20%) c. Anticoagulant therapy
d. Antiplatelet therapy – aspirin, dipyrimadole (Persantine), clopidogrel (Plavix), and
A. Ischemic Stroke – disruption of the blood supply due to an obstruction, usually a ticlolidine (Ticlid)
thrombus or embolism, that causes infarction of brain tissue e. Statins
i. Types f. Antihypertensive medications
Large artery thrombosis
Small penetrating artery thrombosis MEDICAL MANAGEMENT DURING ACUTE PHASE OF STROKE
Cardiogenic embolism
Thrombolytic therapy
Cryptogenic or idiopathic
Criteria for tissue plasminogen activator (tPA)
a. Manifestations of Ischemic Stroke
IV dosage and administration
1. Symptoms depend upon the location and size of the affected area
Patient monitoring
2. Numbness or weakness of face, arm, or leg, especially on one side
Side effects – potential bleeding
3. Confusion or change in mental status
Elevate HOB unless contraindicated (Semi-fowler’s)
4. Trouble speaking or understanding speech
Maintain airway and ventilation
5. Difficulty in walking, dizziness, or loss of balance or coordination
Provide continuous hemodynamic monitoring and neurologic assessment
6. Sudden, severe headache
7. Perceptual disturbances
B. HEMORRHAGIC STROKE
CEREBROVASCULAR TERMS Caused by bleeding into brain tissue, the ventricles, or subarachnoid space.
May be due to spontaneous rupture of small vessels primarily related to
1. Hemiplegia – paralysis of one side of the body hypertension; subarachnoid hemorrhage due to a ruptured aneurysm; or
2. Hemiparesis – weakness of one side of the body intracerebral hemorrhage related to intracranial aneurysms, or medications
3. Dysarthria – difficult speech due to impairment of speech muscle such as anticoagulants
4. Aphasia – expressive aphasia, receptive aphasia
5. Hamianopsia – half blindness Brain metabolism is disrupted by exposure to blood  ICP increases due to blood in
the subarachnoid space  compression or secondary ischemia from reduced
perfusion and vasoconstriction injures brain tissue
Manifestations ANEURYSM PRECAUTIONS

1. Similar to ischemic stroke 1. Absolute bed rest

2. Severe headache 2. Elevate HOB 30° to promote venous drainage or keep the bed flat to increase cerebral
3. Early and sudden changes in LOC perfusion
4. Vomiting 3. Avoid all activity that may increase ICP or BP; implement Valsalva maneuver, acute
flexion, and rotation of the neck or head
Medical Management 4. Exhale through mouth when voiding or defecating to decrease strain
1. Prevention – control of hypertension 5. Nurse provides all personal care and hygiene
2. Diagnosis – CT scan, cerebral angiography, and lumbar puncture if CT is negative 6. Provide non-stimulating, non-stressful environment: dim lighting, no reading, no TV,
and ICP is not elevated to confirm subarachnoid hemorrhage and no radio
3. Care is primarily supportive 7. Prevent constipation
4. Bed rest with sedation 8. Restrict visitors
5. Oxygen MEDICATIONS:
6. Treatment of vasospasm, increased ICP, hypertension, potential seizures, and
prevention of further bleeding 1. Aminocaproic acid (Amiicar, Epsikapron) – to prevent the lysis of any blood clot that
has formed near the site of a rupture
INTRACRANIAL ANEURYSMS 2. Calcium channel blockers – to improve neurologic deficits
Dilation of the walls of a weakened cerebral artery 3. Anticonvulsants (Dilantin)
Can lead to rupture (hemorrhage) 4. Stool softeners – to decrease ICP
5. Analgesics – headache
TYPES:
MULTIPLE SCLEROSIS
1. BERRY ANEURYSM – congenital abnormality of the tunica media of the artery
2. SACCULAR ANEURYSM – distends only a small portion of the vessel wall A progressive autoimmune-related demyelination disease of the brain and spinal cord
3. FUSIFORM ANEURYSM – entire circumference of a blood vessel swells to form an Common in female
elongated tube Nerve impulses are interrupted
4. DISSECTING ANEURYSM – tunica intima pulls away from the tunica media, blood is Precipitated by stress, fatigue, and heat
forced between the two layers Characterized by –
Remissions and exacerbations
Generalized body weakness
ASSESSMENT CAUSES
Numbness
1. Headache 1. Congenital Difficulty in coordination
2. Diplopia 2. Head trauma Loss of balance
3. Blurred vision 3. Hypertension Pain
4. Tinnitus 4. Advancing age Visual disturbances
5. Nausea 5. Infection
6. Hemiparesis 6. Atherosclerosis CHARCOT’S TRIAD LHERMITTE’S SIGN
7. Nuchal rigidity 1. Tremor
8. Irritability 2. Nystagmus Electric shock-like sensation along
9. Seizures 3. Scanning speech – syllables the spine
are inappropriately separated
from each other

Medical Management:

1. Immunodulators
a. Interferon b-1a and interferon b-1b
b. Glatiramer acetate (Copaxone)
2. Adrenocorticosteroid therapy – IV methylprednisolone
3. Symptom management of muscle spasms, fatigue, ataxia, and bowel and bladder
control
 MYASTHENIA GRAVIS (DESCENDING PARALYSIS) GUILLAIN-BARRE SYNDROME (ASCENDING PARALYSIS)

Antibodies directed at Autoimmune disorder with acute attack of peripheral nerve myelin
acetylcholine at the Rapid demyelination may produce respiratory failure and autonomic nervous system
myoneural junction impair dysfunction
transmission of impulses Most often follows a viral or bacterial infection
Excessive cholinesterase – Recovery from several months to two years
destroys acetylcholine
Thymus tumor – site of Aby Manifestations:
production 1. Weakness
Manifestations: 2. Parethesias
3. Pain
1. Diplopia 4. Cranial nerve symptoms
2. Ptosis 5. Tachycardia or bradycardia
3. Weakness of facial muscles 6. Clumsiness – initial symptom
4. Difficulty in swallowing
5. Voice impairment (dysphonia) Nursing Management
6. Generalized weakness 1. Maintain adequate ventilation
Diagnostics: 2. Check muscles groups every 2 hours
3. Prevent complications of immobility
1. TENSILON TEST 4. Promote comfort
Edrophonium Chloride 5. Rehabilitation
10mg IV
Relief of symptoms within 30 seconds
2. PROSTIGMIN TEST
Neostigmine Methylsulfate
1.5mg SC
Relief of symptoms within 15 minutes

Medical and Surgical Management

Pharmacologic therapy
Cholinesterase inhibitor – pyrostigmine bromide (Mestinon)
Plasmapheresis
Thymectomy

Nursing Management

1. Respiratory status
2. Mouth care
3. Skin care
4. Eye care
5. ROM exercises
6. Rest periods
7. Soft diet