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 OBJECTIVES

1. Review the pathophysiology of seizure disorders.

2. Differentiate between types of seizures.

3. Discuss the medication management for seizure

disorders.

4. Describe alternative therapies for seizure disorder

5. Outline a discharge plan for the home care management

for children with seizure disorders.

 GROUP ACTIVITY
• VIEW THE VIDEO “COPING WITH EPILEPSY: FROM SEIZURES
TO SUCCESS.”

• WRITE DOWN POINTS WHICH WOULD BE HELPFUL IN THE

PREPRATION OF A DISCHARGE PLAN FOR A CHILD WITH
SEIZURE DISORDER.

• SHARE TWO OF THOSE POINTS WITH THE CLASS.

 DEFINITIONS
• A seizure is an episodic alteration in motor activity, behavior, sensation,
or autonomic function.

• A seizure is an abnormal, sudden, and excessive electric discharge of

neurons.
• Epilepsy is a condition characterized by two or more unprovoked seizures
that can be caused by a variety of pathologic processes in the brain
• Status epilepticus is a continuous seizure that last more than 30 minutes.

• Status epilepticus is a series of seizures from which the child does not
regain a premorbid level of consciousness.
• An Electroencephalogram (EEG) is a test that is used in the diagnosis of
epilepsy, and care of the patient who has had seizures
 CAUSES OF SEIZURES
Genetic Drugs

Toxins
Pre-natal injuries

Brain trauma Developmental

disorders
 TYPES OF SEIZURES

Febrile Complex

Simple
Absence
Focal (may be simple
or complex)
 FEBRILE SEIZURES
• Associated with • Most common
febrile illness between 6 months
and 5 years
• Absence of CNS
infection or • More common in
electrolyte boys than girls
imbalance
• Does not affect
• Etiology is cognitive
uncertain development
 FOCAL SEIZURES

Focal seizures, also called

partial seizures, occur in only one
part of the brain.

There are two types of focal seizure:

Partial and complex.
 ABSENCE SEIZURES

Pathophysiology is not fully

understood

Associated with problems with

the neurotransmission in the
brain
DEFINITION

Simple(typical) absence or
petit mal seizures are
characterized by a sudden
cessation of motor activity or
speech with a blank facial
expression and flickering of
eyelids
 SIMPLE ABSENCE SEIZURES
Uncommon before
age five (5) years Not associated with
aura

Usually manifest
between the ages Last less than 30
of four (4) to minutes
eight (8) years

More common in Not associated with

girls 2:1 a postical stated
 SIMPLE ABSENCE SEIZURES

Associated with abnormal

pathways in the brain

Associated with low current T

type calcium pathways in
the brain which are
connected to the neurons.
 SIMPLE ABSENCE SEIZURES

Some children can experience

hundreds of absence seizures a
day

Absence children seizures are

typically not associated with
loss of body tone, but their head
may fall forward slightly
COMPLEX (ATYPICAL) ABSENCE SEIZURES

There is typically associated

motor components consisting
of myoclonic movements of
the face, fingers, and
extremities and occasionally
loss of body tone
 STATUS EPILEPTICUS
• Status epilepticus is a continuous seizure that lasts more than
30 minutes or a series of seizures, from which a child does not
regain normal level of consciousness

• Medical emergency that requires immediate intervention.

• Priority nursing care includes implementing principles of the

ABCs of life support

• Monitoring of blood pressure and temperature is also very

important.

• Status epilepticus can result in permanent brain damage

 MEDICATIONS FOR STATUS EPILEPTICUS

• IV Diazepam • Valporic Acid

(IV or rectal)
• IV Lorazepam
(Ativan) • Phenobarbitol

• Loading dose
of Dilantin
 FACTORS THAT TRIGGER A SEIZURE
• Fasting
• Emotional stress
• Sleep

• Sleep deprivation
• Alcohol

• Fatigue • Menstrual cycle

• Heat
• Fever
• Hyperventilation

• Illness
• Flickering lights
 WARNING SIGNS OF A SEIZURE
• Confusion
• An 'aura' is the
• Light headiness
term that some
people use to • Blank stare

describe the • Fumbling

warning they feel
before they have a • Confused speech

tonic clonic seizure. • Feeling of anxiety

• Lip biting
NURSING DIAGNOSIS FOR CHILDREN
WITH A SEIZURE DISORDER
• High risk for injury related to disease process

• Risk for injury related to CNS dysfunction and inability to control self.

• Risk for aspiration and ineffective breathing pattern related to

impaired motor activity, LOC, and loss of airway protection.

• Anxiety/fear of parent/child related to child having a seizure activity

• Interrupted family processes/self esteem disturbance related to child

having a chronic illness
EXPECTED OUTCOMES FOR CHILDREN
WITH SEIZURE DISORDERS
• Child will be protected during a seizure.

• Influencing or triggering factors will be determined and

adjustments made to lessen seizure events.

• Child will experience as few seizures as possible.

• Child and family will cope with the challenges associated

with seizure disorder.

• Child will develop a positive self-image

 MANAGEMENT DURING A SEIZURE

 Prevent Injury

 Lower to the ground

 Place soft padding under child’s head

 Clear the are of hard or sharp objects

 MANAGEMENT DURING A SEIZURE

 Prevent Injury

 Do not put anything into the

child’s mouth

 Do not restrain the child

 MANAGEMENT DURING A SEIZURE
 Prevent Aspiration

 Turn child on the side

 Loosen tight clothing

 Monitor for signs of respiratory distress

 MANAGEMENT FOLLOWING A SEIZURE
 Allow the child to rest and recover

 Continue to monitor respiratory status

 Reorient child

 Record and report the seizure

 DISCHARGE PLAN
Educate child and family on the management of
seizures

Educate child and family on the importance of

compliance with medications

Educate family on the care of the child during and

after a seizure episode

Educate family on when to seek professional help

 DISCHARGE PLAN
 Instruct family to call 911 if the following occurs:

 Child continues to be pale

 Child continues to have bluish skin or lips

 Child continues to have noisy breathing

 Child has difficulty breathing

 DISCHARGE PLAN
 Instruct family to call 911 if the following occurs:

 The seizure lasts for more than 5 minutes

 The child has more than one seizure without regain

consciousness

 The child is having a seizure for the first time

 If the child is injures or has diabetes

 REFERENCES
Broome, M.E., Rollins, J.A. (1999). Core Curriculum for the nursing care of children.
New Jersey: Jannetti Publications Inc.

Hockenberry, M.J. (2004). Wong’s clinical manual of pediatric nursing, 6th ed. St.
Louis: Mosby.

Hockenberry, M.J., Wilson, D. (2007). Wong’s nursing care of infants and children.
St. Louis: Mosby.

Siedel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. (2003). Mosby’s guide to physical
examination. St. Louis: Mosby.

Wong, D. L., Hockenberry, M.J. & Wilson, D. (2003). Wong’s nursing care of infants
and children, (9th Ed.). St. Louis: Mosby.