MENNONITECOLLEGEOFNURSINGat Illinois State University
NUR 317Nursing Care of Children
Seizure Disorder
Definitions-
a. convulsions - involuntary muscle contraction and relaxation
b. seizure- asudden attackresulting fromparoxysmal discharges in cortical neurons
c. epilepsy- having the tendency to experience seizures
I. Epilepsy
- Etiology
- idiopathic -having a genetic tendencythatinsomewayalterstheseizure threshold to influence neuronal discharge
- acquired-having a seizure as a resultofbrain injury during prenatal, perinatal, orpostnatal periods(trauma,hypoxia,infections,etc.)
- Pathophysiology
- Spontaneous electric discharges initiated by a group of hyperexcitable cells referredtoas“epilectic focus”thathave been stimulated bysome physiologic stimuli, activate normal cells spreading this excitation to the brainstem resulting in a generalized seizure.
- Symptoms
- A clear description of the phenomena is a valuable aid in localizing the area involved and frequently suggests the underlying pathology
(So watch all movements ofall extremities/eyemovements,timethem,
know events surrounding event ofseizure)
- Sensory-hallucinating phenomena -an“aura” warns persons ofanimpending attack and can also provide the most reliable clue to help localize the origin of the discharge. AURA ISNOT ALWAYS PRESENT.
- Aura: a sensation ofdizziness or an unusual feeling ofascending abdominal discomfort
- Motoreffects:
- eyemovement-provides cluestofocusofseizure. Discharges inthe cortexofone hemisphere tend tocause theeyes todeviate toopposite side. Bilateral discharges cause the eyes tomove upward orstraightahead.
- Muscle contraction -3types
- CLONIC -opposing muscles contractand relax, alternately producing rhythmicmovements
- TONIC-all muscles are maintained in acontraction foratime causing the person to become rigid
- Jacksonian-muscular twitching begin in one area and spreads toanother
- Sensorimotor: tingling, prickling, hallucinations orlightflashes,tastes,smells, orsounds. Sensations aredetermined bypartofbrain affectedD. Alterations ofconsciousness: maybeunaffected,lostcompletely, oraltered. Amnesia results when there is loss ofconsciousness.
- “Postictalstate”-period following seizure (sometimes drowsy, will sleep)usually
Lasts 5-30 minutesand is characterized by drowsiness, confusion, nausea, hypertension, headache or migraine, and other disorienting symptoms
3. Classification ofEpilepsy (p.1466-1467- Hockenberry, 10thed)
a. Partial seizures -thehallmark ofthese seizures is the onset in a portion of one cerebral hemisphere
1. simple partial: no loss ofconsciousness, local area ofbrain
2. complex partial: may have loss ofconsciousness
b. Generalized seizures -clinical observationsindicate thatthe initial involvement is fromboth hemispheres
1. TONIC-CLONICseizure -“GRANDMAL”
Themostcommon and dramatic ofall seizures. Usually begins without aura; symmetricand generalized tonic contraction ofentire body musculature lasting 10-20 seconds, followed by violent jerking movements during clonic phase lasting 30 seconds. Postictal state-child isdrowsy
and may sleep for several hours. Upon awakening, child may have no recall ofseizure.
a. flexion
b. extension
c. tremorphase d. clonic phase
e. posticatal phase
2. ABSENCEseizures -“PETITMAL”
Characterized by a brief loss ofconsciousness with minimal or no alteration in muscle tone and may go unrecognized because the child’s behavior ischanged verylittle. Appears to“space out”.
Symptoms: minor movements aslip smacking, twitching ofeyelids or
face,orslighthandmovements. Maydrop object being held, but maintain postural control.
- STATUSEPILEPTICUS
Medical emergency: aseries ofseizures atintervals toobrief toallow the child to regain consciousness between attacks. Can lead toexhaustion, respiratory failure, and death.
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4. Management --2goals 1. ascertain typeofseizure
2. attempttounderstand cause
A. Diagnosis
1. Thorough Hx and Assessment
-age ofonset
-typeofseizure &/orbehavior during attack
-timeattackoccurs
-precipitating factors;fever,injury,etc.
- duration and progressionofseizure and postictal state
-complete family hx and physical assessment
2. Laboratorytests
CBC -forinfection
glucose levels -forhypoglycemia
BUN,electrolytes,Calcium-formetabolic disturbances
CSF-forinfection ortrauma
3. Othertesting
Lumbar Puncture,skull X-ray,CTscan,echoencephalogram (EEG), brain scans
B. Therapeutic treatment-3goals
a. control orreduce frequency ofseizures
b. discover and correctcause
c. help child lead as normal a life as possible
- Drug therapy -anticonvulsantsreduce the responsiveness ofnormal neurons to the sudden, high frequencynerve impulses thatarise in the epileptogenic focus.
a. forAbsence seizures: Ethosuxamide (Zarontin) Clonezepam (Clonopin) Valproic Acid(Depakane)
b. forotherseizuretypes: Phenytoin (Dilantin) Phenobarbital Carbamezapine (Tegretol) Valproic Acid(Depakane)
- forstatusepilepticus: IVOR intrarectalDiazepam (Valium)
IVLorazepam(Ativan)
2. Strategyfordrugtreatment-start with one drug and increase until seizures arecontrolled. Oncecontrolled, continue med for prolonged time. Blood levels help maintain optimum therapeutic levels. Repeat EEGq11/2-2years. WHEN MED IS DISCONTINUED, DOSAGE MUST BE REDUCED GRADUALLY OVER
1-2 WEEKS. SUDDEN WITHDRAWEL CAN CAUSE RECURRENCE OF SEIZURES.
3. Complications -Dilantin can cause gingival hyperplasia - frequent gum massage and good oral hygiene are indicated.
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-The American Academy ofPediatrics stressesthatscreening teststodetect subtle intellectual and behavioral side effectsand studies to evaluate and compare theeffectsofanticonvulsant therapyareinorder toprevent detrimental effectson behavior and mental function.
C. Nursing Care (p.1476-1477- Hockenberry, 10thed.)
1. Nursing diagnoses: Risk for Injury, Altered Family Coping, Risk for Altered Self-Image, etc
2. nursing objectives:
a. protectchild during seizure
b. reduce/prevent seizures ifpossible c. help child family cope with stigma
d. help child develop positive self-image
e. identify triggers and assist withadjustments toprevent seizures
3. GENERAL OBSERVATIONSOFCHILD DURING SEIZURE: (p. 1475- Hockenberry, 10th ed.)
4. SEIZURE PRECAUTIONS (p.1478- Hockenberry, 10th ed.)
II. Febrile Seizures
1. Incidence: 3-5%ofchildren affected
2. Occurrence: Between 6monthsand 3years; unusual after5years.
Boysaffected2xmorethangirls. Possible genetic tendency.
3. Etiology: unknown, usually withfever38.8C (101.8F)
usually with URIorGIdisturbance
Roseola—viral infection with temp followed by maculopapular rash.
- Treatment:
a. Preventincrease in temp with antipyretics
- Acetaminophen 10-15mg/kg/dose
- Ibuprofen 10mg/kg/dose
- NO ASPIRIN
- Light clothing—avoid blankets
- Cool liquids
- NOTE: Tepid sponge baths are no longer advocated because ofrisk ofshivering which increases themetabolic rate,thusincreasingtemperatureevenmore.
b. Anticonvulsants maybeprescribed; usually short-term
c. Treatunderlying cause
d. EEGmaybeordered
e. Teachparents the importance ofprevention!!
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