Seizures (Epilepsy) Nursing NCLEX: Tonic-Clonic, Generalized, Focal, Symptoms

this is cereth registered nurse RN comm and in this video i'm going to be going over seizures in this video is part of an Inc Lex review series over the neuro system and as always you can access the free quiz at the end of this video to test you on this condition so let's get started what are seizures they occur when abnormal electrical signals are being fired rapidly from neurons in the brain and we have various types of seizures which we're going to go in detail here in a moment but you can really put them into categories they're either generalized seizures which means that they're affecting both sides of the brain or their focal seizures also known as partial seizures and they're affecting really a specific area of the brain now in a rain we have neurons and what a neuron Xue well they are tasked with handling and transmitting information now when we're talking about seizures let's remember two types of neurons excitatory neurons and inhibitory neurons and just as their name says is really what the role is okay so first excitatory whenever these neurons are stimulated they will cause a response they'll excite things they will cause something to happen in order to do this they will release the neurotransmitter glutamate now on the flip side inhibitory neurons they're going to inhibit a response decrease it and to achieve this they release the neurotransmitter gaba so in a healthy brain that's not having seizure activity you have a nice fine balance between excitatory and inhibitory neurons now let's say that your inhibitory neurons are damaged what's going to happen well excitatory is really just going to take over and stimulate overstimulate parts of the brain sending abnormal signals which will lead to seizure activity and the whole reason I go over this with you is because whenever we're talking about our anti-seizure medications one of the medications we're gonna talk about is barbiturates and what they do is they stimulate the gaba receptors which is going to help decrease the excitation that is going on in this brain because when there's still later those inhibitory neurons gonna release GABA and calm things down in here so we decrease our seizure activity so what causes seizures well anyone can have a seizure adults or children especially if they are suffering from a severe acute condition or illness but once that's corrected cured whatever the seizures will stop and teachers can happen due to like a high fever a central nervous system infection like bacterial meningitis hypoglycemia where that blood sugar just drops way too low can affect the brain because remember the brain loves sugar and it does not like when it doesn't have a lot of it alcohol withdrawal acid-base and balances like acidosis or conditions that cause hypoxia and brain tumors but some patients have what's called epilepsy and this is where a patient is having frequent seizure activity due to a chronic condition and this can be due to a traumatic brain injury where they've had severe trauma to that brain so they're very prone to recurrent seizure activity or congenital birth defect they were born with this they had a massive stroke that has really affected some areas of the brain or they had long lasting effects of an illness like maybe they had a severe case of bacterial meningitis especially those diseases that affect the central nervous system or of course they really aren't sure why the person is having seizure activity it's unknown so idiopathic causes now before we talk about our different types of seizures let's switch gears and talk about the stages of a seizure now we can divide how a person experiences a seizure in two stages and these stages keep in mind vary depending on the seizure type because some seizures will have an aura some will not some will have a very fast post ectis which is the recovery after the seizure some it will take hours today so keep that in mind so our stages include the prodromal the aura the ictus and the post ectis so first the probe this is when symptoms start to appear prior to that big event hence the seizure and what you can see in patients with this is that they will become depressed maybe how anger issues sleeping anxiety gastrointestinal and urinary issues etc now when do these symptoms start they tend to start days before a seizure happens so a lot of patients they start to become aware of what's going on and they will notice this and they will be able to prep themselves for a possible seizure next is aura and like I said before not all patients are going to go through this stage the aura phase but what patients tend to have an aura well patients who experience focal seizures also called the partial seizures or the tonic clonic seizures which is those generalized type of seizures and it tends to happen at the very beginning of the seizure and we're talking about within seconds or minutes before that seizure happens so it's different than the prodromal which happens days so the aura is a warning sign that a bigger seizure is expected so what can the patient report and this really varies on patients so as the nurse taking care of a patient who has a history of epilepsy you want to ask them what is the typical aura for them what - they experience so you can be prepared for it as well and some patients report an altered vision or hearing they can see spots in their vision squiggly lines or they can actually start hearing certain sounds that aren't there like voices they can have the sudden anxiety or dread deja vu a sudden weird taste or smell they can become dizzy or have the inability to speak and if your patient starts to experience any of these signs and symptoms you want to take them seriously and you want to help the patient prep which we're going to go over in our nursing interventions the next stage is the ictus stage and this is the actual seizure the word this means seizure and most seizures tend to last between one to three minutes and the reason I point this out is because as the nurse you want to always time the seizure because seizure is greater than five minutes or if they start to have seizures back-to-back like two or more the patient has entered into a condition called status epilepticus and this is dangerous because it's very unlikely that the seizure is going to stop all by itself and that the patient needs immediate medical treatment like medication to actually stop it and the last stage is the post pictus and just as the name says it's after the seizure so this is the recovery part this is where the brain takes time to recover now this varies like I said before depending on the seizure type for instance with the tonic-clonic which is one of the most severe types of seizures it can take hours two days for the patient to recover but if it's an absent type seizure which is also a generalized seizure it can be immediate now what can a patient report whenever they've had let's say like a ton of clonic seizure afterwards they will be very tired they'll want to sleep and as the nurse you want them to sleep they can be confused they won't remember what happened they can have a headache or have injury to themselves because during the seizure they could have bit their tongue their cheek or heard a body part and the biting of the tongue and the cheek can happen mainly in the tonic clonic seizures now let's talk about the different types of seizures okay at the beginning the lecture I told you there were two categories of seizures we have generalize which again affect the whole brain both sides of the brain or you can have focal seizures also called partial seizures that effect a specific side of the brain so first let's talk about generalized seizures and we're going to talk about the most common type of generalized seizure which is called the tonic clonic seizure formerly refer to as grandma's seizure now whenever a person thinks of someone having a seizure this is really what they think of and what happens typically with this seizure is that these patients tend to have that aura that warning sign beforehand so if your patient has a history of this they tell you that what are you going to do you're going to act on that and you're going to get them safe you're gonna lie them down on their side while on their side not on their back because that will help the tongue go to the side instead of going back and blocking the airway also will help Salathe or any potential blood drain out of the mouth as well and then you're going to cushion their head with a pillow now how it usually progresses that is that the patient loses consciousness why we want to get thin down that line position on their side because their risk for injury then they will progress to the tonic part of the seizure which is where tonic is where you have muscles schnitz Tiffany so the whole body is just gonna stiffen and some patients whenever this happens they can groan cry out because rest weary muscles everything is just literally becoming really hard and stiff they can also bite their tongue or the inside of their cheek so you may see blood coming out of their mouth with saliva as well like foaming out of the mouth so that's what that's from and also from where the respiratory effort is very impaired because all the bodies tiffany they will have apnea and cyanosis they can become bluish where they're not breathing then a couple seconds few seconds later they'll go into the clinic part of the seizure where they have this recurrent jerking so it's like spice relaxation space and relaxation spasm and it's just jerking of the extremities and the patient can also experiencing countenance during this part where they can lose control of their bowels or their urinary system now how long should a seizure last remember that number one to three minutes so your timing that as the nurse anything greater than five minutes what are they possibly entering into status epilepticus which is dangerous because the seizure may not stop on their own with tonic-clonic seizures they are definitely at risk for status epilepticus so remember that and if that does happen you're in the hospital setting you want to initiate your emergency response system whatever you have so you can get a team in there to help you give medications to stop this seizure now during the post ectis after the seizure what what's your patient going to look like well they're probably not even gonna remember what happened they're not gonna recall the event they're gonna be very tired they'll want to sleep they'll be sore from where they had the stiffening of the body and the clinic part of the seizure and they can report a headache and some other types of generalized seizures that really tie in with the tonic clonic is that they can have just a tonic seizure where they have the body stiffening only and they're at risk for injury with that or they can just have the clonic seizure or they have the recurrent jerking and it can either be symmetrical or it can be asymmetrical another type of seizure is called an absence seizure formerly known as petty mall and this tends to be more common in the pediatric patients the children and just as its name says it's absent so the signs and symptoms aren't going to be as pronounced I say to that tonic-clonic seizure we just talked about a hallmark finding in this hub a seizure is staring which appears that the patient and the child is daydream daydreams a lot so they're just staring off and because of this a lot of people may not notice that this child is having a seizure so we can go and notice for a while so whatever they do it they won't respond to you just like someone who's really daydream you gotta snap them out of it but they're not gonna respond to you and if they're doing an activity they'll stop doing the activity and then once the episode the event is over they'll actually continue doing the activity that they saw so it's very short like seconds long so again as you can see that's why it goes unnoticed for a while during the post kick test phase after the seizure it's immediate they recover immediately not ours today is like our tonic clonic but they're not going to remember this event of happening another type of generalized seizure is called a tonic also called drop attacks and here moment you will know why it's called a drop attack so let the name help you tonic whenever we were talking about tonic clonic the tonic part what was happening they had to increase muscle tone because they are having body stiffening when we put an A in front of that word means without without muscle tone so these patients go limp so if the patient is standing they will actually fall now what's one of the heaviest parts on our body our head so what is going to hit the floor when we fall this head so they're at risk for head trauma or if they're sitting there going to slump over our head is really at risk so in the plan of care with these patients because children can suffer from these as well you want to incorporate them wearing a helmet because a lot of times they're not going to know that this is going to happen they're just going to randomly go limb and that head needs to be protected during this type of seizure the patient is not aware of their surroundings and in the post ectis after the seizure it's the recovery is immediate once they regain consciousness now let's look at our focal seizures also called partial seizures we have two types we have focal onset aware also known as simple partial and then we have focal impaired awareness also called complex partial okay first let's talk about this one with this the symptoms vary depending on where the seizure activity is it tends to affect a small area of a lobe so for instance if it's in the CIPA ttle lobe the patient may have vision changes so it's location dependent on what you're gonna see in your patient now the thing to remember to help you differentiate between these two is that in this one the focal onset aware the simple partial the patient is going to be aware of their surroundings whenever this event is taking place which in this time the complex partial the focal impaired awareness they're not aware now a lot of times this simple partial is referred to as the aura because it's short lasts like less than two minutes and sometimes it starts here and it can transpire and form into a complex partial where it can actually extend and go here so a lot of times when patients have this complex partial seizure they will have the aura before it this type of seizure so the focal impaired awareness seizure the patient is unaware so they're not aware of their surroundings but they also will have motor symptoms where they're not going to have that up here and these motor symptoms are called automatism z-- which is like an activity that they're doing automatically without being aware that they're doing it like they're lip-smacking or they're rubbing their hands together or they're trying to grasp for something that isn't there in these type of seizures tend to most commonly arise in the temporal lobe now let's talk about nursing interventions okay as the nurse one of the things we want to do is we want to assess our patient load and we want to ask herself is any of our patients at risk for seizures because just because you're not working on a neuro floor that doesn't mean that you're not going to get patients who can have seizures it can happen to anyone because let's say you're working on a cardiac floor the patient's there because they have a distribute your helping treat that but the patients also withdrawing from alcohol so they're at risk for seizures so you want to put them in seizure precautions now what does that entail well number one you want to make sure that your oxygen and your suction is hooked up and ready to go if you need it you want make sure that that patient has IV access and that that IV access works because you may be giving some anti-seizure medication you want to make sure that the bed rails are padded and get this usually from supply pit those attach those to the bed because if they start having let's say a tonic-clonic seizure they're moving their extremities and their legs they can really bruise them possibly even fracture them if your patient has like bone issues on that railing and their head as well make sure that the bed is in the lowest position possible have a pillow at that head to protect it remove all restrictive clothing or objects that could cause issues and we want to assess and see does that patient have a history of seizures do they have epilepsy and if so ask them about it do they go through the prodromal stage if so what are those signs and symptoms do they have auras if so what are their signs and symptoms so you can be prepared and if they do have auras how fast is that seizure happened whenever that aura happens so they'll give you an idea of how fast you need to act how long do the seizures normally last so if they have a seizure and their seizure normally lasts a minute you can time it while they're having one and make sure that okay this is how long it usually laughs and what type of seizure do they normally have so you can be on the lookout for that another thing is to ask the patient when did you take your seizure medication if they do take seizure medications because a lot of times these patients are coming to you you have to get that medication history and one of the triggers of a seizure as you're gonna learn in a moment is being under medicated because a lot of these seizure medications have to maintain a proper drug level in order for the drug to work so you'll want to look at that and look at those drug levels when those labs are drawn take a look at those are they within normal range now let's talk about what your role is during that actual seizure okay we want to protect our patient because what we've learned is that injury can happen with this they can fall they can hurt themselves so if you can if they have a warning sign you want to easily get that patient on their side and we discuss why the side because that helps move the tongue to the side will help any extra slava blood come out of the mouth instead of pulling back in the throat so we want to help with that and also with the pillow under the head do not restrain the patient because this can hurt them if we do that also hurt yourself do not insert anything in the patient's mouth at all remove any restrictive items on the patient like I just said also think about those eyeglasses they can come off they can Bray cause damage as well and a big thing that I've been hitting on you want to time that seizure we don't want the seizure to be greater than five minutes or if they're having multiple seizures back-to-back cuz they're at risk for what status epilepticus and if that happens you'll want to activate your emergency responses since you're Tommen and that seizure is greater than five minutes you need to do that because regardless you're going to be notifying this position of this seizure but if that status epilepticus does happen the patient needs treatment fast and another thing you're gonna be doing simultaneously while doing all this other stuff is you're gonna mentally be noting the characteristics of that seizure before it happens and during it like for instance did the patient have an aura what did they report or they have them prodromal symptoms what do they report and then the actual seizure happened did they cry out did they experience that stiffening of the body and in a little bit later a couple seconds later they had the jerky in the clonic part so it was tonic-clonic or maybe they just had the tonic signs and symptoms or the clonic they had blood in their mouth where they bit their tongue or their cheek or they're incontinent all of those important little details helps the doctor know hey what kind of seizure was this based on what you seen during the seizure and if you didn't witness the seizure you want to be asking those questions - maybe the nurse nurses aide or the family members of whoever was in that patient's room during the seizure and of course as the nurse you want to try to be as calm as possible reassure that patient family members who are in there who are probably scared half to death if this was like the first seizure that the person has experienced so as the nurse you really want to make sure you're doing that as well now let's talk about what you're going to be doing after the seizure okay the most obvious thing is you want to make sure that your patient is stable house their vital signs especially that airway because it can become compromised during that seizure are they breathing better doing a neuro assessment and you're really wanting to pay attention to how your patient is hating because as we learn with the different types of seizures and all those stages certain seizures will cause a patient to act differently in the post ectis phase so be asking yourself that another thing after notifying the doctor you may be given orders to draw blood especially if they're on a seizure medication and they have a seizure you want to check blood levels or look at other lab work maybe giving medications and the physician may order an EEG an EEG assesses the brain activity think of it like this we always talk about EKGs EKGs assesses the electrical activity in the heart the EEG is assessing the electoral electrical activity on the brain they place these electrodes in certain spots of the brain with a sticky glue stuff and it looks at the brains activity so some things you want to remember about is it's painless if your patient ask you God doesn't hurt you will not allow the patient to have caffeine a stimulant prior to the tests about eight hours prior in addition holding seizure medications and other stimulants they can affect the test because you know we don't want a patient to have a seizure but if they're going to have a seizure it's great for them to have a seizure dinner during an EEG so they can look at that see exactly what's going on where it's coming from so we want to give them their seizure seizure medications after the test they can eat before the test just no caffeine so don't let them have their cup of coffee with their breakfast also you'll want to make sure that the patient's hair is cleaned it's been washed and dried because these little electrodes have to stick on the scalp and if the patient has oily hair that hasn't been washed in a while you're gonna have a lot of problem getting those electrodes to stick so help that technician out make sure that patients hair is clean before sending them down for their EEG in addition you'll want to look at the order and make sure you're doing the right prep work because there's different types of EEG s and if you're not aware you can always call the department because they're really helpful in helping and you need to make sure does this patient are they allowed to sleep before the exam because sometimes they don't want them to sleep the night before or only sleep half of the night so always look at that now let's talk about some education pieces you can provide to your patient about things that can cause a seizure because you want to be educating them to avoid these things because if they do these things it can increase the risk of actually having a seizure so to help us remember seizure triggers let's remember the mnemonic stop seizure so our first s is stress stress can cause seizures t4 trauma Oh for over exertion P for period pregnancy really anything that changes hormones causes hormone shifts even ovulation and your female patients can cause a seizure the other s sleep loss efore electrolyte and metabolic issues like hypoglycemia so really warn your patients who are diabetic who have seizure issues like epilepsy that they always make sure that their blood sugar is good acidosis dehydration so making sure that they're drinking plenty of fluids especially in hot weather I for illness z for visualization disturbances and this can be like sounds certain sounds can trigger seizures and patients also lights like strobe lights can do this as well or even certain smells so anything that's really stimulating those senses can cause seizures you for under medicated again maybe they're not compliant with their medications or they haven't been going to get their drug levels checked which you really want to stress that to your patients the importance of going in getting that blood drawn so they can make sure that their therapeutic and then are for recreational drugs tell your patients to avoid these and then e for alcohol tell your patients to avoid drinking alcohol because that can also lead to seek seizures as well now let's switch gears and let's do a quick overview of the most common medications used to treat seizures epilepsy okay the first strikes we're going to talk about is called barbiturates and a popular bar [ __ ] who it is called phenobarbital and it's used a tree the tonic clonic seizures which is the generalized seizures or focal seizures it can also be used to treat status epilepticus now how does it work now think back to that quick review I had done over the path of physiology and what they do is they stimulate the gaba receptors so those inhibitory neurons and this helps with inhibitory neurotransmitter where you're going to decrease the excitement going on in the brain now some side effects that the patient can have are drowsiness ataxia where they really are uncoordinated and as a nurse what you want to do whenever you're giving this medication you need to really watch out for respiratory depression and hypotension so be looking at that and drug level maintenance to maintain this drug in therapeutic levels is 15 to 40 micrograms per milliliter another drug category is called the high danto ins and a popular drug is called phenytoin and its use in tonic clonic or focal seizures and the patient wants to watch out for gingival hyperplasia because what can happen is that the gums can enlarge and bleed easily so as a nurse you want to assess their gums you want to tell the patient to have a really good mouth care also we can cause bone marrow suppression so you want to watch those platelets and white blood cells and have the patient regularly assess their skin for rashes cuz this medication can also cause seat caused Steven Johnson syndrome and they'll need to report that to their doctor when you give this medication you don't want to give it with milk or antacid because this interferes with the absorption and a therapeutic finish Honan level is 10 to 20 micrograms per milliliter next we have the benzodiazepines and this is used to treat absent seizures tonic-clonic seizures or focal seizures and some popular ones are like diazepam or lorazepam and these are used a law in status epilepticus because they're fast-acting now side effect is that they can cause the patient to feel very drowsy they can also if they've been used a lot on that patient the patient and develop tolerance where that medication just isn't really as effective as it used to be it can also impair the liver so you want to monitor for that look at their liver studies and the reversal agent for benzodiazepines is flumazenil and anytime you're giving these medications you just want to make sure that you have that on hand to easily give that if you do give these medications in case toxicity or something happens where you can reverse the side effects in addition valproate can be used like valproic acid and it can be used for all types of seizures but it can cause liver issues to monitor the liver as well as white blood cells platelets and educate the patient about potential GI issues as well now let's quickly talk about treatments other than medications that can be used for seizures one thing of course is surgery this is where they can remove an area of the brain that's causing the seizure like in focal seizures where there's that specific area they can go in remove part of the temporal lobe like a temporal lobectomy in addition when medications aren't working they can put in an electrical device that sends electrical signals to the vagus nerve called a vagus nerve stimulator and lastly another treatment that can be used specifically in the pediatric patient who has epilepsy is called the ketogenic diet and this is used when the seizures are not controlled by medication and they can follow a diet it's a very very specialized where they consume foods that are high in fat and low in carbs and this can actually decrease seizure activity okay so that wraps up this review over seizures thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos

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Keywords: seizures, seizures symptoms, epilepsy, seizure types, seizure causes, seizures nursing, seizure nursing care, seizure nursing management, epilepsy causes, epilepsy treatment, epilepsy symptoms, grand mal seizures, tonic clonic, petit mal, drop attacks, myoclonic, partial seizures, focal seizures, focal onset aware, focal impaired awareness, absence seizure, atonic seizure, EEG seizures, ketogenic diet, anti seizure medication, aura seizure, nclex

Id: adIZtqtOZss

Length: 30min 15sec (1815 seconds)

Published: Sat Jun 02 2018