Case Study (Seizure Disorder)
Prepared By: Tiongson, Elena Marie R. Valondo, Jennylyn Vallejo, Lynette Varilla, Krisren (Group 6)
Submitted to: Ms. Louuie Marrie Carag RN, MSN
Seizure Disorder Introduction Also known as convulsions, epileptic seizures, and if recurrent, epilepsy. It is a sudden alteration in normal brain activity that cause distinct changes in behavior and body function. They are thought to result from abnormal, recurrent, uncontrolled electric discharges of neurons in the brain. Predisposing factors include head or brain trauma, tumors, cranial surgery, metabolic disorders (hypocalcemia, hypoglycemia or hyperglycemia, hyponatremia, anoxia); central nervous system infection; circulating disorders; drug toxicity; drug withdrawal states (alcohol, barbiturates); and congenital neurodegenerative d isorders. There are two basic types of seizures: Epileptic: These seizures have no apparent cause (or trigger) and occur repeatedly. These
seizures are called a ³seizure disorder´ or ³epilepsy.´ Nonepileptic: These seizures are triggered (provoked) by a d isorder or another condition
that irritates the brain. In children, a fever can trigger a nonepileptic seizure.
Signs and Symptoms In about 20% of people who have a seizure disorder, seizures are preceded by unusual sensations (called aura), such as the following: y
Abnormal smells or tastes
y
Butterflies
y
A feeling of déjà vu
y
An intense feeling that a seizure is about to begin
in the stomach
Almost all seizures are relatively brief, lasting from a few seconds to a few minutes. Most seizures last 1 to 2 minutes. When a seizure stops, people may have a headache, sore muscles, unusual sensations, confusion, and profound fatigue. These after-effects are called the postictal state. In some people, one side of the body is weak, and the weakness lasts longer than the seizure (a disorder called Todd's paralysis). Most people who have a seizure disorder look and behave normally between seizures. Other possible symptoms include numbness or tingling in a specific body part, brief episodes of unresponsiveness, loss of consciousness, confusion, and loss of muscle or bladder control.
athophysiology
P
y
B efore
age 2: High fevers or temporary metabolic abnormalities, such as abnormal blood
levels of sugar (glucose), calcium, magnesium, vita min B6, or sodium, can trigger one or more seizures. Seizures do not occur once the fever or abnormality resolves. If the seizures recur without such triggers, the cause is likely to be an injury during birth, a birth defect, or a hereditary metabolic abnormality or brain disorder. y
2 to 14 years: Often, the cause is unknown.
y
After
age 25: A head injury, stroke, or tumor may da mage the brain, causing a seizure.
Alcohol withdrawal (caused by suddenly stopping drinking) is a common cause of seizures. However, in about half of people in this age group, the cause is unknown. Seizures with no identifiable cause are ca lled idiopathic. Conditions that irritate the brain²such as injuries, certain drugs, sleep deprivation, infections, fever²or that deprive the brain of oxygen or fuel²such as abnormal heart rhythms, a low level of oxygen in the blood, or a very low level of sugar in the blood²can trigger a single seizure whether a person has a seizure disorder or not. A single seizure that results from such a stimulus is called a provoked seizure (and thus is a nonepileptic seizure). Peo ple with a seizure disorder
are more likely to have a seizure when they are under excess physical or emotional stress or deprived of sleep. Avoiding these conditions can help prevent seizures. Rarely, seizures are triggered by repetitive sounds, flashing lights, video games, or even touching certain parts of the body. In such cases, the disorder is called reflex epilepsy. Causes of Seizures Cause
Examples
High fever
Heatstroke Infections
Brain infections
Abscess AIDS Malaria Meningitis Rabies Syphilis Tetanus Toxoplasmosis Viral encephalitis
Metabolic disorders
High blood levels of sugar or sodium Kidney or liver failure Low blood levels of sugar, calcium, magnesium, or sodium Underactive parathyroid gland Vitamin B6 deficiency (in newborns)
Inadequate oxygen supply to the brain
Abnormal heart rhythms Carbon monoxide poisoning Near drowning Near suffocation Stroke Vasculitis
iagnostic Procedure
D 1.
EEG, with or without video monitoring, locates epileptic focus, spread, intensity, and duration, helps classify seizure t ype.
2.
CT scanning or MRI identifies lesion that may cause of seizure.
3.
Single photon emission CT scanning (SPECT) or positron emission tomography (PET) identifies seizure foci.
4.
Neuropsychological studies evaluate for behavioral disturbances.
5.
Serum electrolytes, glucose, and toxicity screen determine the cause of first seizure.
6.
Lumbar puncture and blood cultures may be necessary if fever is present.
Medical Management 1. Antiepileptic drugs (AEDs) may be used singly or in co mbination to increase effectiveness, treat mixed seizure types, and reduce adverse effects. 2. A wide variety of adverse reactions may occur, including hepatic and renal dysfunct ion, vision disturbances, drowsiness, ataxia, anemia, leukopenia, thromboc ytopenia, psychotic symptoms, skin rash, stomach upset, and idiosyncratic reactions.
Surgical Management 1. Surgical treatment of brain tumor or hematoma may relieve seizures caused by these. 2. Temporal lobectomy, extratemporal resection, corpus callosotomy, or hemispherectomy may be necessary in medica lly intractable seizure disorders.
ursing Management
N 1.
Monitor the entire seizure event, including prodromal signs, seizure behavior, and postictal state.
2.
Monitor complete blood count, urinalysis, and liver function studies for toxicity caused by medications.
3.
Provide safe environment by padding side rails and removing clutter.
4.
Place the bed in low position.
5.
Do not restrain the patient during seizure.
6.
Do not put anything in the patient¶s mouth during seizure.
7.
Maintain a patent airway until the patient is fully awake after a seizure.
8.
Provide oxygen during the seizure if the patient becomes cyanotic.
9.
Place the patient on side during a seizure to prevent aspiration.
10.
Protect the patient¶s head during the seizure.
11.
Teach stress reduction techniques that will fit into t he patient¶s lifestyle.
12.
Tell the patient to avoid alcohol because it interferes with metabolism of AEDs and adds to sedation.
13.
Encourage the patient to determine existence of triggering factors for seizures, such as skipped meals, lack of sleep, and emotional stress.
14.
Remind the family the importance of following medication regimen and maintaining regular laboratory testing, medical check ups, and visual examinations.
15.
Encourage patient to follow a moderate lifestyle routine, including exercise, mental activity, and nutritious diet.