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Seizures. A seizure is sudden, abnormal, and excessive electrical discharges from the brain that can change motor or autonomic function, consciousness, or sensation Epilepsy is a chronic neurological disorder characterized by recurrent seizures

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seizures
Seizures
  • A seizure is sudden, abnormal, and excessive electrical discharges from the brain that can change motor or autonomic function, consciousness, or sensation
  • Epilepsy is a chronic neurological disorder characterized by recurrent seizures
  • Seizures may be a symptom of epilepsy or another neuro disorder
etiology
Etiology

Normal stability of neuron cell membrane is impaired

  • Idiopathic
    • No Cause Identified
    • Usually onset before age 20
  • Acquired
    • Underlying Neurological Disorder
    • Brain Injury
classification of seizures
Classification of seizures
  • Partial
    • Begin on one side of cerebral cortex, may progress to other side and become generalized
  • Generalized
    • Both cerebral hemispheres involved

S+S depend on area where abnormal electrical discharges occur

signs symptoms
Signs & Symptoms
  • Aura
    • Visual distortion
    • Odor
    • Sound

Patients may have this warning, allowing time to improve safety

signs symptoms1
Signs & Symptoms
  • Partial Seizures
    • Automatisms
      • Repetitive, purposeless movements while in dream-like state
    • Maintain consciousness
    • Usually <1 minute
    • Paresthesias if begins in parietal lobe
    • Visual disturbances if occipital lobe
    • Involuntary movements if motor cortex, usually begin in arm and hand, progress to leg and face
signs symptoms2
Signs & Symptoms
  • Complex Partial/Psychomotor
    • Partial seizure as described, but…
    • Lose consciousness
    • May last 2 – 15 minutes
signs symptoms3
Signs & Symptoms
  • Generalized Seizures
    • Absence (Petit Mal)
      • Staring that lasts several seconds
      • http://www.youtube.com/watch?v=z9V2sNmIoJk&feature=related
signs symptoms4
Signs & Symptoms
  • Generalized Seizures
    • Tonic Clonic (Grand Mal)

May have aura, usually lose consciousness

      • Tonic phase
        • Rigidity
      • Clonic phase
        • Muscle contraction and relaxation
        • Incontinence
      • Postictal period-recovery period after a seizure
slide9

http://www.youtube.com/watch?v=nV40H_g-NJo&NR=1

  • http://www.youtube.com/watch?v=H2vH1igOoh0&feature=related
  • http://www.youtube.com/watch?v=p5U2tpaH3fA&feature=related
    • http://www.youtube.com/watch?v=VC6HJPZr1VU&feature=related
diagnosis
Diagnosis
  • EEG
    • Can determine site of origin, frequency and duration, dx subclinical
  • Look for underlying cause
  • Accurate observation/reporting of seizure
therapeutic interventions
Therapeutic Interventions
  • Correct Cause
  • Anticonvulsant Medication
    • Taper slowly
    • Common side effect-drowsiness
  • Surgical Resection
    • If focus is located in nonvital tissue, resceting area can prevent spread to other areas of brain
emergency care seizures
Emergency Care: Seizures

Prevent injury

  • Pad side rails
  • Keep away from furniture, walls
  • Do not restrain
  • Loosen tight clothing, belts, jewelry
  • Monitor airway
  • Turn on side to prevent aspiration
  • Once seizure has begun, do not force airway/suction into patient’s mouth
  • Suction, CPR PRN (suction, oral airway at bedside)
  • Observe and document
status epilepticus
Status Epilepticus
  • 30 minutes of seizure activity without return to consciousness
  • Therapeutic Interventions
    • Ensure airway and oxygenation
      • Intubation and mechanical vent
    • Administer IV diazepam (Valium) or lorazepam (Ativan) or phenobarbitol
spinal trauma
Spinal Trauma
  • Characterized by a decrease or loss of sensory and motor function below the level of the injury
  • Damage results from bruising, tearing, cutting , edema or bleeding into the spinal cord
    • Causes?
  • Complete injury means no motor or sensory function below the level of the injury
  • Incomplete means some functioning remains
spinal trauma1
Spinal Trauma
  • Injury to C3 or above is usually fatal
  • C4-C5 injuries likely require ventilation
  • Quadriplegia vs. quadriparesis
  • Paraplegia vs. paraparesis
  • Spinal Shock
    • SCI affects autonomic nervous system
    • Lasts from a week to months
    • Immediately after injury, sympathetic NS is disrupted
      • Vasodilation
      • Hypotension
      • Bradycardia
      • Hypothermia
whiplash
Whiplash
  • See handout
increased intracranial pressure
Increased Intracranial Pressure
  • Pathophysiology
    • Increase in
      • Brain
      • Blood
      • CSF
slide18
ICP
  • Normal ICP 0-15mm Hg
    • Affected by pathologic conditions
      • Most Common causes of IICP
        • Brain Trauma
        • Brain Tumor
        • Intracranial Hemorrhage
    • Also affected by positioning, arterial pulsations, increase in intrathoracic pressure
signs symptoms5
Signs & Symptoms
  • Restlessness
  • Irritability
  • Decreased LOC
  • Hyperventilation
  • Pupil changes (due to compression of occulomotor nerve)
  • Cushing’s Response (classic late response)
    • Body attempts to compensate for IICP caused cerebral perfusion deficits with increased systemic blood pressure
icp monitoring
ICP Monitoring
  • Monitors are placed thru burr hole drilled thru skull
  • Cared for in ICU-often ventilated and pharmacologically sedated/paralyzed
    • External Ventricular Monitor and Drain
    • Subarachnoid Bolt Monitor-ease of placement
    • Intraparenchymal Monitor-directly into brain tissue
interventions to prevent iicp
Interventions to prevent IICP
  • Keep HOB elevated 30*
  • Keep head and neck in proper alignment
    • Avoid neck flexion
  • Antiemetics and antitussives PRN
  • Stool softeners PRN
  • Minimize suctioning
  • Avoid hip flexion
  • Prevent noxious stimuli
  • Space care activities
traumatic brain injury tbi
Traumatic Brain Injury (TBI)
  • Trauma
    • Hemorrhage
    • Contusion
    • Laceration
  • Can Cause
    • Cerebral Edema
    • Hyperemia
    • Hydrocephalus
    • Brain Herniation
    • Death
etiology1
Etiology
  • MVA most common
  • Falls
  • Assaults
  • Sports-related injuries
mechanisms of injury
Mechanisms of Injury
  • Closed or nonpenetrating head injury (blunt)
    • Rapid back and forth movement causing bruising and tearing of brain tissues and vessels
  • Open or penetrating head injury
    • Break in the skull with brain tissue/vessel damage
  • Acceleration
    • Moving object hits stationary head
  • Deceleration
    • Head in motion hits a stationary object
  • Acceleration-Deceleration/Contra-Coup
    • Combination of two
types of injury
Types of Injury
  • Concussion: see handout
    • Brief or no LOC, <5 mins
    • Headache, dizziness, N/V, vertigo
    • May have amnesia
    • CT/MRI negative
    • Rest, fluids, Tylenol, frequent LOC monitoring
    • Avoid narcotics, sedatives, opiods, no driving
    • Concussion syndrome may last months
types of injury1
Types of Injury
  • Contusion
    • Bruising of brain tissue
    • May develop hemorrhage
    • Symptoms depend on area(s) and severity
      • Brainstem-decreased LOC (may be permanent), motor response, pupil reaction, eye movement, elevated RR, fever
    • CT scan shows tissue swelling
    • Treatment supportive
types of injury2
Types of Injury
  • Hematoma
    • Subdural (A)
      • Usually venous
      • Between dura and arachnoid membranes
    • Epidural (B)
      • Usually arterial
      • Between dura and skull
types of injury3
Types of Injury
  • Subdural Hematoma
    • Acute vs Chronic
      • If chronic, may be months from injury to S+S
        • Forgetful
        • Lethargic
        • Irritable
        • Headache
    • Damage to brain tissue as blood accumulates
      • LOC changes
      • Hemiparesis
      • Dilated pupil
      • Extremity weakness
types of injury4
Types of Injury
  • Epidural Hematoma
    • Often associated with skull fracture
    • Arterial, so usually progresses quickly
    • Loss of consciousness after injury>regain consciousness, coherent>then rapid deterioration
    • Decreased LOC, seizures
diagnosis1
Diagnosis
  • CT-test of choice, rapid results
  • MRI
  • Neuropsychological Testing
therapeutic interventions1
Therapeutic Interventions
  • Surgical Removal of Hematoma
    • Burr holes, craniotomy
  • Control IICP
    • ICP Monitoring
      • Drainage of CSF
    • Osmotic Diuretic
      • Mannitol (Osmitrol)
    • Mechanical Hyperventilation
  • Therapeutic Coma
complications of tbi
Complications of TBI
  • Brain Herniation
  • Diabetes Insipidus
    • Damage to Pituitary=too little ADH
  • Acute Hydrocephalus
    • Ventriculoperitoneal shunt
  • Labile Vital Signs
  • Cognitive and Personality Changes
  • Often life-long deficits
persistent vegetative state pvs
Persistent Vegetative State (PVS)
  • PVS-Continual condition of complete unawareness of the environment, there is at least partial preservation of hypothalmic and brain stem functioning
  • Coma-state of unconsciousness from which one cannot be aroused and is unresponsive
nursing diagnoses tbi
Nursing Diagnoses TBI
  • Ineffective Cerebral Tissue Perfusion
  • Ineffective Airway Clearance
  • Ineffective Breathing Pattern
  • Disturbed Thought Processes
  • Self-Care Deficit
  • Pain
  • Sensory-Perceptual Disturbance
  • Impaired Physical Mobility
  • Risk for Injury
nursing care tbi
Nursing Care TBI
  • ICU-monitoring ICP
  • Monitor neuro status frequently
    • Glasgow Coma Scale
    • Pupil response
    • Muscle strength
    • Vital signs
    • Monitor for seizures
    • Posturing
      • Decorticate
      • Decerebrate
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