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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


Seizures


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


Seizures
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


Brain herniation
Brain Herniation


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