Seizure Disorder Case Study (Generalized)

Seizure Disorder (Generalized Seizures) Jane and Jenny, her 4-year old daughter, was walking out of the preschool center when Jenny collapsed in a series of fits. Scared and unsure w hat to do, Jane held Jenny’s head on her lap as her little g irl convulsed. The ambulance arri ved as contacted by a bystander, and they w ere brought to the emergency department where Jenny underwent M RI. Jenny w as d ia gnosed with seizure disorder (Generalized Seizures), and the physician already educated Jane on what to anticipate with thi s disorder to avoid panic and confusion during seizures. 1. Description: A generalized seizure occurs when the abnormal electrical activity causing a seizure begins in both halves (hemispheres) of the brain at the same time. 2. Pathophysiology: Seizures are caused by paroxysmal discharges from groups of neurons, which arise as a result of excessive excitation or loss of inhibition. The key unit of neurotransmission is the synapse, and the fundamental components of synapses are ion channels. 3. Clinical Manifestations:     Temporary confusion A staring spell Uncontrollable jerking movements of the arms and legs Loss of consciousness or awareness  Cognitive or emotional symptoms, such as fear, anxiety or déjà vu Neonatal seizures may be subtle with:         Roving eye movement Repetitive blinking Sucking, lip smacking Tongue thrusting Swimming movement of arms Leg pedaling movement Apnea Tachycardia 4. Lab findings or Diagnostic Findings Lab tests: CBC, Blood chemistry, urine toxicology If meningitis suspected: Urine culture, blood culture, lumbar puncture Radiology tests: CT/MRI/angiography EEG: often performed at follow-up visit between seizures 5. Clinical Therapy       Thorough history Description and length of seizure Presence or absence of an aura Loss of consciousness Many seizures are self-limiting Prolonged seizures: Airway management, Supplemental oxygen, IV benzos, Monitor VS 6. Nursing Management:  Nursing Diagnosis  Ineffective airway clearance R/T inability to control secretions during seizures  Risk for trauma R/T falls with seizures  Anxiety R/T unpredictable nature of seizure disorder  Nursing Interventions and Rationale  Ensure safety: pad the side rails, remove hazardous items in the room, wear medical alert, wear helmet in case of recurrent seizures  Maintain airway patency: place nothing in the mouth, side-lying position when seizure happens, monitor O2 (>95%) sat and HR  Medication administration: precautions when administering IV Benzos (slowly over several minutes to minimize risk or respiratory or circulatory collapse), medications for daily management are given orally  Emotional support: child may be perceived to be different (refer the child and parents to support group and counseling services)  Goals  Child will achieve good seizure control with medication and proper diet (keto)  Child will not be injured incase of a seizure episode  Child will verbalize the precautions he/she will takes when at school or playing sports (wearing medical band, wearing helmet)  Education/Discharge Teaching  Give medications on time. Medications should not be stopped abruptly, and dose is tapered when discontinuation is planned  Ketogenic diet is used for children who do not respond to antiepileptic drugs: high fat, moderate protein, low carbs  Always wear helmet when playing outside  Keep the home free of hazardous items of the floor  Side-lying position during seizure to facilitate secretion drainage QUIZ 1.In diagnosing seizure disorder, which of the following is the most beneficial? A. Brain scan B.Skullradiographs C.Lumbar puncture D.Electroencephalogram 2.After explaining to the parents about their child’s unique psychological needs related to a seizure disorder and possible stressors, which of the following interests uttered by them would indicate further teaching? A. Dependency B. Cognitive delays C.Poor self-image D.Feeling different from peers 3. Tatiana has a seizure disorder; which of the following would be the lowest priority when caring for her? A. Assessing for signs and symptoms of increased intracranial pressure (ICP). B. Educating the family about anticonvulsant therapy. C.Observing and taking down data on all seizures. D.Assuring safety and protection from injury. 4.Angie is an adolescent who has a seizure disorder; which of the following would not be a focus of a teaching program? A. Peer pressure B. Drug and alcoholabuse C.Ability to obtain a driver’s license D.Increased risk of infections 5.Nurse Kim is giving discharge instructions to a client who will be taking phenobarbital (Luminal). The nurse would educate the client in which of the following that directly correlates with the safety of the client? A. Take the medication with meals only. B.Decrease the dosage once with symptoms of dizziness and lightheadedness. C.Take the medication at the same time each day. D.Avoid usingsleepaids while taking the medication.