CONVULSIVE Disorder (CONVULSIONS

Disorder of the CNS char. by paroxysmal seizures with or without loss of consciousness, abnormal motor activity, alteration in sensation & perception & change in behavior.

Can you outgrow febrile seizure? Difference between: Seizure- 1st convulsive attack

Febrile seizure Normal if < 5 yo Epilepsy – 2nd and with history of seizure

Pathologic if > 5 yo

Predisposing Factor

Head injury due birth trauma

Toxicity of carbon monoxide

Brain tumor

Genetics

Nutritional & metabolic deficit

Physical stress

Sudden withdrawal to anticonvulsants will bring about status epilepticus

Status epilepticus – drug of choice: Diazepam & glucose

S & Sx

I. Generalized Seizure

a.) Grand mal / tonic clonic seizures

With or without aura – warning symptoms of impending seizure attack- Epigastric pain- associated with olfactory, tactile, visual, auditory sensory experience

- Epileptic cry – fall

- Loss of consciousness 3 – 5 min

- Tonic clonic contractions

- Direct symmetrical extension of extremities-TONIC. Contractions-CLONIC

- Post ictal sleep -state of lethargy or drowsiness – unresponding sleep after tonic clonic

b.) Petimal seizure – (same as daydreaming!) or absent seizure.

- Blank stare

- Decrease blinking eye

- Twitching of mouth

- Loss of consciousness – 5 – 10 secs (quick & short)

II. Localized/partial seizure

a.) Jacksonian seizure or focal seizure – tingling/jerky movement of index finger/thumb & spreads to shoulder & 1 sideof the body with janksonian march

b.) Psychomotor/ focal motor – seizure

-Automatism – stereotype repetitive & non-purposive behavior

- Clouding of consciousness – not in control with environment

- Mild hallucinatory sensory experience

HALLUCINATIONS

1. Auditory – schitzo – paranoid type

2. Visual – korsakoffs psychosis – chronic alcoholism

3. Tactile – addict – substance abuse

III. Status epilecticus – continuous, uninterrupted seizure activity, if untreated, lead to hyperprexia – coma – death

Seizure: inc electrical firing in brain=increased metabolic activity in brain=brain using glucose and O2=dec glucose, dec O2.

Tx:Diazepam (drug of choice), glucose

Dx-Convulsion- get health history!

1. CT scan – brain lesion
2. EEG electroencephalography

- Hyperactivity brain waves

Nursing Management

Priority – Airway & safety

1. Maintain patent a/w & promote safety

Before seizure:

1.
1. Remove blunt/sharp objects
2. Loosen clothing
3. Avoid restraints
4. Maintain siderails
5. Turn head to side to prevent aspiration
6. Tongue guard or mouth piece to prevent biting of tongue-BEFORE SEIZURE ONLY!
Can use spoon at home.
7. Avoid precipitating stimulus – bright glaring lights & noises
8. Administer meds

1. Dilantin (Phenytoin) –( toxicity level – 20 )

SE Ginguial hyperplasia

H-hairy tongue

A-ataxia

N-nystagmus

A-acetaminophen- febrile pt

Mix with NSS

- Don’t give alcohol – lead to CNS depression

b. (Tegretol) Carbamasene- given also to Trigeminal Neuralgia. SE: arrythmia

c. Phenobarbital (Luminal)- SE: hallucinations

2. Institute seizure & safety precaution. Post seizure: Administer O2. Suction apparatus ready at bedside

3. Monitor onset & duration

- Type of seizure

- Duration of post ictal sleep. The longer the duration of post ictal sleep, the higher chance of having status epilepticus!

4. Assist in surgical procedure. Cortical resection

5. Complications: Subarachnoid hemorrhage and encephalitis

Question: 1 yo grand mal – immediate nursing action = a/w & safety

a. Mouthpiece – 1 yr old – little teeth only

b. Adm o2 inhalation – post!

c. Give pillow – safety (answer)

d. Prepare suction

Neurological assessment:

1. Comprehensive neuro exam
2. GCS – Glasgow coma scale – obj measurement of LOC or quick neuro check

3 components of ECS

M – motor 6

V – verbal resp 5

E – eye opening 4

15

15 – 14 – conscious

13 – 11 – lethargy

10 – 8 – stupor

7 – coma

3 – deep coma – lowest score

Survey of mental status & speech (Comprehensice Neuro Exam)

1.) LOC & test of memory

2.) Levels of orientation

3.) CN assessment

4.) Motor assessment

5.) Sensory assessment

6.) Cerebral test – Romhberg, finger to nose

7.) DTR

8.) Autonomics

Levels of consciousness (LOC) –

1. Conscious (conscious) – awake – levels of wakefulness
2. Lethargy (lethargic) – drowsy, sleepy, obtunded
3. Stupor (stuporous) – awakened by vigorous stimulation

Patient has general body weakness, decrease body reflex

1. Coma (Comatose) light – (+) all forms of painful stimulations

Deep – (-) to painful stimulation

Patient consciousness
1. Alert – not all pt are alert & oriented to time & place
2. Coherent
3. Awake- answer
4. Aware

Different types of pain stimulation

- Don’t prick

1. Deep sternal stimulation/ pressure 3x– fist knuckle

With response – light coma

Without response – deep coma

1. Pressure on great toe – 3x
2. Orbital pressure – pressure on orbits only – below eye
3. Corneal reflex/ blinking reflex

Wisp of cotton – used to illicit blinking reflex among conscious patients

Instill 1-drop saline solution – unconscious pt if (-) response pt is in deep coma

1. Test of memory – considered educational background

a.) Short term memory –

- What did you eat for breakfast?

Damage to temporal lobe – (+) antero grade amnesia

b.) Long term memory

(+) Retrograde amnesia – damage to limbic system

1. Levels of orientation

Time Place Person

Graphesthesia- can identify numbers or letters written on palm with a blunt object.

Agraphesthesia – cant identify numbers or letters written on palm with a blunt object.