Seizures are episodes of abnormal motor,sensory,autonomic and psychic activity(or a combination of these )that results from sudden excessive discharge from cerebral neurones. A part or all of the brain is involved. The international classification of seizures differentiates between two main types., partial seizures that begin in one part of the brain and generalized seizures that involve electrical discharge in the whole brain.
INTERNATIONAL CLASSIFICATION OF SEIZURES
Partial seizures(seizures beginning locally)
Simple partial seizures (with elementary symptoms, generally without impairment of consciousness)
Complex partial seizures (with complex symptoms, generally with impairment of consciousness)
- With impairment of consciousness only.
- With cognitive symptoms
- With affective symptoms
- With psycho sensory symptoms
- With psychomotor symptoms(automatisms)
- Compound forms
Partial seizures secondarily generalized
- Tonic clonic seizures
- Tonic seizures
- Clonic seizures
- Absence(Petitmal) seizures
- Atonic seizures
- Myoclonic seizures(Bilaterally massive epileptic)
- Unclassified seizures
Generalized seizures(Convulsive or non convulsive, bilaterally symmetric,without local onset)
- The underlying cause is an electrical disturbance (Dysrrhythmia)in the nerve cells in one section of the brain., these cells emits abnormal,recurring,uncontrolled,electrical discharges.
- Idiopathic causes(Genetic or developmental causes)
- Acquired causes which includes
2. Hypoxemia of any cause including vascular insufficiency.
4. Head injury.
6. Central nervous system infections.
8. Drug and alcoholic withdrawal.
NURSING MANAGEMENT(DURING A SEIZURE)
- The circumstances before the seizure(visual, auditory or olfactory stimuli, tactile stimuli, emotional or psychological disturbances,sleep,hyperventilation)
- The occurrence of an aura(premonitory or warning sensation that can be visual, auditory or olfactory)
- The first thing the patient does in the seizure where the movements or the stiffness begins, conjugate gaze position, position of the head at the beginning of the seizure. This information gives clue to the location of the seizure lesion in the brain.(In recording it is important to record whether the beginning of the seizure is observed or not)
- Observe the areas in the body involved during seizure and the type of movements involved.
- The size of both the pupils and whether both the eyes are open or closed.
- Whether the eyes or head is turned to one side
- The presence or absence of automatisms(involuntary motor activity, such as lip smacking or repeated swallowing.
- Incontinence of urine or stool
- Unconsciousness if present and the duration.
- Any obvious paralysis or weakness of arms or legs after any seizure.
- Inability to speak after the seizure.
- .Whether or not the patient speaks afterwards.
- Cognitive status(confused or not confused after the seizure.
- Protect the patient both physically and psychologically.
- Provide privacy and protect the patient from curious onlookers
- Ease the patient to the floor if possible.
- Protect the head with a pad to prevent injury(from striking a hard surface)
- Loosen constrictive clothing
- Push aside any furniture that may injure the patient during seizure.
- If the patient is on bed put side rails
- If an aura preceded insert an oral airway to reduce the possibility of the patient from biting the tongue or cheeks.
- Do not attempt to open the jaws that are clenched in a spasm or to insert anything. Broken teeth and an injury to the tongue and lips may result from such an action
- Do not restrain the patient during a seizure episode.
- Place the patient in side lying position and the suction apparatus and the oxygen cylinder should be nearby the patient.
NURSING CARE AFTER THE SEIZURE
v Keep the patient on one side to prevent aspiration. Make sure that the airway is patent.
v There is usually a period of confusion after an episode of grandmal seizure.
v A short apnoeic period may occur during or immediately after a generalized seizure.
- The nurse initiates ongoing assessment and monitoring of respiratory and cardiac function because of the risk for delayed depression of the respiration and blood pressure secondary to the administration of the anti seizure medications and sedatives to halt the seizures.
- The patient is usually kept in side lying position.Suction apparatus should be available.
- Cardiac monitoring and recording of the seizure activity.
- IV Line should be closely monitored.
- A patient at long term seizure therapy is at risk for fracture resulting from bone disease(Osteoporosis,Osteomalacia and hyperparathyroidism) So precautions should be taken to prevent injury.
- The nurses must protect themselves from injury
- Ineffective airway clearance related to loss of consciousness,apnea,excessive secretions, jaw clenching, or airway occlusion by the tongue or foreign body
- Risk for status epilepticus related to inadequate pharmacological control or misidentification of the underlying cause.
- Risk for injury related to excessive uncontrolled muscle activity
- Knowledge deficit(seizure management)related to lack of exposure to information