By: Aiza

Functions of the Nervous System

The nervous system directs the

complex processes of the body's internal environment and also provides a link to the external world. This allows us to respond to changes both from internal sources as well as form external stimuli.

Neuron
Nerves are made up

of small cells called neurons. In order for the brain to feel, think, and give orders to muscles, the neurons fire electrical and chemical signals to each other.

Seizure is..

sudden, uncontrolled electricity in the brain.

discharge

of

episode of abnormal motor, sensory, autonomic, or psychic activity that result from sudden excessive discharge from cerebral neurons.

Epilepsy is..
a disorder characterized recurrent seizure by

Partial seizure

electrical disruption involves a limited area of the brain consciousness usually not impaired

Generalized seizure

electrical disruption involves the entire brain.

consciousness is always impaired

Generalized seizure

Absence seizure brief loss of consciousness automatism Myoclonic seizure Sudden, brief muscle contraction Atonic seizure loss of muscle tone

Generalized seizure

Tonic seizure increased muscle tone Clonic seizure Loss of consciousness Decrease muscle tone Jerking movement

Tonic-Clonic Seizure

Status Epilepticus

series of generalized seizures that occur without full recovery of consciousness between attack

Phases of Seizures

Prodromal phase

Signs or activity before the seizure

Sensation or warning that the patient remembers Actual seizure After seizure

Aural phase

Ictal phase

Postictal phase

Physiological

Iatrogenic

CNS infections Metabolic disorders Brain trauma/injury Stroke Biochemical imbalance Fever Hormonal changes

New medications or withdrawal Alcoholism

Seizure Triggers

Lack of sleep Flashing lights Loud music Fatigue Smoking Alcohol consumption

Precipitating Factors: Sensory stimuli, CNS infection/disorder, Brain trauma

Predisposing Factors: Age, Genetics, Lifestyle

Electrical disturbance in the nerve cells of the brain Uncoordinated flow of electrical activity in the brain
Normal inhibitory mechanism prevents spread of electrical discharges form focal area

EEG

Vagal Nerve Stimulation therapy

Spread to brain stem

Spread to both hemisphere

PARTIAL SEIZURE

GENERALIZED SEIZURE

PARTIAL SEIZURE
Electrical impulse transmitted into the cerebral cortex Motor cortex: Jerky/stiffening clonus Sensory cortex: Numbness Tingling Seeing flashes of lights Hearing buzzing Unpleasant odor/taste Psychic Symptoms: Dj vu Jamais vu Anxiety Irritability Hallucination illusion Autonomic Symptoms: Pallor Sweating Epigastric discomfort Flushing Pupil dilatation

GENERALIZED SEIZURE
Tonic-clonic seizure
Hydantoins Benzodiazepines barbiturates Succinimides Valproic Acid

Absence seizure

AURAL PHASE Auditory/visual hallucination Unpleasant odor or taste

TONIC PHASE Sharp tonic muscle contraction Sudden loss of consciousness tonic cry Extension of arms/legs Jaw clenched Increase BP, HR Cyanotic Loss of gag reflex

Sudden brief cessation of all motor activity

Blank staring Lack of awareness, responsiveness

CLONIC PHASE

CLONIC PHASE Violent jerking movement Urinary bowel incontinence Biting of tounge Increased salivation

POST-ICTAL PHASE poor coordination Mild impairment of fine motor movements Loss of memory of entire event Vomiting Severe headache

Continuous seizure with incomplete recovery of consciousness STATUS EPILEPTICUS Heavy metabolic demand Interfere respiration RESPIRATORY ARREST

Venous congestion and hypoxia of the brain

DEATH

Fatal brain damage

Partial seizure

Motor signs include:

Clonus Eye movements and turning of the head to the one side Speech arrest, vocalization

Partial seizure

Sensory signs include:

Seeing flashes of lights Numbness, tingling Hearing humming, buzzing Experiencing unpleasant odor/taste

Partial seizure

Autonomic signs and symptoms include:

Pallor Sweating Flushing Epigastric discomfort Pupil dilatation

Partial seizure

Psychological symptoms include:

Dj vu Jamais vu Anxiety Hallucination/illusion irritability

Generalized Seizure
Tonic-Clonic Seizure Aural Phase

auditory/visual hallucinations Unpleasant odor/taste

Generalized Seizure
Tonic-Clonic Seizure Tonic phase sharp tonic muscle contraction Sudden loss of consciousness Yell or tonic cry Extension of arms and legs Increase BP, HR Cyanosis Loss of gag reflex

Generalized Seizure
Tonic-Clonic Seizure Clonic phase

violent jerking movements Urinary bowel incontinence Biting of tounge Increased salivation

Generalized Seizure
Tonic-Clonic Seizure Post-ictal phase poor coordination Mild impairment of fine motor movements Loss of memory of entire event Vomiting Severe headache

Generalized Seizure
Absence Seizure Blank staring Automatism (lip smacking, chewing grimacing, eyelid fluttering) Lack of awareness, responsiveness

Diagnostic Tests

Medical History Complete Neurological and Behavioral Exam- to test for motor abilities, behavior and intellectual capacity.

Diagnostic Tests

Blood Studies- to
check for signs of

infections, electrolyte
imbalance, anemia or

diabetes.

Diagnostic Tests
Electroencephalogram (EEG)- to help confirm the seizure diagnosis and localize any lesions. - It provides graphic record of the brains electrical activity

Electroencephalogram (EEG)

Diagnostic Tests
Skull X-rays- to
identify possible

fractures, deformities
in bony structure or

calcification

Diagnostic Tests
MRI/CT Scan- to
reveal any brain

abnormalities that
might be causing

seizure

Diagnostic Tests

Lumbar Puncture- to
determine the

presence of infection
or elevated protein

level in CSF

Pharmacological Management

HYDANTOINS (phenytoin, ethotoin, mephenytoin, fosphenytoin) ACTION- stabilize the nerve cell membrane throughout the brain reducing and limiting the excitability and conduction through the nerve pathway.

HYDANTOINS

CONTRAINDICATION AND PRECAUTION - Hydantoins are NOT given to pregnant patient because it can cause fetal hydantoin syndrome.

HYDANTOINS
ADVERSE EFFECT: GINGIVAL HYPERPLASIA severe liver toxicity Confusion bone marrow depression

Pharmacological Management
G-U-M-S G- gingival hyperplasia
U-Use

alternate birth control & preventive dental check-

M- Mouth care

up
S- Soft toothbrush and dont stop abruptly

Pharmacological Management

BENZODIAZEPINES (Diazepam, Clonazepam, Clorazepate) ACTION- act on the Limbic system and the RAS (reticular activating system) to make the GABA ( Gammaaminobutyric acid) more effective causing interference with neuron firing.

BENZODIAZEPINES
ADVERSE EFFECT: sedation drowsiness depression lethargy blurred vision dry mouth Hypotension

BENZODIAZEPINES
NURSING CONSIDERATION:
Provide comfort measures to help

patients tolerate drug effects

Have available FLUMAZENIL as

an antidote for benzodiazepines overdose.

Pharmacological Management

BARBITURATES (Phenobarbital) ACTION- CNS depressants that inhibit the neuronal impulse conduction in the ascending RAS (reticular activating system).

BARBITURATES
ADVERSE EFFECT:

CNS depression

Nausea and vomiting

constipation

BARBITURATES
NURSING CONSIDERATION:
Provide stand-by life support facilities in

cases of severe respiratory depression or hypersensitivity reaction. frequent meals, access to bathroom facilities, environmental control, safety precaution and skin care.

Provide comfort measures including small

CARBAMAZEPINE
ACTION- decreases synaptic transmission in the CNS by affecting sodium channels in neurons

CARBAMAZEPINE
ADVERSE EFFECT: Dizziness Drowsiness Unsteadiness Nausea and Vomiting Suicidal thought/behavior

CARBAMAZEPINE
NURSING CONSIDERATION: Instruct patient to take carbamazepine around the clock, exactly as directed.

If a dose is missed, take as soon as possible but not just before next dose; do not double doses.

THERAPIES
Vagus nerve

stimulation therapy- to prevent seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve.

THERAPIES
Ketogenic dietspecial high-fat, low-carbohydrate diet that helps to control seizures in some people with epilepsy.

During Seizure

A major responsibility of the nurse is to

observe and record the sequence of signs:

Date, time of onset, duration Level of consciousness movements

During Seizure

Ensure adequate ventilation

Loosen clothing Do not force anything into the mouth Turn on the side
Clear any hazard or hard object from surroundings

Protect the person from injury

DO NOT restrain movement Stay with them until they feel well again

After Seizure

Document the events leading to and occurring during and after seizure.
Check breathing, keep in side-lying position.

Stay and talk to the person.

Give reassurance until they are fully recovered.

Do not offer something to eat or drink until you

are sure they are fully recovered.

Nursing Diagnosis
Risk for Ineffective airway clearance Risk for injury related to seizure activity Fear related to possibility of seizure.

Risk for Ineffective Airway Clearance

Provide interventions to maintain a patent airway:

Loosen clothing around the neck Turn on the side. Do not force anything into the mouth If prescribed and available, administer oxygen.

Risk for Injury related to seizure activity

Placed bed in low position with two to three side rails up and padded

Clear any hazard or hard object from

surroundings

DO NOT restrain movement

HEALTH TEACHINGS

Avoid activities that need concentration such

as driving, machinery work, and dangerous work like swimming, fire work etc. It's a good idea for you to carry a card or wear a MedicAlert bracelet which says that you have

epilepsy.

Be sure to take your medication correctly.

HEALTH TEACHINGS
It's also important to keep a detailed seizure

record. Each time a seizure occurs, write down

the time, the type of seizure it was and how long it lasted.

Also make note of any unusual circumstances, such as changes in medication, increased stress or other events that might trigger seizure activity.

HEALTH TEACHINGS

Get adequate rest every night, and make a conscious effort to eat a balanced diet, exercise and manage stress effectively.

Wear a medical bracelet to help emergency personnel.

1.) Babs had a tonic-clonic seizure immediately after her injury. Your best action for this type of seizure would be to a.) Place a hard object between her teeth to protect her tongue. b.) Restrain her from any movement by holding her down. c.) Turn her onto her back and administer immediate CPR. d.) Protect her from hitting her arms against any hard surface. Answer

2.) If Babs were having an absence seizure, your best action would be to: a.) Ask her to hold her breath for a count of ten. b.) attempt to distract her by calling her name. c.) tell her to talk to keep her attention focused. d.) observe her carefully but initiate no action.

Answer

3.) Suppose Babs is prescribed phenytoin sodium (Dilantin) for tonic-clonic seizures. An important health measure you would teach her is to a.) use soft bristle toothbrush b.) know the drug may cause severe itchiness. c.) have her hearing tested every 3 months. d.) report any signs of loss of hair color. Answer

4.) The primary teaching plan for a patient with epilepsy should include which of the following precautions. a.) Warn your coworkers that you have a seizure

disorder
b.) Wear a medical alert bracelet c.) Lose weight to help control your seizures d.) Avoid situations that are stressful Answer

5.) Which of the following is the priority safety intervention when protecting the patient having a seizure a.)Placing tounge blade between their teeth

b.)Ensure the patient is retrained

c.) Position the patient to prevent aspiration of secretions d.) Determine if the patient is incontinent Answer

6.) Which of these should you do if you see someone having a seizure a.) Panic b.) Stick a spoon, finger or another object in his

mouth
c.) Hold the person down so that he wont hurt

himself
d.) None of these answer

7) A person with epilepsy is able to do which of the following: a.) Work b.) Participate in sport c.) Swim d.) All of these Answer

8.) After a seizure, the patient may experience an aura, sensor alteration involving sight, sound or smell

TRUE or FALSE ?

Answer

9.) Andidote for BENZODIAZEPINES OVERDOSE

Answer

10) Type of seizure that is characterized by a sudden brief cessation of all motor activity accompanied by blank stare and responsiveness a.) Tonic-Clonic seizure

b.) Absence Seizure

c.) Partial Focal Seizure d.) Complex Partial Seizure Answer

Thank You
-- Apelada, Monaliza G. BSN- Level III