SEIZURES

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Types of Seizure

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Grand mal seizure Petit mal seizure Jacksonian seizure Psychomotor seizure Febrile seizure

SEIZURES

Sudden, excessive, disorderly electrical discharges of the neurons. The most common type of seiure is grand mal seizure GRAND MAL SEIZURE

Characterized by aura

Aura may be flashing lights, smells, spots before the eyes, dizziness.

Phase of Grand mal Seizure

Accompanied by dyspnea, drooling of saliva, urinary incontinence POST/ICTAL Characterized by exhaustion, headache, drowsiness, deep sleep of 1 to 2 hours, disorientation

PETIT MAL / Absence Seizure or Little Sickness

Not preceeded by an aura There is little or tonic-clonic movements There is sudden cessation of ongoing physical activities Characterized by blank facial expression & automatism like lip chewing, cheek smacking

Regain of consciousness is as rapid as it was lost; lasts for 10 to 20 secs. Usually occurs during childhood & adolescence

JACKSONIAN (Focal Seizure)

Common among clients with organic brain lesion like frontal lobe tumor Aura is present like numbness, tingling, crawling feeling Characterized by tonic-clonic movements of group of muscles e.g. hands, foot or face Then it proceeds to grand mal seizure

PSYCHOMOTOR SEIZURE

It has a psychiatric component Aura is present (hallucinations) Characterized by mental clouding (being out of touch with the environment). The client appears intoxicated During the time of loss consciousness

There are ongoing physical activities It is manifested by confusion, amnesia and need for sleep The client may commit violent or antisocial acts, e.g., going naked in public, running amok, during the time of loss of consciousness

FEBRILE SEIZURE

This is common among children under 5 years of age when body temperature is rising Status epilepticus a type of seizure occurring in rapid succession and full conciousness is not regained between seizures. Brain damage may occur secondary to prolonged hypoxia and exhaustion

During which time recurring seizures occur The attack is usually related to failure to take prescribed anticonvulsants.

Collaborative Management
1. Stay with the client 2. Protect the client from the injury Put up padded side rails If the client is sitting or standing, ease him up onto the floor Protect head with small pillow or place the head onto lap Do not apply restraints Do not insert tongue blade during tonic-clonic movements 3. Promote patent airway Turn the client to the side Loosen constricting clothings especially around neck

Collaborative Management
5. pharmacotherapy: 1. Anticonvulsant Hydantoins Barbiturates Succinimides Oxazodiazepines/oxazolidinedione Benzodiazepines Iminostilbenes Valproate

Collaborative Management
2. Anticonvulsant drugs supress the abnormal electric impulses from the seizure focus to other cortical areas. Thus preventing the seizure but not eliminating the cause of the seizure. 3. Anticonvulsants are classified as central nervous system (CNS) depressants. 1. Hydantoins - Phenytoin (Dilantin) - Mephenytoin (Mesantoin) Ethotoin

Nursing Intervention

Monitor serum drug levels to prevent toxicity Ensure adequate nutrition Avoid driving & performing hazardous activities until the client adapts to drug dosage Avoid alcohol and CNS depressants To prevent gum hyperplasia, advice client to:
- have oral care - use soft-bristled

Nursing Intervention

Monitor serum glucose levels of diabetic client Monitor CBC Instruct client to take the anticonvulsant at the same time every day with food or milk, to prevent G.I. Irritation Phenytoin is contraindicated in pregnancy

HEADACHE

Types of Headache

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MIGRAIN HEADACHE CLUSTER HEADACHE TENSION HEADACHE

MIGRAINE HEADACHE

Caused by inflammation &dilatation of blood vessels in the brain One side of the head is more affected than the other It tends to occur with stress or life crisis It lasts for hours to days The pain is throbbing and pulsatile

Aura of acute attacks of migraine includes visual field defects, confusion, paresthesia, paralysis in extreme cases. Symptoms of Migraine * nausea and vomiting * chills * fatigue * irritability * sweating * edema * photophobia * phonophobia ( sound sensitivity)

Collaborative Management

Provides quiet, dark environment Stress theraphy and relaxation techniques Diet: small frequent meal Avoid the following foods: chocolate, nuts, onions, food seasoning, cheese, citrus fruits, coffee, pork, dairy products, red wine.

PHARMACOTHERAPY: 1. Beta- adrenergic blockers Inderal ( Propranolol) Tenormin (Atenolol) Lopressor (Metoprolol) 2. Calcium channel blockers Calan (Verapamil) 3. Tricyclic antidepresants Elavil (Amitriptyline) Toprafil ( Imipramine) 4. Ergotamine tartrate 5. NSAIDs

PHARMACOTHERAPY:
Ibuprofen Naproxen 6. Opiod analgesics Demerol (Meperidine) Butorphanol nasal spray 7. Tripans ( Selective Serotinin Receptor Agonists) Imitrex (Sumatriptan) Amerge (Naratriptan) Maxalt (Rizatriptan) Zomig ( Zolmitriptan)

CLUSTER HEADACHE

Characterized by episodes clustered together in quick succession for few days or weeks with remission that lasts for months The infraorbital region and spread to head and neck It is prescipitated by alcohol or nitrate

SYMPTOMS :
*flushing * tearing of eyes * nasal stuffiness * sweating and swelling of temporal vessels

TREATMENT: Narcotics analgesic during acute phase

TENSION HEADACHE

It is related to tension and muscle contraction It is episodic and vary with stress It is usually bilateral Involves neck and shoulders

SYMPTOMS:
* Sustained contraction of head and neck muscles

TREATMENT:
1. Nonnarcotic analgesics Acetaminophen Propoxyphene Phenacetin ASA 3. Elavil (Amitriptyline) 4. Relaxation Techniques

Refference: Medical - Surgical Nursing 2nd Edition 2009 Author: Josie Quimbao Udan, RN, MAN

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