NEUROLOGIC

DISORDERS
Common Health Problems
Of the Neonate & Infant
• Hydrocephalus
• Spina Bifida
• Encephalocele
 HYDROCEPHALUS
• An imbalance in either absorption or
production of cerebrospinal fluid
within intracranial cavity
• Classified as either congenital or
acquired
• Etiology unknown; usually diagnosed
at birth or within two to four months of
life
Infant
• 2 Types:
Non communicating – Obstruction
within the ventricles(congenital
malformation, neoplasm,
hematoma)
Communicating – Inadequate
absorption of CSF resulting
from infection, trauma.
 Clinical Manifestations are
categorized by age
• Infant:
- Increased head circumference
- Tense bulging anterior fontanel
- Distended scalp veins
- High pitched cry, irritability
- Feeding problems
- Discomfort when held
• Older Child
- Headache
- Vomiting especially in the morning
- Diplopia
- Blurred vision
- Behavioral changes
- Decreased motor function
- Decreased level of consciousness
- Seizures
 Treatment

• Pressure is relieved by the surgical

insertion of a shunting device
• Components of a shunt include a
catheter, reservoir and pumping
device with one way valve and distal
tubing with regulator valve
• Most common type of shunts
are VENTRICULO –
PERITONEAL and
VENTRICULO – ATRIAL
• Complications include shunt
failure (Lethargy, Irritability,
vomiting) and Infection
Ventriculoperitoneal shunt (VP
shunt)
CSF – colorless fluid with water, CHON,
glucose.
Nursing Management:
• prevent breakdown of scalp or infection
and a damage to spinal cord
• monitor increase ICP
• promote adequate nutrition
• keep eyes moist and free of irritation
• “support the parents”
• monitor LOC q2 – q4 hours.
• keep suction and O2 equipment at bedside.
 Nursing Problems with
Interventions
a. Potential for injury related to increased
ICP
1. Preoperatively: Focus on assessing
neuro function; measure head
circumference (Occipito – Frontal area)
2. Postoperatively: Neuro assessment
with daily head circumference
 - Position on non – operative site:
check anterior fontanel to determine
positioning of the head; do not pump
shunt without physician’s order
- Strict fluid limits (No more than
70% - 80% of daily fluid requirement)
- Control environmental stimuli;
seizure precaution
 Potential for infection

• Classic signs include elevated vital

signs, decrease LOC, vomiting and
feeding problems
• Assess incision site frequently for
manifestations of inflammation or
leakage
 Additional nursing problems
• Alteration in nutrition: less than body
requirements – frequent small feedings;
planned rest periods after feeding; daily
weight
• Knowledge deficit; instruct parents
regarding manifestations of shunt failure,
infant stimulation to help maximize child’s
potential, stress management techniques
 SPINA BIFIDA
• Congenital problem where there is
closure in spinal column.
• A developmental defect in which the
newborn baby has part of the spinal
cord and its coverings exposed
through a gap in backbone
• One form of neural tube defect.
• Can be diagnosed at about 16th week
of pregnancy by a maternal blood test
• Confirmed by Amniocentesis thus
making termination of pregnancy
possible
2 Classification:

Spina Bifida Occulta – affected side L5

and S1 with no protrusion of the
spinal contents; no symptom, just a
sign; hidden through a hair (tuft hair).

Spina Bifida Cystica – presence of sac

along the spine.
 Spina Bifida
• Spina bifida occulta
 Spina Bifida
• Spina bifida cystica
 Symptoms

• Paralysis of the legs

• Incontinence
• Mental retardation
• high level of alpha- fetoprotein in the
amniotic fluid (Pregnancy)
Classification of Cystica:
Myelomeningocele – 75% of
the case; non-translucent sac
(opaque).
Signs & Symptoms:
- urine retention
- bowel incontinence
- paralyzed legs
Meningocele – 25% of the case,
transilluminated, clear; no nerve
roots involved.
Signs and Symptoms:
- with function below the sac
- meninges and CSF affected
- urine retention
- bowel incontinence
- paralyzed legs
Diagnosis:
- Serum Transilluminated Test
- Lumbar puncture (CSF analysis);
opaque color of CSF.
- Amnioncentesis (prenatal)

Hydrocephalus – most common

complication of Myelomeningocele.
Positioning of the
patient having
lumbar puncture
Pre-Op management:
• Careful handling of the patient particularly
the sac to avoid rupture, pressure,
irritation, leakage of the protruding sac.
(Prone position only with head on the
sides.)
• No diapers on the site.
• To prevent trauma, cover sac with gauze
or OS soak with normal saline solution.
• Closure of the sac should be done within
48 hours (can delay if it is only in the skin).
• Provide meticulous skin hygiene
to prevent irritation. Provide sterile
doughnut ring to cover the lesion.
• Watch for signs of increase ICP.
• Do passive ROM exercise to
impaired lower extremities.
• Scrupulous perineal care
necessary.
Post-Op Care:
• keep in prone position
• monitor urine output (for bladder
injury)
• measure head circumference
daily
• monitor movement of lower
extremities
 MYELOMENINGOCELE

• The spinal cord and the nerve roots

are exposed, often adhering to the
fine membrane that overlies them
• Usually associated with other neuro
defects (Hydrocephalus)
• Unknown etiology
myelominingocele
myelominingocele
 Pathology
• Partial to complete paralysis
determined by location of defects
• Musculoskeletal problems such as
club foot, scoliosis or congenital hip
dysplasia
• Bowel and bladder problems which
include constipation, incontinence or
neurogenic bladder
• Diagnosis
- Amniocentesis (98% accurate)

Treatment
- Decision to correct the defect or not
- Early surgical closure is advocated to
preserve neural function, reduced risk
of infection and control hydrocephalus
 Nursing Problems
• Potential for infection
- Preoperatively, the main goal is to
prevent rupture of sac to prevent
infection
a. Position in prone
b. Cover sac with moistened gauze
c. Check sac for tears or cracks
d. do not cover sac with clothing of diaper
 e. Perineal care to prevent contamination of
sac
f. Monitor for manifestation of meningitis
Postoperatively – Promote healing and
reduce neurological complications
a. Position prone w/ head slightly lower
than the body
b. place protective barrier across incision
to prevent contamination
Long term problems of infection are
related to urinary retention, reflux and
chronic UTI
a. teach crede maneuver to parents
b. Intermittent self – catheterization
can be performed as early as 5 – 6
years of age
c. Hydration and early recognition of
UTI’s
Potential for injury related to
Increase ICP secondary to
hydrocephalus
– Neuro checks with daily head circumference
– Monitor signs and symptoms of increase
ICP
– Instruct family regarding recognition of
shunt infection/ malfunction
– Place a small pad under the lower portion
of the legs to prevent orthopedic problems
 Ineffective family coping
• Parents will need help dealing with the
issue of “ chronic sorrow” as well as the
long term aspects of the condition
• Anger and denial
• Assess family support and available
resources
• Remember that every family’s method
of coping is different
 CEREBRAL PALSY
• Motor function impairment
• Difficult in controlling the voluntary
muscles due to brain injury.
• Cannot be diagnosed early in life not
unless the child started to move.
• Most common permanent disability of
childhood.
• High risk babies with APGAR below 5
Signs & Symptoms: (will vary acc.
to portion of brain that is damage
or involve)

- Weakness
- Paralysis and incoordination of
voluntary movements of muscles
- Seizures
- visual and hearing difficulties
- emotional disorders (mood
swings, irritability, abnormal
posture, short attention span),
impulsiveness
- primitive reflexes
- speech problem
- poor swallowing
Classification:
1. Spastic – muscles are
hypertonic, persistent neonatal
reflexes, positive babinski,
contractures
2. Flaccid – muscles weak, soft,
flabby
3. Athetotic – snake or worm-like
movement; disappears when
asleep or relax.
4. Rigid – “lead-pipe tonicity”
5. Ataxic – primary incoordination;
gait awkward; wide-based.
6. Atonic – lack of tone or no
response of muscle to a stimuli.
7. Tremor – uncontrollable
involuntary motions of a rhythmic
alternating pendular pattern.
• Diagnosis:
• Delayed motor development
• Persistent neonatal reflexes
• Scissoring
• Treatment
• Symptomatic
• Orthopedic
• Physical Therapy
• Respiratory Therapy
Nursing management:

1. Aim: muscle re-education

maximize – assets
minimize – liabilities
- physiotherapy
- provide non-stimulating
environment
- give muscle relaxants/anti-
convulsant drugs
- maintain safe environment (use
safe toys)
- prevent from accidental falls
- encourage independence while
providing adequate nutrition ( cut
food into smaller pieces)
- serve food that sticks to the spoon
like mashed potato.
- position patient properly
- disregard messy eating; put bib.
- allow child to hold the spoon guiding
it to his mouth.
- discipline is necessary for the child
to feel the love and security (don’t
overprotect)
 REYE’S SYNDROME
• Characterized by acute encephalopathy
and fatty degeneration of the liver and
other abdominal organs.
• Occurs after viral illness, particularly
after URI or varicella (chickenpox)
• Administration of aspirin is a contibuting
factor.
Signs & Symptoms:

- URI 1 – 3 days after

- Fever
- Hepatic problem
- Decrease level of
consciousness
- Malaise cough
Diagnosis:

- Liver function test

- AST,SGOT, ALT, SGPT, LDH,
serum ammonia levels are
elevated because of poor liver
function.
- Delayed prothrombin time
Management:

- Neurologic assessment
- Monitor I/O (cerebral edema and
prevent dehydration)
- Osmotic diuretics (mannitol) may
be administered to reduce
cerebral edema
- Monitor glucose level and
bleeding time (low blood glucose
level can lead to seizures;
prolonged bleeding time can
indicate coagulation problems as
a result of liver dysfunction.
- Avoid use of aspirin
 Multiple sclerosis
• Chronic, progressive disease of the
CNS, characterized by small patches of
demyelination in the brain and spinal cord
• It is a major cause of disability in young
adults
• It may be caused by an autoimmune
response to slow – acting or latent viral
infections
 Manifestations
• Occur in young adults 20 – 40 years old
• Vision disturbances ( Nystagmus,
blurred vision, diplopia)
• Muscle dysfunction ( Weakness,
paralysis ranging from monoplegia to
quadriplegia, sapsticity, intention tremor
and gait ataxia)
• Urinary disturbances
( Incontinence, urgency and
frequent infection)
• Emotional lability ( Mood swings,
irritability and euphoria)
• Poorly articulated speech
• Difficulty with balance
• Dysphagia
 Diagnostics

• EEG ( Shows nonspecific

abnormalities)
• CT Scan ( Lesions within the
brains white matter)
• MRI ( 90% of patients have
lesions in the brain)
 Nursing Management

• Aim of treatment is to shorten

exacerbations and relieve neurologic
deficits
• Methylprednisolone ( reduces CNS
inflammation during exacerbation)
• Glatiramer Acetate ( Reduce
frequency of attack)
• Interferon beta – 1a or beta 1b
( Reduce disability progression)
• Fluoxetine ( Depression)
• Baclofen / Dantrolene ( Relieve
Spasticity)
• Oxybutynin ( Relieve urine retention)
• Bed rest
• Physical therapy and massages
• Measure to prevent fatigue
• Meticulous skin care
• Bowel and bladder training
• Antibiotic treatment for bladder
infection
• Counselling
• Daily exercise to maintain muscle
tone and joint mobility, improve
coordination and boost morale
• Avoid stress, infections and fatigue
• Well balanced, nutritious diet that
contain sufficient fiber
• Adequate fluid intake and regular
urination
• Prevent injury
 Myasthenia gravis

• Produces sporadic but progressive

weakness and abnormal fatigue in
skeletal muscles
• Affects muscles innervated by the
cranial nerves ( face, lips, tongue,
neck and throat) but it can affect any
muscle group
• Antibodies attach to the Ach receptor
sites. They block, destroy and weaken
these sites, leaving them insensitive to
Ach, thereby blocking neuromuscular
transmission
• The disease involves the respiratory
system
• Women ( 18 – 25 ) Men ( 50 – 60 )
• Accompanies autoimmune and thyroid
disorders
 Signs & Symptoms

• Extreme muscular weakness: increased

with fatigue and relieved by rest
• Weak eye closure, ptosis, diplopia
• Blank, masklike facial expression
• Difficulty chewing and swallowing
• Respiratory failure
 Diagnostics

• Tensilon Test ( confirms the

diagnosis by temporarily improving
muscle function after an IV injection
of edrophonium or neostigmine. This
test also differentiates a myasthenic
crisis from cholinergic crisis
 Treatments

• Treatment is symptomatic
• Drug therapy
Anticholinesterase ( Neostigmine /
Pyridostigmine) Fatigue & Muscle
weakness
Corticosteroids – Relieve symptoms
• Plasmapheresis (Removing the
plasma from the blood)
• Thymectomy (removal of Thymus
gland)
• Anticholinesterase drugs are not
effective during myasthenic crisis, so
they are discontinued until respiratory
function begins to improve
 Management

• Establish accurate neurologic and

respiratory baseline. Be alert for signs
of impending crisis (muscle
weakness, respiratory distress,
difficulty talking / chewing)
• Be prepared to give atropine for
anticholinesterase overdose/ toxicity
• Plan period of exercise, meals, patient
care and daily activities to take advantage
of peaks in the patient’s energy level
• Provide soft, solid foods instead of liquids
to reduce the risk of choking
• Encourage patient to take role in deciding
about his care
• Encourage the family to discuss their
feelings. Listen and provide emotional
support
 TRIGEMINAL NEURALGIA
• Tic douloureax
• Disorder of the 5th cranial nerve,
characterized by excruciating, knife-
like pain along the branches of the
nerve.
• Causes:
- Not certain
- Vascular compression and pressure
(cause by aging)
- Demyelination of trigeminal root
- Likely to occur on 5th and/or 6th
decade of life
- Common to women and with MS
Signs & Symptoms:
- Burning or knife-like pain lasting for 1-
15 minutes, usually over the lip or chin
and in the teeth.
- Pain precipitated by the stimulation of
trigger zones during activities such as
brushing the hair and eating, or when
sitting in a cold draft.
- Sudden closure of an eye
- Twitching of the mouth
Medications:
- Anti-seizure meds
Carbamazepine (Tegretol)
- To decrease transmission of nerve
impulses to the nerve terminals.
Nursing Responsibility:
- Taken with meals
- Serum level should be monitored
- Monitor for bone marrow depression
(prolonged use of Carbamazepine)
Carbamazepine toxicity
- Drowsiness
- Nausea & vomiting
- Dizziness
• Aplastic anemia could occur.
Other meds:
- Gabapentin
- Baclofen – control pain associated with
spasm
- Dilantin – oral hygiene needed.
Nursing Diagnosis:
- Pain related to nerve root
damage.
- Self-care deficit
- Activity intolerance
Surgical management:
- micro-vascular decompression
- radio frequency thermal
coagulation
- percutaneous balloon micro-
compression
 Nursing Intervention:
- preventing pain
- providing post-op care
• Instruct patient not to rub eyes
• Artificial tears or eye drops to
prevent dryness of the eyes
• Chew on unaffected area
 Cerebral Aneurysm

• Localized dilation of a cerebral

artery, results from weakness in the
arterial wall
• Slightly higher in women than men,
especially those in their late 40’s to
mid 50’s
• Prognosis is uncertain because
aneurysms can rupture and cause
subarachnoid hemorrhage; ½ of all
patients suffering subarachnoid
hemorrhages die immediately
• Results from congenital vascular
disease, infection or atherosclerosis
• Blood flow exerts pressure against a
congenitally weak of arterial wall,
causing it to stretch and thin.
• A rupture is followed by a
subarachnoid hemorrhage
 Signs & Symptoms

• Most patients are asymptomatic until

the time of bleeding
• Initial signs:
- Headache, nausea
- Nuchal rigidity
- stiff back and legs
• If Ruptured:
- Sudden severe headache
- Nausea and projectile vomiting
- Altered LOC, including deep coma
- Fever, restlessness, irritability,
seizure, photopobia and blurred vision
- hemiparesis, dysphagia & visual
defects, dilated pupils
 Diagnostics

• Angiography (Confirm an unruptured

cerebral aneurysm, diagnosis usually
follows the rupture)
• CT Scan may help subarachnoid
hemorrhage
• MRI may detect vasospasm
 Management
• If surgery is too risky, a more
conservative treatment for cerebral
aneurysm
• Patient must avoid stimulants (coffee)
and aspirin
• Corticosteroids ( Reduce edema)
• Nimodipine ( limit possible neuro
deficits)
• If the patient is hypotensive he may
receive DOPAMINE to ensure
adequate brain perfussion
• Assess neuro status to screen
changes in the patients condition
• Maintain adequate nutrition
• Promote activity based on the
patient’s ability
• Provide support for the family
• Refer the patient to appropriate
health care team members
• Check for patent airway, normal
breath sounds, consistent LOC and
adequate hydration and nutrition
• If the patient can’t speak, set up
simple means of communication
• Tell the patient’s family to talk to him
in a normal tone
 BELL’ PALSY
• Unilateral inflammation of the 7th cranial
nerve.
• Results in weakness or paralysis of the
facial muscle on the affected side
• Affects all age – groups, but occurs
most commonly in patients under age 60
• Onset is rapid but 80 – 90% of all
patients, it subsides spontaneously,
complete recovery in 1 to 8 weeks
• Causes:
- Hemorrhage
- Vascular ischemia
- Viral infection/disease (Herpes simplex,
Herpes zoster)
- Autoimmune disease
Signs & Symptoms:
- Facial muscle distorted due to
paralysis or weakness
- Increase lacrimation or tears
- Painful sensation on the face
- Speech difficulties
- Patient unable to eat on the affected
side
Nursing Diagnosis:
- Pain r/t inflammed nerve
- Impaired verbal communication
r/t speech difficulties
- Body image disturebance r/t
facial paralysis
Medications:
- Corticosteroids – reduces facial nerve
edema & improves nerve conduction
(Prednisone)
- Analgesic – for pain
Nursing intervention:
Dependent:
- hot compress – causes vasodilation
- electrical stimulation –avoid atrophy of
facial muscles
Independent:
- Protection of eye from injury
- Protective shield at night
- Massage several times a day
to regain muscle strength
(Upward motion)
- Teach patient facial exercises
• Give patient frequent and complete
mouth care. Remove the residual
food that collects between thecheeks
and gums
• Provide support and reassure the
patient that recovery is likely within 1
– 8 weeks
• Assess the effectiveness of pain
medication
CEREBROVASCULAR ACCIDENT
(CVA)
• Disorders that disrupts blood flow to
the brain.
• 2 Types:
1. Ischemic
a. thrombosis – cause by severe
atherosclerosis.
b. embolic – thrombus that travels to
the Circle of Willis.
Causes of thrombus formation:
- prolonged immobility
- atrial fibrillation
- deep venous thrombosis
- mitral valve stenosis, CHF, MI
2. Hemorrhagic – rupture of blood vessels
Causes:
- HTN
- aneurysm
- arterio-venous malformations
Etiology:
- thrombotic strokes is higher
among males. Estrogen decreases
LDL.
- persons >65 y/o (elasticity is lost –
can’t stand high pressure)
- genetic predisposition (most
influential factor)
• Transient Ischemic Attack
- brief loss of O2 to the brain thus
short loss of memory for a period of
time. Manifestations usually last for
24 hours.
- 35% of TIA progresses to stroke.
• Aneurysm
- caused by congenital arteriosclerotic
rupture of blood vessels.
• Types of Aneurysm:
1.Saccular – found on the
bifurcation of Circle of willis; 2%
of population.
2.Berry – small saccular, found on
junctures of Circle of Willis
3.Fusiform – basilar or internal
carotid arteries.
• Arteriovenous malformations
– congenital
– familial
– occurs twice in males than in
females
– usually manifests in late
adolescence or adulthood
Signs & Symptoms (aneurysms, AVM’s)
- headache
- photophobia
- focal neurologic signs (seizures)
- N & V (projectile)
- hemiparesis
- ipsilateral pupillary and oculomotor
non-reactivity
- blurred vision
- cerebral edema and increase ICP
- seizures – abnormal firing of
neurons
- widening pulse pressure
- bradycardia
- decrease LOC
- HTN
* Common complication of aneurysm
are re-bleeding and vasospasm.
Diagnostic:
1. CT Scan – radioisotopes to visualize
the brain;assess for claustrophobia
2. Spinal Tap – L3-L5 inserted in
subarachnoid
- consent
- C form position
- Spinal needle G18 to withdraw
CSF
Post-op:
- monitor site of incision
- monitor sensation of extremities
- encourage increase OFI
- FOB for 6-8 hours
3. Cerebral Angiogram
Pre:
- clear liquid
- sedatives
- mark distal pulses
- check for seafood allergies
CEREBRAL
ANGIOGRAM
Post-op:
- LOC
- sensory and motor deficit
- hematomas
- peripheral pulses
- place pt. bed rest overnight
- place extremities extended
4. EEG – photic stimulation produce brain
waves.
- avoid caffeine (stimulate sympathetic
nervous system)
- wash hair before and after procedure.
EEG
5. Electromyography (EMG) – detect nerve
conduction and velocities
Pre: - consent
- feel discomfort – very fine needles
inserted to the muscles
6. MRI – determines area of pathology
Pre: - remove metals including dentures
- remove credit cards, cell phones
EMG
MRI
Nursing Diagnosis:
- Ineffective Tissue Perfusion r/t brain injury
- Alteration on sensory perfusion r/t brain
dysfunction
- Altered LOC r/t brain trauma
- Impaired physical mobility
- Risk for Injury
- Impaired Skin Integrity
- Altered Nutrition
- Impaired Urinary elimination
Meds:
- mannitol – decrease ICP due to
cerebral edema
- to avoid rebound action
- could cause crystallization
- dexamethasone (Decadron) –
stabilize cell; anti-inflammatory
Meds for Ischemic CVA:
- Tissue Plasminogen Activator
(breakdown clot formation)
- Streptokinase
- Urokinase
- Aspirin – anti-platelets; can cause GI
upset
- Ticoldipine & Clopidogrel (Plavix) are
substitute for aspirin
- Isotonic solution (PNSS, PLR)
Surgical management:
- Burr holing to evacuate blood clots
- endarterectomy (carotid)

Pre: Consent
Post: instruct not to cough & suction
slowly because these could lead to
increase ICP.
ENDARTERECTOMY
Nursing Intervention:
- check LOC
- watch signs/sx of increase ICP
- protect pt from injury
- GCS and V/S monitoring
- check for signs of hyperthermia
(presence of shivering increases
metabolic demand for O2)
- could administer antipyretics sparingly
(could cause liver toxicity)
Rehabilitation:
- approach pt on the unaffected side and
provide stimulus for affected fields.
- exercise progressing to ROM
- prevent atrophy
- promote strength tone of muscle
- prevent decubitus ulcer, hypostatic
pneumonia
- promote circulation
- teach assistive devices
- Crutches – length of armpit to
foot plus 6 inches (should be
in pair)
- electric stimulation
- give cerebral stimulants
- walking with cane – unaffected
part
- therapist (Physical therapist and
Speech Therapist)
CRUTCHES
 Hemorrhagic Stroke
Signs & Symptoms:
- Contralateral hemiparesis
- Contralateral hemiplegia
- Tetraplegia
- Paraplegia
- Aphasia – speech
Expressive aphasia – Broca’s area
Global aphasia – both are affected
Receptive aphasia – Wernicke’s area
- Astereognosis
- Mental status changes
- recent - long term
- remote - short term
- immediate recall
- test judgment (abstract thinking)
- anopsia (visual fields affected)
Bitemporal hemianopsia – both side
Homogenous hemianopsia – one side
Anisicoria – one pupil dilated, one
constricted
- confusion
- dizziness
- behavioral changes
- severe headache and LOC are
the outmost manifestation with
patient having hemorrhagic
stroke.
 SEIZURES
• episodes of abnormal motor, sensory,
autonomic or pyschic activity that result
from sudden excessive discharge from
cerebral neurons.
• a part or all of the brain may be involved.
• Classification:
- Partial seizure – begins in one part of the
brain.
- Generalized seizure – involved electrical
discharges of the whole brain.
• Causes:
- idiopathic
- acquired
- CVA
- hypoxemia
- fever
- head injury
- HTN
- CNS infections
- Metabolic and toxic conditions
- brain tumors
- drug and alcohol withdrawal
(benzodiazepine)
- allergies (anaphylactic shock)
• Signs & Symptoms
- loss of consciousness
- excess movement
- loss of muscle tone or movement
- disturbance in behavior, mood,
sensation and perception (aural stage)
Nursing Diagnosis:
- Sensory and Perceptual alteration r/t
abnormal electrical discharges of the
brain.
Nursing Interventions:
- observed and record the sequence of signs
- circumstances before seizures
- occurrence of aura
- first thing the pt does in the seizure
- type of movement in the part of body involved
- areas of the body involved
- size of both pupils
- whether the eye or head is turned to one
side
- presence or absence of automatism
- incontinence of urine or stool
- duration of seizure
- unconsciousness, if present, the duration
- obvious paralysis or weakness after seizure
- ability to speak after the seizure
- patient sleeps or not after seizure
- cognitive
- preventing injury and supporting the patient
• after seizure:
- document
- positioning
- maintain patent airway
- do seizure precaution
- safety
 EPILEPSY
• group of syndromes characterized by
unprovoked, recurring seizures
• excessive discharge of neurons
• Types:
- generalized
- partial – with pattern, Jacksonian
- Status epilepticus - uncontrolled
• Nursing Diagnosis:
- Sensory-perceptual alteration r/t
abnormal firing of neurons.
- Altered LOC r/t brain hypoxia
- Confusion
- High risk for injury
• Nursing Intervention:

- maintain patent airway

- don’t restrain
- protect from injury
- decrease stimulation
- cool environment
- note precipitating factors
- padded tongue depressor
- note for the time of seizure
• Meds

- Valium (Diazepam)
- Pentothal Na
- Phenytoin (Dilantin)
- Valproic acid
- Lamotigrine (Lamictal)
- Phenobarbital (Na Luminal)
 - Secobarbital (Seconal)
- Gabapentin (Neurontin)
- Carbamazepine (Tegretol)

Side Effects:
Dilantin – gingival hyperplasia,
gum hypertrophy
Phenobarbital – drowsiness,
ataxia