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Goals:
To understand the signs and symptoms of a seizure
To understand the nursing care that can be offered pre, during and post seizure activity
To understand how to use the suctioning machine
What is a Seizure?
A sudden, abnormal, excessive electrical discharge from the brain that can change motor and/or autonomic function, consciousness or sensation
Epileptic vs Non-Epileptic
EpilepticAn abnormal excessive amount of neural
activity in the brain that originates in the central nervous system
Non-Epileptic A response to stimulus that does not originate
in the central nervous system
What are some causes of non-epileptic seizures?
Alcohol withdrawal Fever Hypoxia Drug Intoxication Poisoning Cardiopulmonary Blood Loss Metabolic Tumours Head Injury Hyperthermia
…and many more
2 Basic Types of Seizures
Partial
Start in a specific part of the brain
Simple – no loss of consciousness
Complex – loss of consciousness
Generalized
Affect the whole brain
(Absence/petit mal and tonic-clonic/grand mal)
If a partial becomes a generalized, called a secondary generalized seizure
Signs and Symptoms of Impending Seizure Activity
The person reports unusual symptoms including:
Smelling burnt toast Feeling of spiders crawling on arms Other odd odours, tastes or
sensations Auras
Terminology
Ictus
The actual seizure activity
Postictal phase
Post seizure
Partial Seizure - Simple
Confined to 1 brain lobe Person is fully aware but unable to control
what is happening May have sudden intense feelings of fear,
bliss or déjà vu May have aura, tingling/numbing sensation,
see flashing lights Ictus phase usually short, which can make it
difficult to identify true seizure activity
Symptoms correspond to brain lobe involved…
Temporal: memory, sound, smell, emotions*
Frontal: movement of extremity or change in speech
Parietal: tingling or feeling of warmth down one side of body
Occipital: see flashing lights, fireballs, bright colours shooting across half visual field
Nursing Management of a Partial Seizure
Symptoms can be frightening to the conscious person
Offer reassurance this will pass Assess immediate environment Remember – a partial can be a
warning sign for a stronger seizure
Partial Seizures - Complex
Affects an entire hemisphere; does not spread Person can not respond to commands and will not
remember event May appear to be fully awake but with a blank stare Automatisms – involuntary automatic behaviours such
as chewing, lip smacking, hallucinations, odd behaviour (undressing or laughing uncontrollably)
Postictal phase may be minimal or nonexistent Without warning, mall fall to the ground
Nursing Management
Same as partial seizures If person falls to the ground, assess for
injury, limb displacement Behaviour may change if person thinks he
is being restrained – do not restrain! Use a calm and reassuring voice If the person gets up and starts walking
away, be prepared to follow
Generalized Seizures – Non Convulsive Also called Absence or Petit Mal May stop speak mid sentence, blank stare Repeated lip smacking/eye blinking Sudden brief lapse of consciousness Will not remember event Can be frequent but very short duration Can normally continue with activities they
were doing before seizure
Generalized – Atypical Absence/Petit Mal
Longer than generalized non convulsive
Up to 45 minutes Longer recovery time Loss of awareness not always
complete
Generalized – Myoclonic Seizures Sudden brief jerking of muscle
group(s) lasting a few seconds Affected areas can range from pinky
finger to entire torso Person may report soreness or
cramping in area that was affected Can affect bowel/bladder control May lead to a tonic clonic seizure
Generalized – Atonic Seizures
Occurs as result of sudden loss of tone in postural muscles
Will drop to ground if standing/slump if in chair
Consciousness will be lost for a split second
Common injuries include ankles, knees, chin (site of impact)
Generalized – Convulsive Seziures Tonic-Clonic/Grand Mal Muscle spasm in which arms and legs flex Alternates between contraction and
relaxation Can strike without warning Initial tonic phase – falls, brief flexion of
back followed by staring Arms may be up in air, signalling tonic
phase is about to start
Generalized – Convulsive Seizures Continued May scream or moan as air is pushed from
lungs in a tight spasm Breathing could be impaired during this
time/become cyanotic May lose bladder/bowel control Pupils may become dilated Muscular contractions start at 8 spasms per
second and intensify Can appear very violent
Generalized – Convulsive Transition from Tonic to Clonic
As tonic evolves, periods of muscle relaxation will occur/lengthen until end of seizure
Postictal phase – will be very still with flaccid muscles
Excessive salvation can obstruct airway Minutes to hours to regain consciousness Exhaustion – may sleep for hours Will not remember the episode May have head ache, muscle aches,
injuries
Nursing Management of a Generalized Seizure
Communicate throughout the episode, give reassurance it will be stopped and he won’t be left along
Protect ehad from banging on floor while convulsive movements occur
Loosen tight clothing Try to turn into recovery position Do not force anything in mouth Check frequently after all seziure activity
ends
Status epileptics – lasts longer than 30 minutes – an emergency!
Suctioning Equipment
Suction machine Suction tubing and oral
sucker/younker Sterile water Personal protective equipment as
needed
Suctioning Procedure
Attach tubing and younker, ensure good fit; turn on machine
Gently insert younker into mouth Move to all parts of mouth as necessary Clean suction tubing/younker by suctioning
sterile water Oral younker may be used on same person
for 24hrs Collection container good for 24hrs Document – Amount, appearance, any
trauma
Suctioning Reminders
Never use the younker to ‘pry’ open the mouth/teeth
Never use fingers to pry open mouth/teeth
If person starts biting, do not use the younker as a bit block
Talk to the person during the entire procedure
