Care of the

Care of the patient with convulsionA Simple Guide For Student NursesH. DeepaniRN, BN, Nursing TutorSchool of NursingColomboSri Lanka

Convulsion/epilepsy/ seizureSudden alteration in normal brain activity that cause distinct changes in behavior and body function.

Types Petitmal/ minor /partialGrandmal / major/ generalizedStatus epilepticus

Etiology / causesBrain injuryBrain tumorsBrain surgeryCerebral infections meningitis/encephalitisDrug toxicity- penicillin, theophyllineHypoglycemia & hyperglycemiahypoxia

Causes ctd..

Hepatic comaPregnancy Induced HypertensionHigh feverCongenital diseasesAlcohol withdrawal

Phases of major epilepsyOnset /AuraTonic phaseClonic phasePost convulsive phase

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Clinical featuresOnset AuraTonic phaseRigidity of entire bodyJerky muscle movementEpileptic cry due to contraction of diaphragmTongue biteExcessive salivationUrinary & fecal incontinenceunconscious

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Clonic phaseRelaxation of all musclesDeep coma Noisy breathing

Post convulsive phaseConfusedSleepyc/o headache & muscle painNot aware about the attack

CLINICAL MANIFESTATION

Simple Partial Seizure

Only finger or hand may shake

Mouth may jerk uncontrollably

May talk unintelligibly

Dizzy

May experience unusual sound or unpleasant sounds, odor, or taste but without loss of consciousness

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Simple Partial Seizure Manifestations

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Investigations EEGMRI scanCT scanLumber puncture (CSF analysis)Blood investigations (BU, SE, Blood suger)

treatmentPharmacologicalsurgical

complicationsStatus epilepticus

A series generalized seizures that occur without full recovery of consciousness between attacks.

Considered a medical emergency.

Status Epilepticus Interfere with respirations.

STATUS EPILEPTICUS

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Nursing diagnosesIneffective airway clearance r/t excessive production of secretionRisk for injury r/t involuntary muscle movementKnowledge deficit r/t disease & its controlIneffective coping r/t stress imposed by the diseaseFear r/t ever present possibility of having seizure

Objectives To maintain airway patencyTo prevent injuryTo improve knowledgeTo facilitate copingTo alleviate fear

Nursing care First aidKeep in lateral position- head turned to a side (floor/ bed)Remove equipment which may cause injury from environmentLoosen clothInsert a tongue depressor if aura is identifiedDo not give anything by mouthDo not try to stop muscle spasms force fullySend to the hospital immediatelyKeep in a bar bedInform Dr. immediately

Guidelines for Seizure Care

observationPresence of auraDuration (started time- time ended)Type of muscle contractionsRespiratory statusLevel of consciousnessSkinEyesPresence of secretions presence of fecal & urinary incontinenceAny injuries after seizurePost-ictal behaviour

Other careGive IV anti-epileptic drugs immediately as orderedO2 inhalation if cyanosis is presentSuck out secretionsKeep nil per oralIf febrile take measures to reduce feverCheck temperature 4 hourlyObserve client hourly & maintain recordsPerineal care & loose dry cloth if incontinent presentGive a drink after patient is fully recovered

Continue anti-epileptic medications as ordered Diazepam ,phenobarbitone, paraldehyde

Health educationKeep the diagnosis card safe and with the patient alwaysContinue medications Keep medications under lock and keyOffer medication by a responsible personNever leave client aloneProvide balanced dietDo not give anything by mouth during seizure

Take immediate measures to control fever if there is a history of febrile fitsFollow clinics regularlyComplications of medicationsEg. Hypertrophy of gums, gums bleeding, drowsyness, loss of apetiteDo not engage in harmful activitiesEg. Driving, machine operator, swimming, work with fire, sand mining, climbing treesFirst aid for epilepsy

Questions ?

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