BY

DR. Fatma Abbas Salem

Care for patient with Brain Disorders

Care for patient with seizures

Definition:

Seizures are episodes of abnormal motor,

sensory, autonomic, or psychic activity or a

combination of these that result from

sudden excessive discharge from cerebral

neurons (Hickey 2009).

Care for patient with seizures

The international classification

Partial seizures that begin in

one part of the brain.

Generalized seizures that

involve electrical discharges in

the whole brain.

Causes

a. Idiopathic (genetic, developmental defects)

b. Acquired seizures include:

1. Cerebral anoxia.

2.Cerebro vascular disease.

3.Fever (childhood).

4.Head injury.

5. Hypertension.

Causes

6. Central nervous system infections.

7. Metabolic and toxic conditions (renalfailure,

hypornatremia, hypo calcemia, hypoglycemia,

pesticide, exposure)

8. Brain tumor.

9. Drug and alcohol withdrawal.

10. Allergies.

CLINICAL COURSE

Aura epileptic cry, loss of

consciousness, fall, tonic & clonic

convulsions and incontinence -

postical confusion – headache &

sleep.

Medical Management

Major anticonvulsive

medications as.

Carbamazepine (Tegretol)

Clonazepam(Klonopin)

Lamotrigine (Lamicatal)

Phenol barbital (Luminal)

Phenytoin (Dilantin)

Surgical treatment.

Indicated for patients whose epilepsy

results from intracranial tumors,

abscesses, cysts or vascular anomalies.

Nursing management

Assessment:

A major responsibility of the nurse is to observe and record the sequence of signs. The natural of the seizure usually indicates the type of treatment that is required (AANN, 2007)1. Description of circum stances before the seizure

(visual, auditory, or olfactory stimuli, tactile stimuli, emotional or psychological disturbances sleep, hyperventilation).

2. The occurrence of an aura.

3. The first thing the patient does in the seizure where the movements or the stiffness begins, the position of the head at the beginning of the seizure.

Nursing ASSESSMENT

4. The type of movements in the part of the

body involved.

5. The areas of the body involved.

6. The size of both pupils and whether the

eyes are open.

7. Whether the eyes or head turned to one

side.

8. The presence or absence of automatisms

(involuntary motor activity, such as lip

smacking or repeated swallowing.

NURSING ASSESSMENT

9. Incontinence of urine or stool.

10.Duration of each phase of the seizure.

11.Unconsciousness if present and its duration.

12. Any obvious paralysis or weakness of arms or

legs after seizure.

13. Inability to speak after the seizure.

14. Whether or not the patient the patient sleeps

afterward.

15. Cognitive statues (Confused or not confused)

after the seizure.

Care during seizure

1. Provide privacy and protect the

patient from curious on lookers.

2. Ease the patient to the floor if

possible.

3. Protect the head with a pad to

prevent injury from striking a hard

surface.

4. Loosen constrictive clothing.

5. Push aside any furniture that may

injure the patient during the seizure.

Care during seizure

6. If the patient is in bed, remove pillows and

raise side rails.

7. IF an aura precedes the seizure, insert an

oral air way to reduce the possibility of the

patient's biting the tongue or cheek.

8. Do not attempt to pry open jaws that are

clenched in a spasm or to insert anything.

Care during seizure

9. No attempt should be made to restrain

the patient during the seizure, because

muscular contractions are story and

restrain can produce injury.

10. If possible, place the patient on one side

with head flexed forward which allows the

tongue to fall forward and facilitates

drainage of saliva and mucous. If suction

is available use it if necessary to clear

secretions.

Nursing care after the seizure

1. Keep the patient on one side to prevent

aspiration.

2. Make sure the airway is patent.

3. There is usually a period of confusion after a

grand mal seizure.

4. The patient on awaking should be reoriented

to the environment.

5. If the patient becomes agitated after a seizure

(postictal use persuasion and gentle restrain

to assist him or her to stay calm.)

1.