Epilepsy a Seizure Disorder

Rebekah Brothers

Snead State Community College

4/13/2014

NUR 203 Nursing Through the Lifespan

Abstract

In this paper Evidence-Based practice will be used as a guide through the nursing process for clients with a seizure disorder. This is a discussion on etiology of seizures. We will also explain the different types of seizures. The specific care for clients experiencing a seizure. The critical data that the physician needs in order to help the client. And the education of the client and family on how to deal with this disorder.
*This sounds good for an abstract. It doesn’t necessarily have to be long*

Witnessing a seizure is not something you are likely to forget, but as a bedside nurse it is something you are bound to experience. Seizures are a transient disruption in brain function caused by excessive electrical discharge of cortical neurons in one or more areas of the brain. They affect an estimated 25 million Americans. Each year in the United states, 300,000 people—120,000 of the younger than 18 have a seizure for the first time, and about 181,000 people are diagnosed with epilepsy. The proper functioning of the brain involves the brain sending electronic pulses to receptors for information communication. The receptors include muscles, nerves, and the spinal cord. However, any disruption of a part of the brain will mean that the brain sends abnormal messages to the receptors which in turn respond through seizures. Seizure disorders can begin at any stage in life and attack anyone. In childhood, seizures are characterized by altered movements, awareness levels and attention due to synchronous neural activity. Epilepsy is an underlying neurological disorder that affects the system governing the brain's electrical energy, making the patient susceptible to recurring seizures. Just because a patient has a seizure, does not mean they have an epilepsy disorder. Seizures can be caused by other conditions, including high fever, head injury, infection, and lack of sleep or oxygen. It is estimated that approximately 50 percent of seizures have no known cause. Regardless of the cause of a patient's seizure, it is crucial that you understand the different types of seizures. Educating patients with epilepsy about how the condition is treated and how it may affect their lives is also a key part in our nursing role. In planning your care for one of these patients, nurses must be able to differentiate between the types of seizures. One category of seizures is partial seizures which affect and occur in just a section of the human brain. This is common in about 60 percent of the epileptic patients. Partial seizure can be simple or complex depending on the part of the brain they originate from. Simple partial seizures can be characterized with simple movements like uncontrolled hand movement for just a few seconds. A complex partial seizure comes in as the person experiences losses or alterations in consciousness causing them to yield dream-like experiences which may be confused with possible migraines.

The second category of seizures is generalized seizures. Generalized seizures involve both cerebral hemispheres. During an absence seizure a person experiences twitching or jerking muscles while they stare into the open space. They often will have repetitious movements known as automatism, which make them appear strange and may be confused for mental illness. These repetitive behaviors are involuntary and last for just a few seconds. Atonic seizures are associated with a general loss of the tone of the muscles. These clients will often fall and as a result, suffer injury. Clonic seizures could last several minutes with muscle contracting and relaxing. A tonic seizure results in loss of consciousness and sudden increase of muscle tone, lasting from 30 seconds to several minutes. A generalized clonic-tonic seizure result in mixed symptoms like stiffened body with repetitive jerks of the legs and arms along with the loss of consciousness. These were formally known as grand mal seizures.

Nurses can play a valuable role in managing epilepsy. As the professionals who spend the greatest amount of time with patients and their careers, they may be best placed to gain vital information about the circumstances around the event, which is important in establishing or excluding a diagnosis of epilepsy. There are steps nurses take to prevent the client from injuring himself. First, position client on their side. If they are out of bed position them on the floor with a pillow under their head. By placing patients on their side, it allows secretions to drain from their mouth making aspiration less likely. Never place a tongue blade in the client’s mouth. However, make sure that suctioning equipment is available at bedside. It is important to pad the side rails of the bed of any patient who might have seizures. Keep oxygen readily available at bedside and move all sharp objects away from the patient. If the patient is wearing tight or constricting clothes, make sure to remove or loosen them. It is very critical to time the duration of the seizure. If the patient has a seizure that lasts more than three minutes make sure the patient's airway is patent. Use your facility's protocol for medication to administer for controlling or stopping the seizure. Typically Lorazepam, Phenytoin, or Fosphenytoin will be used. Closely monitor the patient's vital signs and monitor their cardiac status. Stay with the patient during the seizure, making sure to note all characteristics of the episode. The information should include: any warning signs; actions during event; was patient conscious; feeling after the event; duration time; how frequently are they happening. Once the client is stable, chart all the information gathered during the seizure episode. The physician will need all this data to form a treatment plan for this client.

Drug therapy is the mainstay of treatment for seizure disorders. Approximately 50 percent of clients treated will have their seizures completely eliminated. A further 30 percent will have their seizures reduced down to a level where they can carry out normal lives. The remaining 20 percent are either resistant to the medication or the level of doses are so high that it becomes preferable to have no control over the seizures at all. Surgery is an option for a small portion of clients that suffer from epilepsy. In these cases, the injured brain tissue can be removed through a surgical procedure similar to a lobotomy. This is only an option if the medication fails and damaged tissue is confined to an area of the brain that can be safely removed without damaging other functions. Since the qualifications for surgery are so strict, the number of candidates is small in comparison to the total number of epileptic clients.

We have found that up 50 percent of patients with epilepsy do not comply with their prescribed regimen, so education is important for these clients. We should stress to always take their anti-epileptic drugs as prescribed. Often these clients feel healthy so they will skip or dose or stop taking the medication all together. Educating them that the sudden discontinuance of the drug can trigger seizures is very important. Advise women on anti-epileptic drugs who want to become pregnant to discuss her plans with her physician. Tell all clients with epilepsy that observing certain restrictions will help them avoid unnecessary injuries. They should avoid skydiving, motorsports, or any other sport that a moment of inattention could result in grave injuries. Clients with epilepsy, particularly children, may develop behavioral or emotional problems stemming from embarrassment or frustration with their condition. With that in mind, refer clients and their families to appropriate support organizations such as the Epilepsy Foundation.

Nurses also play a role in offering reassurance, information and support to patients and their families following the diagnosis, giving advice on all aspects of the condition, including its management, treatment and lifestyle implications. They can encourage and support patients to live as full lives as possible by discussing concerns an epilepsy diagnosis may raise, including driving, working, safety and leisure issues. Epilepsy specialist nurses also have a role in the follow-up of patients and monitoring their response to treatment - a role which has proved valuable.

References (put in alphabetical order)

Lefter, S., Costello, D., McNamara, B., & Sweeney, B. (2011). Clinical and EEG features of seizures in adults with down syndrome. Journal Of Clinical Neurophysiology, 28(5), 469-473.

Cross, C. (2004). Seizures: regaining control. Rn, 67(12).

Incorpora, G., Pavone, P., Castellano-Chiodo, D., Praticò, A., Ruggieri, M., & Pavone, L. (2013). Gelastic seizures due to hypothalamic hamartoma: Rapid resolution after endoscopic tumor disconnection. Neurocase (Psychology Press), 19(5), 458-461. doi: 10.1080/13554794.2012.701634.

You will need to use in-text citations for these references (for where you got the information from...if you did not paraphrase then it needs to be put in direct quotation marks “”))

Example: (Lefter, Costello, McNamara, Sweeney, 2011, p. ??); (Cross, 2004, p.??); (Incorpora, Pavone, Castellano-Chiodo, Practico, Ruggieri, & Pavone, 2013, p.??)