Seizure: Status Epilepticus: A comprehensive powerpoint Presentation by Dave Manriquez.

1. SEIZURE: STATUS EPILEPTICUS
PRESENTED BY: DAVE JAY S. MANRIQUEZ RN. For ADULT HEALTH
NURSING 1

2. SEIZURE
sudden, excessive, disorderly electrical discharges of
the neurons.
EFFECTS OF SEIZURE: alteration in the following
 mental status
 LOC
 sensory and special senses
 motor funtion
CLASSIFICATION OF SEIZURES
A. Primary Generalized Seizure
B. Partial Seizure
GENERALIZED SEIZURES:
GRAND MAL (Tonic-Clonic)
 most common type of seizure
The phases are as follows:
The phases are as follows:

4. PETIT MAL (Absence Seizure or Little Sickness)
 not preceeded by AURA
 little or no toni-clonic
 charac blank facial expression, automatism like lip-chewing,
cheek smacking
 regain of consciousness as rapid as it was lot for 10-20secs
 usually occurs during childhood and adolescence
JACKSONIAN / FOCAL SEIZURE
 common for patients with organic brain lesion like frontal
lobe tumor
 aura is present(numbness, tingling, crawling feeling)
 charac by tonic-clonic movements of group muscle e.g.
hands, foot, or face then it proceeds toi grand mal seizure
FEBRILE SEIZURE
 this is common for children <5yo, when temp. is rising
PSYCHOMOTOR SEIZURE
 aura is present (hallucinations or illusion)
 charac by mental clouding (being out of touch with the
envt)
 appears intoxicated
 the client may commit violent or antisocial acts, e.g. Going
naked public, running

5. PARTIAL SEIZURE
2 TYPES OF PARTIAL SEIZURES:
A. Simple Partial Seizure
B. Complex Partial Seizure
 Simple Partial Seizure
 Awareness Preserved
 Memory Preserved
 Consciousness Preserved

6. Complex Partial Seizure
Awareness Preserved
Memory Preserved
Consciousness Preserved

7. CAUSES OF SEIZURES IN CHILDREN
• Birth Traumas
• Infections – Meningitis
• Congenital Abnormalities
• High Fever
CAUSES OF SEIZURES IN MIDDLE YEARS
• Head Injuries
• Infections
• Alcohol
• Stimulant Drugs
• Medications its Side Effects
CAUSES OF SEIZURES IN THE ELDERLY
• Brain Tumors
• Strokes

8. CHEMICAL IMBALANCES CAUSE SEIZURE
• Alcohol
• Cocaine
• Other Drugs
• Low blood sugar, low oxygen, low blood sodium,
low calcium, kidney and renal failure

9. Nursing Management During a Seizure
- The nursing goal is to prevent injury to the patient. This includes not
only physical support but psychological support as well.
 Provide privacy
 Ease the patient on the floor, if possible
 Protect the head with a pad to prevent injury
 Loosen constrictive clothing
 If aura precedes the seizure, place a padded tongue blade between
the teeth
 Do not attempt to pry open jaws that are clenched in a spasm to
insert anything
 No attempt should be made to restrain the patient during the seizure
 Place the patient on one side with head flexed forward
 The patent should be reoriented to the environments and happening
upon awakening

10. Nursing Assessment during a Seizure
- Observe and to record the sequence of symptoms.
3. Description of the circumstances before the attack.
4. The first thing a patient does in an attack.
5. The type of movements in the part of the body
involved.
6. The size of both pupils.
7. Whether or not there is automatisms
8. Duration of each phase of the attack
9. Unconsciousness, ability to speak, consciousness

11. Epilepsy
Disorders of brain function characterized
by recurring seizures.
Disturbance in consciousness, movement,
behavior, mood, sensation, perception. It
is not a disease but a symptom.
Electrical disturbance in one section of
nerve cells causing uncontrolled electrical
discharges.

12. How is Epilepsy Diagnosed?
History
Physical Exam
Electroencephalogram
MRI (Neuro-imaging)
CT Scan

13. 6 Truths about Epilepsy
1. Not to be called epileptic but a person with a seizure
disorders
2. In epilepsy there might be seldom brain damage, brain
function is disturb by seizure
3. Difference level of Intelligence
4. Violence does not follow epilepsy
5. Non usually inherited – cause is unknown and usually
associated with environmental causes
6. Epilepsy is not a curse is a medical condition

14. Nursing Diagnoses
• Fear related to the ever-present possibility
of having seizures
• Ineffective coping related to stresses
imposed by epilepsy
• Knowledge deficit about epilepsy and its
control
• High risk for injury during seizures

15. Goals:
Short Term Goals:
• Maintenance of control of seizures
• Achievement of a satisfactory psychosocial adjustment
• Acquisition of knowledge and understanding about the condition
Long Term Goals:
• To achieve a satisfactory life adjustment
• To prevent or manage episodes of status epilepticus
Nursing Interventions:
• Seizure Control
• Improved Coping Mechanisms
• Patient Education

16. STATUS EPILEPTICUS
 (ACUTE PROLONGED SEIZURE ACTIVITY)
 IS A SERIES OF GENERALIZED SEIZURE THAT
OCCUR WITHOUT FULL RECOVERY OF
CONSCIOUSNESS BETWEEN ATTACKS
 THE TERM HAS BEEN BROADENED TO INCLUDE
CONTINUOUS CLINICAL OR ELECTRICAL
SEIZURES LASTING AT LEAST 30 MINUTES, EVEN
WITHOUT IMPAIRMENT OF CONSCIOUSNESS.
 A seizure is a sudden disruption of the brain's
normal electrical activity, which can cause a loss of
consciousness and make the body twitch and jerk.
This condition is a medical emergency.

17. CAUSES
Not taking anticonvulsant medication
Also caused by an underlying condition,
such as meningitis, sepsis, encephalitis,
brain tumor, head trauma, extremely
high fever, low glucose levels, or
exposure to toxins.

18. SymptomS
 The characteristic symptom of status
epilepticus is seizures occurring so frequently
that they appear to be one continuous seizure.
These seizures include severe muscle
contractions and difficulty breathing.
Permanent damage can occur to the brain and
heart if treatment is not immediate. A
person's symptoms can range from simply
appearing dazed to the more serious muscle
contractions, spasms, and loss of
consciousness. The specific symptoms depend
on the underlying type of seizure.

19. TW C
O ATEGORIES OF STATUS EPILEP US
TIC
CONVULSIVE
Epilepsia partialis continua is a variant it involve an hour, day
or even week-long jerking. It is a consequence of vascular
disease, tumor or encepalitis and drug resistant.
NONCONVULSIVE
Complex Partial Status Epilepticus CPSE and absence status
epilepticus are rare forms of the condition which are marked by
nonconvulsive seizures. In the case of CPSE, the seizure is
confined to a small area of the brain, normally the temporal
lobe. But the latter, absence status epilepticus, is marked by a
generalised seizure affecting the whole brain, and an EEG is
needed to differentiate between the two conditions. This results
in episodes characterized by a long-lasting stupor, staring and
unresponsiveness.

20. NURSING DIAGNOSIS
High Risk for Injury r/t Seizure
Activity
Individual Coping r/t perceive social
stigma, potential changes in
employment

21. HOW IT IS DIAGNOSED?
Status epilepticus is diagnosed according to its
characteristics symptoms. The doctor will order test to
look for the cause of the seizures. This may include:
 Blood test
 ECG to check for an abnormal heart rhythm
 EEG to check electrical activity in the brain
 MRI or CT scan to check for braing tumord or signs of
damage to the brain tissue.

22. MEDICATIONS
Diazepam (Valium) this will stop motor movement
Phenytoin (Dilatin)
Phenobarbital (Barbita)
Paraldehyde
Thiopentahl sodium (Pentotal sodium)
General anesthesia may also be used as a
treatment of last resort to stop seizure activity

23. NURSING INTERVENTIONS
PREVENTING INJURY
REDUCING FEARS OF SEIZURE
IMPROVING COPING MECHANISMS
PROVIDING PATIENT AND FAMILY
EDUCATION
MONITORING AND MANAGING POTENTIAL COMPL
TEACHING PATIENTS SELF-CARE

24. PREVENTING INJURY
Injury prevention for the patient with seizure is a
PRIORITY.
 patient should be placed on the floor and
remove any obstructive items
 patient should never be forced into a
position
 pad side rails
 do not attempt to pry open jaws that are
clenched in a spasm to insert anything.
 if possible place the patient on one side with
head flexed forward,

25. PATIENT EDUCATION
 TAKE MEDICATION AT REGULAR BASIS
 AVOID ALCOHOL. Lowers seizure threshold
 ADEQUATE REST
 WELL-BALANCED DIET
 AVOID DRIVING, OPERATING MACHINES,
SWIMMING UNTIL SEIZURES ARE WELL
CONTROLLED.
 LIVE AN ACTIVE LIFE

26. REDUCING FEARS OF SEIZURE
Fear that a seizure may occur unexpectedly can
be reduced by the patients adherence to the
prescribed treatment regimen. Cooperation of
the patient and family and their trust in the
prescribed regimen are essential for control of
seizures.
Periodic monitoring is necessary to ensure the
adequacy of the treatment regimen and to
prevent the side effects..

27. IMPROVING COPING MECHANISMS
It has been noted that the social, psychological,
and behavioral problems frequently
accompanying the attack can be more handicap
than the actual seizure.
Counselling assists the individual and family to
understand the condition and the limitations
imposed by it. Social and recreational
opportunities are good for mental health .
Nurses can improve the quality of life for patients
with the disorder by educating them and their
family about the symptom and also the
management.

28. PROVIDING PATIENT AND FAMILY EDUCATION
Ongoing education and encouragement should
be given to patients to enable them to overcome
these feelings. The patient and family should be
educated about the medications as well as care
during a seizure.
Perhaps the most valuable facets are education
and efforts to modify the attitudes of the patient
and family toward the disorder.

29. MONITORING AND MANAGING POTENTIAL
COMPLICATIONS
 Patients should have plan to have
serum drug levels drawn at regular
intervals. The patient and family are
instructed about the side effects and
are given specific guidelines to
assess and report signs and
symptoms indicating medication
overdose.

30. TEACHING PATIENTS SELF CARE
Like thorough oral hygiene after each meal, gum
massage, daily flossing, and regular dental care.
The patient is also instructed to inform all health
care providers of the medication being taken
because of the possibility of drug interactions.
An individualized comprehensive teaching plan
is needed to assist the patient and family to
adjust to this chronic disorder.