convulsion disorders (epilepsy) (MANAGEMENT (Anticonvulsants, other. These…
convulsion disorders (epilepsy)
A seizure results when a sudden imbalance occurs between the excitatory and inhibitory forces within the network of cortical neurons in favor of a sudden-onset net excitation.
The brain is involved in nearly every bodily function, including the higher cortical functions; if the affected cortical network is in the visual cortex, the clinical manifestations are visual phenomena.
The pathophysiology of focal-onset seizures differs from the mechanisms underlying generalized-onset seizures.
Overall, cellular excitability is increased, but the mechanisms of synchronization appear to substantially differ between these 2 types of seizure and are therefore discussed separately.
Aura. An aura (unusual sensations) precedes seizures in about 20% of people who have a seizure disorder.
Short duration. Almost all seizures are relatively brief, lasting from a few seconds to a few minutes; most seizures last 1 to 2 minutes.
Postictal state. When a seizure stops, people may have a headache, sore muscles, unusual sensations, confusion, and profound fatigue; these after-effects are called the postictal state.
Todd paralysis. In some people, one side of the body is weak, and the weakness lasts longer than the seizure (a disorder called Todd paralysis).
Visual hallucinations. Visual hallucinations (seeing unformed images) occur if the occipital lobe is affected.
Convulsions. A convulsion (jerking and spasms of muscles throughout the body) occur if large areas on both sides of the brain are affected.
NURSING CARE PLAN
. Teach SO to determine and familiarize warning signs and how to care for patient during and after seizure attack; avoid using thermometers that can cause breakage; use tympanic thermometer when necessary to take temperature; uphold strict bedrest if prodromal signs or aura experiences.
Promote airway clearance.
Maintain in lying position, flat surface; turn head to side during seizure activity; loosen clothing from neck or chest and abdominal areas; suction as needed; supervise supplemental oxygen or bag ventilation as needed postictally.
Determine individual situation related to low self-esteem in the present circumstances; refrain from over protecting the patient; encourage activities, providing supervision and monitoring when indicated.
Enforce education about the disease.
Review pathology and prognosis of condition and lifelong need for treatments as indicated; discuss patient’s particular trigger factors (flashing lights, hyperventilation, loud noises,); know and instill the importance of good oral hygiene; review medication regimen, necessity of taking drugs as ordered.
, other. These agents prevent seizure recurrence and terminate clinical and electrical seizure activity; anticonvulsants are normally reserved for patients who are at increased risk for recurrent seizures.
The ketogenic diet, which relies heavily on the use of fat, such as hydrogenated vegetable oil shortening (e.g., Crisco), has a role in the treatment of children with severe epilepsy.
Activity modification and restrictions.
clinicians should discuss the following types of seizure precautions with patients who have epileptic seizure: driving, ascending heights, working with fire or cooking, using power tools, taking unsupervised baths, and swimming.