 Hello, welcome to Nursing School Explained. Today's topics are seizures. So let's take a look at this. So seizures are defined as a transient, uncontrolled electrical discharge of neurons that can be spontaneous and without apparent cause. So there's something going on in the brain that causes the brain cells to be extra excitable and then that impulse spreads around other, to other brain cells. And then when we talk about seizures, another term that often comes up as epilepsy. So epilepsy is defined as the continued predisposition to seizures. So that is somebody that although they're on medication and they're being treated for whatever the underlying cause might be, they continue to have episodes of seizures. And we'll look into the different types of seizures here in a little bit. So the pathophysiology, these hyper excitable neurons fire abnormally and this can be due to any kind of malformation. So that might be a brain tumor, that might be an arterial venous malformation in the brain, that might be scar tissue from a stroke, for example, or from a traumatic head injury. So all kinds of structural changes in the brain can predispose a patient to having seizures. And seizures are an abrupt imbalance between excitatory and inhibitory neurons. Keep in mind that usually we have this nice balance of excitation and inhibition with all the weight of the neurotransmitters function, but in seizures, we have this imbalance and then the excitatory neurons, they win in this imbalance, which causes the electrical impulse to spread to other areas of the brain. And then if the patient has prolonged or recurring seizures, so that happen continuously different episodes, they're an increased risk for future seizures. So unfortunately, this is something that the patients will be predisposed to. So then let's look at the different types of seizures. So we need to distinguish between partial, which are also called focal, and also generalized seizures. So simple seizures are basically, there is no change in level of consciousness. And this is something that we have to keep in mind whenever we talk about seizures. Is there any alteration in consciousness? So is there any loss of consciousness, changes in mental status? So for simple seizures or partial focal seizures, the simple ones, there is no change in any kind of consciousness. And there might be a sudden change in mood. So let's say the patient, they might all of a sudden hear things or taste things or see things that are not real. Complex seizures, so the patient will have some sort of alteration in mental status, so positive change in our loss of consciousness. And the patient remains with eyes open and there might be purposeful movements, but the patient is unable to interact with the environment or with the person that's trying to determine are they having a seizure or what is going on. There might be some lip smacking, some repetitive motions such as hitting something repetitively or continuously smacking their lips and they are not able to interact with the person that might try to get them out of this seizure activity. And these typically last about one to three minutes. Now generalized seizures, as you can imagine, a bigger area of the brain is affected here, which means that these excitatory impulses spread through a generalized area of the brain and therefore they are a little bit more severe. So first of all, we have absence seizures and these usually occur in children and this might be somebody sometimes classified as daydreaming. So these are children that all of a sudden might just stare off and you think that they are daydreaming but actually what they're experiencing is a seizure. Then there are myoclonic seizures, so there is no altered mental status. So this might be somebody who all of a sudden starts to have a jerk of their shoulder or any kind of their body part. They just are unable to control that muscle part, the myoclonic seizures of their body. And then we have atonic seizures and atonic basically meaning without tone. So the patient will have an alteration in mental status and they're also called drop attacks. So these are all of a sudden, they become completely atonic, so they just kind of drop to the ground because their body is just not responding at all. And then we have the most important or the most severe ones, which are atonic-clonic seizures. So these are the ones that most people think about when they think about seizures. Now the patient will have altered mental status and this tonic phase is usually characterized by some sort of stiffening that lasts for a few seconds, about 10 to 20 or so and then it's followed by a jerking movement. That's that clonic phase of the seizure and that can last from several seconds up to some minutes. And so imagine when there's all these neurons that are hyper-excitable, that are firing continuously to neighboring brain tissues that involves basically mal-firing and no control over the body with the stiffening and then the jerking movement, there is some significant effect to the patient's body. So when they finally stop seizing, it's called they're in a post-icto phase and that just basically means post-seizure. And because the patient, no matter how long this tonic seizure has lasted, because they have been in this hyper-excitable state, it they will be very slow to regain consciousness. What also happens with these tonic-clonic seizures, the patient might be incontinent of urine or stool that might be biting their tongue. So we have to be extra careful in protecting their airway or they might have any kind of other trauma as you can imagine from these jerking movements that they're experiencing. So post-icto phase here is this phase where the patient comes out very slowly and then slowly over maybe half an hour, up to two hours, they regain consciousness and all of a sudden they're completely back to being oriented as usual. Now complications of seizures is called status epilepticus. Just like a complication of asthma status asthmaticus in seizures, it's called status epilepticus. And these are seizures that can last for up to or greater than five minutes. So imagine what's going on in the patient's brain and body when there's this continued jerking movement for this prolonged period of time. The patient might be unable to protect their airway, so they might turn cyanotic, they might completely stop breathing and they might go into respiratory failure because they basically just stop breathing because their body's so hyper-excitable, they're not able to protect their airway, they might be producing phlegm or maybe they are bleeding because they bit their tongue as their jaw is so tight. So this is a significant, significant problem that patients can die from. Now how else do you just diagnose? So first and foremost, we need to perform an EEG, an electroencephalogram, which basically means that a multitude of electrodes are hooked up to the patient's head and then a special machine will measure the brain waves to try and identify where this area of these excitatory neurons is located. And then they can determine the types of seizures that the patients might be having and then initiate treatment from there. Another diagnostic test would be a CATSKIN or an MRI because remember we talked about that structural changes might be causing seizures such as scar tissue from strokes or head injuries or brain tumors or any of these other things. So imaging here will definitely help determine this. Now blood glucose is always important because remember when the blood glucose goes low, so when the patient is hypoglycemic, the patient might be experiencing seizures. So it's very important to rule out blood glucose as a cause of a seizure because the patient might not have anything else going on in their brain. The reason for their seizure is just that their blood glucose is low. Additionally, diagnostic tests, let's write down here BMP because you might recall there are certain electrolytes that are also important with neuro-transmitter regulation. And so when the patient's sodium level goes either high or really low, they are prone to having seizures. So certainly we're gonna wanna check that on a metabolic panel. And the other cause I haven't talked about before for seizures that are not related to the neurons or any kind of structural deficiencies is alcohol withdrawal. So if the patient is used to consuming a certain amount of alcohol each day and then suddenly they're unable to or they are not consuming this specific level of alcohol that their body has now become accustomed to, they are prone to having alcohol withdrawal seizures. So then they're gonna require a whole lot of other interventions to make sure that this doesn't continue to happen. And then if we look at neonates, so I wrote down here, we have to rule out torch infections. And so when neonates are born, they can have seizures as well. And again, we have to consider structural abnormalities such as hydrocephalus, for example, or spina bifida, but also certain kind of infections that could have been transmitted from the mother to the neonate could cause seizures. And so this acronym torch is very helpful here and it stands for Toxoplasmosis. Other infections, rubella, cytomegalovirus or HSV or herpes simplex virus. So then the child will get tested for all these infections to see if that's the cause of their seizure. Now, as for treatment, it's determined that this is not a structural abnormality or even if it is, the patient might need to take an anti-convulsant and anti-seizure medication, anti-convulsants. Now there is a list of different medications, a variety of different medications available, but for our purposes here, I wrote down dilantin or phenytoin, which is a very commonly used kind of an old fashioned but still very applicable anti-seizure medications. And this always comes up on NCLEX exam. So I wrote down here, side effect is gingival hyperplasia. So basically their gum tissue will overgrow. So they will be extra kind of large and you will see that gum tissue after years of consumption, of course, the gum tissue will become large and kind of overgrow on the teeth. So for these patients, a nursing education measure is always to educate the patient on proper dental hygiene, regular dental checkups as well as daily flossing and brushing. So that always likes to come up. Now, dilantin is a medication that needs to be administered through filter tubing if it is administered in the IV. Keep that in mind, because there are certain crystals and particles in there that otherwise could enter the patient's bloodstream and cause some problems. And then when the patient is experiencing a seizure, so one of those tonic-clonic seizures and maybe even status epilepticus, we need to do something to stop the seizures. And the medications that we use here are benzodiazepines. Those are the ones that end in PAM. So that will be your lorazepam, which is also adivin, or diazepam, which is valium. Now, benzodiazepines, as you can imagine, if the patient is having tonic-clonic seizures, they're not going to be able to take that medication by mouth and we're not gonna wanna wait 45 to 60 minutes for this medication to take effect. So benzodiazepines are also available rectally, IV and IM. So certainly if the patient is having status epilepticus or tonic-clonic seizures and they're at the hospital, we need to make sure that we administer this benzodiazepine in the IV to stop the seizure. Now, nursing care during a seizure. So first of all, if we know that the patient either has a history of seizures, has been admitted to rule-out seizures, or has any kind of structural change in the brain, such as a brain tumor and stroke or brain injury, we need to make sure that we always, always, always have suction and oxygen equipment at the bedside. Because like I talked before, the patient might bite their tongue or they might have excessive secretions and then they are at risk for aspiration. So we need to be able to suction their mouth as well as if they're not able to control their respiratory status, then they're at risk for basically stopping breathing. So we need to make sure that we have oxygen available at the bedside. And this needs to be like a non-rebreather mask, some high flow delivery system. We certainly wanna initiate seizure precautions and those usually mean that there is padded side rails. So certain hospitals have seizure pads that are kind of thicker pads, almost think about like a gym mat, there are cushions that can be kind of hung over the side rails. So in case the patient is having that tonic-clonic seizure and they're moving around in bed, they don't get hurt by hitting their arm or leg or maybe even their head on that usually pretty tough side rail. And then if the patient is experiencing this tonic-clonic seizure, we wanna make sure we protect their head to protect them from injury. We wanna turn them to the side so that any kind of secretions or blood from biting their tongue doesn't just go straight down their airway, but rather kind of moves out to the side. We wanna loosen their clothing so that they're not constricted and choking on any clothing item. And we wanna ease them to the floor. So this is something that could happen, for example, if you're at an airport or anywhere in the general public, well all of a sudden, somebody's having a tonic-clonic seizure and let's say this is somebody who's wearing a tie. So you wanna make sure that you loosen their clothing and then gently ease them to the floor and then turn them to their side so their airway can be protected and hopefully will protect them from having any kind of injuries. And then things that we do not want to do, do not want to do is restrain the patient or put anything in their mouth. These are kind of old wives' tales and practices that have been established many, many years ago that are still kind of out there, but this is something that we don't want to do. And so if we logically think about that, if the patient is having uncontrolled jerking movements, we don't wanna hold them down because if they have these movements, they might dislocate a shoulder, they might break an arm or a leg. And certainly if they're already having issues with their airway, we don't wanna put anything in their mouth. We wanna keep that airway open as much as we can and have that suction equipment readily available so that we can help them clear their airway in case there is a problem. So thank you for watching this video on seizures. I'll be posting more videos on pediatric neurological problems here shortly. 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