A seizure is sudden, abnormal, and excessive electrical discharges from the brain that can change motor or autonomic function, consciousness, or sensation
Epilepsy is a chronic neurological disorder characterized by recurrent seizures
Seizures may be a symptom of epilepsy or another neuro disorder
Seizures
Normal stability of neuron cell membrane is impaired
IdiopathicNo Cause IdentifiedUsually onset before age 20
AcquiredUnderlying Neurological DisorderBrain Injury
Etiology
PartialBegin on one side of cerebral cortex, may
progress to other side and become generalizedGeneralized
Both cerebral hemispheres involved
S+S depend on area where abnormal electrical discharges occur
Classification of seizures
AuraVisual distortionOdorSound
Patients may have this warning, allowing time to improve safety
Signs & Symptoms
Partial SeizuresAutomatisms
Repetitive, purposeless movements while in dream-like state
Maintain consciousnessUsually <1 minuteParesthesias if begins in parietal lobeVisual disturbances if occipital lobeInvoluntary movements if motor cortex, usually
begin in arm and hand, progress to leg and face
Signs & Symptoms
Complex Partial/PsychomotorPartial seizure as described, but…Lose consciousnessMay last 2 – 15 minutes
Signs & Symptoms
Generalized SeizuresAbsence (Petit Mal)
Staring that lasts several seconds
http://www.youtube.com/watch?v=z9V2sNmIoJk&feature=related
Signs & Symptoms
Generalized SeizuresTonic Clonic (Grand Mal)
May have aura, usually lose consciousness
Tonic phaseRigidity
Clonic phase Muscle contraction and relaxationIncontinence
Postictal period-recovery period after a seizure
Signs & Symptoms
http://www.youtube.com/watch?v=nV40H_g-NJo&NR=1
http://www.youtube.com/watch?v=H2vH1igOoh0&feature=related
http://www.youtube.com/watch?v=p5U2tpaH3fA&feature=related
http://www.youtube.com/watch?v=VC6HJPZr1VU&feature=related
EEGCan determine site of origin, frequency and
duration, dx subclinicalLook for underlying causeAccurate observation/reporting of seizure
Diagnosis
Correct CauseAnticonvulsant Medication
Taper slowlyCommon side effect-drowsiness
Surgical ResectionIf focus is located in nonvital tissue, resceting
area can prevent spread to other areas of brain
Therapeutic Interventions
Prevent injury Pad side railsKeep away from furniture, wallsDo not restrainLoosen tight clothing, belts, jewelryMonitor airwayTurn on side to prevent aspirationOnce seizure has begun, do not force
airway/suction into patient’s mouthSuction, CPR PRN (suction, oral airway at
bedside)Observe and document
Emergency Care: Seizures
30 minutes of seizure activity without return to consciousness
Therapeutic InterventionsEnsure airway and oxygenation
Intubation and mechanical ventAdminister IV diazepam (Valium) or lorazepam
(Ativan) or phenobarbitol
Status Epilepticus
Characterized by a decrease or loss of sensory and motor function below the level of the injury
Damage results from bruising, tearing, cutting , edema or bleeding into the spinal cordCauses?
Complete injury means no motor or sensory function below the level of the injury
Incomplete means some functioning remains
Spinal Trauma
Injury to C3 or above is usually fatalC4-C5 injuries likely require ventilationQuadriplegia vs. quadriparesisParaplegia vs. paraparesisSpinal Shock
SCI affects autonomic nervous systemLasts from a week to months Immediately after injury, sympathetic NS is disrupted
VasodilationHypotensionBradycardiaHypothermia
Spinal Trauma
See handout
Whiplash
Increased Intracranial Pressure
PathophysiologyIncrease in
BrainBloodCSF
Normal ICP 0-15mm HgAffected by pathologic conditions
Most Common causes of IICP Brain Trauma Brain Tumor Intracranial Hemorrhage
Also affected by positioning, arterial pulsations, increase in intrathoracic pressure
ICP
RestlessnessIrritabilityDecreased LOCHyperventilationPupil changes (due to compression of
occulomotor nerve)Cushing’s Response (classic late response)
Body attempts to compensate for IICP caused cerebral perfusion deficits with increased systemic blood pressure
Signs & Symptoms
Monitors are placed thru burr hole drilled thru skull
Cared for in ICU-often ventilated and pharmacologically sedated/paralyzedExternal Ventricular Monitor and DrainSubarachnoid Bolt Monitor-ease of
placementIntraparenchymal Monitor-directly into
brain tissue
ICP Monitoring
Keep HOB elevated 30*Keep head and neck in proper alignment
Avoid neck flexionAntiemetics and antitussives PRNStool softeners PRNMinimize suctioningAvoid hip flexionPrevent noxious stimuliSpace care activities
Interventions to prevent IICP
Traumatic Brain Injury (TBI)Trauma
HemorrhageContusionLaceration
Can CauseCerebral EdemaHyperemiaHydrocephalusBrain
HerniationDeath
MVA most commonFallsAssaultsSports-related injuries
Etiology
Closed or nonpenetrating head injury (blunt)Rapid back and forth movement causing bruising
and tearing of brain tissues and vesselsOpen or penetrating head injury
Break in the skull with brain tissue/vessel damage
AccelerationMoving object hits stationary head
DecelerationHead in motion hits a stationary object
Acceleration-Deceleration/Contra-CoupCombination of two
Mechanisms of Injury
Concussion: see handoutBrief or no LOC, <5 minsHeadache, dizziness, N/V, vertigoMay have amnesia
CT/MRI negative
Rest, fluids, Tylenol, frequent LOC monitoringAvoid narcotics, sedatives, opiods, no drivingConcussion syndrome may last months
Types of Injury
ContusionBruising of brain tissueMay develop hemorrhageSymptoms depend on area(s) and severity
Brainstem-decreased LOC (may be permanent), motor response, pupil reaction, eye movement, elevated RR, fever
CT scan shows tissue swellingTreatment supportive
Types of Injury
Types of InjuryHematoma
Subdural (A)Usually venousBetween dura
and arachnoid membranes
Epidural (B)Usually arterialBetween dura
and skull
Subdural HematomaAcute vs Chronic
If chronic, may be months from injury to S+SForgetfulLethargicIrritableHeadache
Damage to brain tissue as blood accumulatesLOC changesHemiparesisDilated pupilExtremity weakness
Types of Injury
Epidural HematomaOften associated with skull fractureArterial, so usually progresses quicklyLoss of consciousness after injury>regain
consciousness, coherent>then rapid deterioration
Decreased LOC, seizures
Types of Injury
CT-test of choice, rapid resultsMRINeuropsychological Testing
Diagnosis
Surgical Removal of HematomaBurr holes, craniotomy
Control IICPICP Monitoring
Drainage of CSFOsmotic Diuretic
Mannitol (Osmitrol)Mechanical Hyperventilation
Therapeutic Coma
Therapeutic Interventions
Brain HerniationDiabetes Insipidus
Damage to Pituitary=too little ADHAcute Hydrocephalus
Ventriculoperitoneal shuntLabile Vital SignsCognitive and Personality ChangesOften life-long deficits
Complications of TBI
Brain Herniation
PVS-Continual condition of complete unawareness of the environment, there is at least partial preservation of hypothalmic and brain stem functioning
Coma-state of unconsciousness from which one cannot be aroused and is unresponsive
Persistent Vegetative State (PVS)
Ineffective Cerebral Tissue PerfusionIneffective Airway ClearanceIneffective Breathing Pattern Disturbed Thought ProcessesSelf-Care Deficit PainSensory-Perceptual DisturbanceImpaired Physical MobilityRisk for Injury
Nursing Diagnoses TBI
ICU-monitoring ICPMonitor neuro status frequently
Glasgow Coma ScalePupil responseMuscle strengthVital signsMonitor for seizuresPosturing
DecorticateDecerebrate
Nursing Care TBI