Med-Surg - Nervous System, part 7: Seizures

Hi, I'm Cathy, with LevelUpRN. In this video, we are going to talk about seizures as well as status epilepticus. And at the end of the video, I'm going to give you guys a quiz to test your knowledge of some of the key facts I'll be covering in this video. So definitely stay tuned for that. And if you have our LevelUpRN medical-surgical nursing flashcards, available at leveluprn.com, definitely pull those out so you can follow along with me.

Seizures are characterized by the uncontrolled electrical discharge of neurons in the brain, and if a patient has two or more episodes of unprovoked seizures, then they would be diagnosed with epilepsy.

Pathophysiology behind seizures is that we have a disease, injury, or unknown cause that is resulting in hyper excitability of neuron activity and decreased inhibition of neurons.

So risk factors associated with seizures include a fever. So febrile seizures are the most common form of seizures in children. Other risk factors include cerebral edema, infection such as meningitis, fluid and electrolyte imbalances, particularly hyponatremia, and drug or alcohol withdrawal.

In terms of triggers, fatigue, stress, flashing lights, and caffeine can cause a seizure to occur in those who are susceptible.

There are several different types of seizures. I'm going to go over four here.

So first of all, we have a tonic-clonic seizure, which was previously known as a grand mal seizure. This is characterized by three phases. During the first phase, this is the tonic episode phase, we have the stiffening of muscles and the loss of consciousness. Then we move into the clonic episode, which is where we have one to two minutes of rhythmic jerking of the extremities. So we have contraction, relaxation, contraction, relaxation of those muscles. And then from the clonic episode, we go into the postictal phase. This is characterized by confusion, sleepiness, and possible agitation.

Another type of seizure to be familiar with is something called an absence seizure. So this type of seizure is characterized by loss of consciousness for a few seconds, and it resembles daydreaming. So I had a good friend when I lived in Texas, and her daughter in school kept getting called out for not paying attention and for daydreaming. As it turns out, she was having seizures. Because again, this type of seizure is characterized by that appearance of daydreaming. Other symptoms of absence seizures include picking at clothes, lip smacking, as well as eye fluttering.

Another type of seizure to be familiar with is a myoclonic seizure. This is where we have the brief jerking of the extremities. Typically, no loss of consciousness though.

And then we have an atonic seizure. So A means no or lack of, and then tone. So with an atonic seizure, we have loss of muscle tone. If a patient is standing when they experience an atonic seizure, that will often result in falling due to that loss of muscle tone.

Diagnosis of seizures can be done with the help of an EEG, which is an electroencephalogram.

In terms of treatment, we would treat seizures with antiepileptics or anticonvulsive agents. So this can include valproic acid, carbamazepine, as well as phenytoin, and there are many others. I actually have a whole video dedicated to antiepileptic agents in my pharmacology playlist. So if you want details about those medications, definitely check that out.

In terms of procedures, the patient can have a vagal nerve stimulator surgically implanted. So this device goes under the skin on the left side of the chest, and it sends electrical pulses about every five seconds to the vagus nerve, which in turn alters levels of neurotransmitters in the brain. Another procedure that can be used is a craniotomy to remove the part of the brain tissue that is responsible for the seizures.

In terms of nursing care when a patient is having a seizure, it's incredibly important for you to know what you should and should not do during the seizure. So if your patient is standing or sitting, you want to lower them to the floor or the bed, and turn them to their side. You should loosen any restrictive clothing. You do not place anything in their mouth, and you do not restrain the patient at all either. And while the patient is having their seizure, you should note the onset and duration of the seizure.

After the seizure is complete. You want to check your patient's vital signs and their neurological status. You want to reorient the patient, and then implement seizure precautions if that has not already been done. So that means padding the side rails of the bed. And then you want to help determine what a possible trigger was for the patient's seizure.

A life threatening complication of seizures is something called status epilepticus. This is where a patient has a prolonged seizure that lasts more than five minutes, or fails to regain consciousness between seizures.

Risk factors include a CNS infection, head trauma, as well as drug withdrawal or toxicity.

In terms of treatment, we're going to give the patient antiepileptic agents such as phenytoin. In addition, we would give benzodiazepines such as lorazepam and anesthetic agents such as propofol, and possibly barbiturates such as phenobarbital.

In terms of nursing care, number one priority, we're going to want to maintain a patent airway and administer oxygen as prescribed. In addition to providing the medications that we just talked about, we're going to want to assist with intubation as well.

All right. It's time for quiz. I have three questions for you. First question. What type of seizure is characterized by blank staring, eye fluttering, and picking at clothes? The answer is an absence seizure. Question number two. What phase of a tonic-clonic seizure is characterized by confusion and sleepiness? The answer is the postictal phase. Question number three. What life-threatening disorder is characterized by a prolonged seizure or failure to regain consciousness between seizures? The answer is status epilepticus.

All right. That's it for this video. In my next video, I will be talking about meningitis. So you'll definitely want to stay tuned for that. Take care.