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Department
Nursing
Course
NURS 301
Professor
Unknown
Semester
Spring

Description
Alterations in Neurological System Health/Musculoskeletal Trauma 02/10/2014 Seizure Disorders Definition/Etiology/Incidence Primary (idiopathic epilepsy) no identifiable brain lesions or specific cause—genetic factors­­epilepsy Secondary—underlying brain lesion, most commonly tumor/trauma Amount of seizures can help determine if its epilepsy Risks Metabolic disorders Acute alcohol withdrawal DTs Electrolyte disturbances Heart disease High fever Stroke Substance abuse Pathophysiology Seizure changes level of consciousness, may not have twitching might just stare into space, motor sensory  ability and/or behavior Generalized—entire body Partial—half the body, twitch Unclassified—no fit into any category Secondary—from some other problem—treat underlying cause no more seizures Epilepsy (primary)—different brain electrical activity—chronic repeated unprovoked seizure activity Abnormal electrical neuronal activity An imbalance of neurotransmitters—GABA Or combination of both Idiopathic—we don’t know why they have it Types of seizures Generalized—both hemispheres Tonic—stiffening Clonic—jerking Tonic­Clonic (generalized) may lose control of bowel and bladder Absence seizures—zoning out Myoclonic—muscles Atonic—followed by postictal phase (I don’t know what happens) Partial—one hemisphere of the brain (if its one the right side the left side is affected) Focal/Local—focus point (right hand starts to twitch or just half of the face) Partial complex—all over the place Amnesia Older adults Mimic dementia Status epilepticus More than 5 min or repeated seizures over 30 mins—EMERGENCY Establish airway ABGs IV push lorazepam, diazepam Rectal diazepam Loading dose IV phenytoin Diagnostic Studies/Lab Studies 2 or more seizures by a person without a secondary cause diagnoses epilepsy CT scan MRI brain  PET scan *EEG Labs are drawn to rule out metabolic alterations Treatment Plan/Pharmacology Precautions Oxygen Suction Airway IV access­Valium for pts during seizure Side rails up No tongue blades Interview is KEY When and how long trigger, etc.  Diagnosis is based on history and physical Management depends on type Observe/document Patient safety Side­lying position No restraints Pharm management See chart 44­3 page 934 Evaluate most current blood level of medication if appropriate Be aware of drug­drug/drug­food interactions Maintain therapeutic blood levels for maximal effectiveness Do not administer warfarin with phenytoin Document and report side/adverse effects Surgical management—rare  Vagal nerve stimulation (VNS) Conventional surgical procedures Anterior temporal lobe resection  Partial corpus callosotomy  Nursing Process Education Compliance with AEDs Social service resources to assist with medication costs Discrimination prohibited Alternative employment may be needed Vocational rehabilitation may be subsidized  ALS/MS/Guillian­Barre’/Myasthenia Gravis Definition GB— Demyelinization of peripheral nerves Ascending paralysis—feet up (as opposed to MG—from head down)—weak in the legs can be vague Auto immune Etiology MS­­Affect women twice as much as men  GB—H1N1 vaccine—typically triggered by history of acute illness, trauma, surgery, immunization (most 1­3  weeks before onset of GB)—stress on the body, decreased immune status Risks: page 988 Reversible  Key features Ascending paralysis—flaccid paralysis w/o atrophy Decreased or absent DTR Incidence Pathophysiology GB—patients present with vague symptoms, may need resp support if it gets to the diaphragm  Demyelination of peripheral nerves Results from destruction of the myelin sheath Result of immune­mediated pathologic processes Symptoms: Initial muscle weakness and pain Ascending paralysis Begins in the legs and spreads to the upper body This can increase until the patient is totally immobile Can require ventilation b/c of weak or paralysis of respiratory muscles Autonomic dysfunction Acute course: The acute or initial period  (1 to 4 weeks), which begins with the onset of the first  symptoms and ends when no further deterioration occurs The plateau period  (several days to 2 weeks) The recovery phase  (gradually over 4 to 6 months, maybe up to 2 years), which is thought to coincide  with remyelination and axonal regeneration (Some patients do not completely recover and have permanent  neurologic deficits, referred tochronic GBS .) Diagnostic Studies/Lab Studies GB— Lumbar puncture, CBC, EPSs (demonstrate demyelinating neuropathy), EMG (peripheral nerve function),  MRI, CT Priority nursing care Respiratory care Pain management Communication and emotional Nutritional Involvement of family, other team members
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