neurology management of patients with neurological dysfunction chapter 61
TRANSCRIPT
![Page 1: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/1.jpg)
Neurology
Management of Patients with Neurological Dysfunction
Chapter 61
![Page 2: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/2.jpg)
Nursing management
• Ineffective airway clearance r/t alt. LOC– HOB – Lateral/semi-prone– Suctioning
• Hyper-oxygenate – Chest physiotherapy– Postural drainage– Auscultate – Intubation– Mech. vent
![Page 3: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/3.jpg)
Nursing management
• Risk of injury r/t LOC– Padded side-rails– Lines & equipment– Restraints– Dignity
• Privacy• Speak to pt
![Page 4: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/4.jpg)
Nursing management
• Deficient fluid volume r/t NPO– Skin turgor– Mucous membranes– I&O– labs
![Page 5: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/5.jpg)
Question?
• Which of the following lab values is most useful in assessing dehydration?– K+– Na+– Hematocrit– BUN– Urine specific gravity
![Page 6: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/6.jpg)
Question?
• What affect does dehydration have on a pt BUN level?– Increase– Decrease
![Page 7: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/7.jpg)
Question?
• What affect does dehydration have on a pt. Hematocrit level?– Increase– Decrease
![Page 8: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/8.jpg)
Nursing management
• Impaired oral mucous membranes r/t mouth breathing etc.– for dryness, inflammation, crusting– Oral care q8h– Lips– Move endotracheal tube each day (rt–lf–rt)
![Page 9: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/9.jpg)
Nursing management
• Alt. in nutrition, less than body requires– NGT/GT– HOB
![Page 10: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/10.jpg)
Question?
• Mrs. Jones has an NGT and has 2 medication that need to be given at 12:00 pm. Can the nurse crush the meds and give them at the same time?– Yes– No
• Each med is given separate and flush with 20-30 ml of water after each dose
![Page 11: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/11.jpg)
Question?• How do you measure for NGT tube placement?A. From the tip of the nose ear lobe xyphoid
process B. From the tip of the nose ear lobe xyphoid
process + 6 inchesC. From the ear lobe tip of the nose xyphoid
processD. From the ear lobe tip of the nose xyphoid
process + 6 inches
![Page 12: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/12.jpg)
Question?
• What is the most effective way to check NGT placement?
A. Inject 20 cc of air and listen for gurgleB. Aspirate stomach contentsC. X-ray
![Page 13: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/13.jpg)
Question?
• Mrs. Nop had an NGT placed 7 days ago and is tolerating feeding well. You are assigned to give her a 250 bolus feeding of Ensure. How should you make sure the NGT is in the stomach and not the lung?
A. Inject 20 cc of air and listen for gurgleB. Aspirate stomach contentsC. X-rayD.None of the above are necessary
![Page 14: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/14.jpg)
Nursing management
• Risk for impaired skin integrity r/t immobility– Reg. turning
• drag
– ROM– Splints
• Foam boats
– Beds
![Page 15: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/15.jpg)
Nursing management
• Impaired tissue integrity of cornea r/t I corneal reflex– Clean
• Cotton-ball & normal saline
– Cold compress• edema post-op
– Eye patch warning!
![Page 16: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/16.jpg)
Nursing management
• Ineffective thermoregulation r/t damage to hypothalamic center– Minimal bedding– Anti-pyretic– Cool sponge bath– Fan– Hypothermic blanket
![Page 17: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/17.jpg)
Nursing management
• Impaired urinary elimination (incontinence or retention)– Scan bladder– Retention Foley– S&S of infection
• Fever• Cloudy urine
![Page 18: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/18.jpg)
Nursing management
• Bowel incontinence– Bowel sounds– Abd girth– Monitor BM
• Frequency• Consistency
![Page 19: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/19.jpg)
Nursing management
• Disturbed sensory perception– Touch– Talk– Orient– Familiar sounds (tape player)
• Favorite TV/radio
– When arousing from coma • stimuli
![Page 20: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/20.jpg)
Nursing management
• Interrupted family processes r/t health crisis– Grief process
![Page 21: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/21.jpg)
What’s your advice?
• While assessing the patency of a central line for an unresponsive, terminally ill patient, I was startled when the patients wife said to me, “this isn’t how it was suppose to be. He’s just a year away from retirement, and we had wonderful plans to travel across the country.” I didn’t know what to say except, “I’m sorry.” I’d like to do better if this situation come up again. What should I have said?
![Page 22: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/22.jpg)
Small Group Questions
1. What is the priority nrs dx for a patient with alt. LOC?
2. Describe cerebral blood flow during suctioning.3. How can a nrs best assess for dehydration?4. Give 5 nrs interventions for a patient at risk for
injury & for impaired joint and skin integrity.
![Page 23: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/23.jpg)
Increased Intracranial Pressure
• Rigid vault• Contains 3 components
– Brain tissue– Blood– CSF
• Normal ICP 10-20 mmHg
![Page 24: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/24.jpg)
I-ICP
• Minor changes in ICP– Straining– Coughing– Sneezing– Posture– BP
![Page 25: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/25.jpg)
I-ICP
• Etiology of I-ICP– Head injury– Stroke– Inflammatory process– Intra-Cranial surgery
![Page 26: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/26.jpg)
I-ICP
• I-ICP Cycle– I-ICP – cerebral perfusion – Ischemia – Further edema – Herniation (shift brain tissue) – Deathmosis
![Page 27: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/27.jpg)
I-ICP
• PaCO2 • Cerebral vasodilatation
• cerebral blood flow
• -ICP
• PaCO2 • Cerebral
vasoconstriction • cerebral blood flow
• -ICP
![Page 28: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/28.jpg)
I-ICP
• Cerebral edema– Abn. of fluid – brain tissue volume – I-ICP
![Page 29: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/29.jpg)
I-ICP
• Compensation– Bodies attempt to ICP– Cushing’s response
• Widening PP• Bradycardia
• Decompensation– Ischemia– Infarction
![Page 30: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/30.jpg)
What is the earliest S&S of I-ICP?
A. HyporeflexiaB. ParesethesiaC. Visual distrubanceD. Altered level of consciousnessE. Motor slowingF. Pupils fixed
![Page 31: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/31.jpg)
I-ICP
• Early S&S– #1 Alt LOC
• restlessness or confusion
– H/A– Pupillary changes– Weakness on one side
![Page 32: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/32.jpg)
I-ICP
• Late S&S– Stupor coma– Pulse & Resp
• • Erratic (Cheyne-stoke, ataxic, Biot’s)
– BP & Temp•
– Projectile vomiting
![Page 33: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/33.jpg)
I-ICP
• Late S&S– Decorticated posturing– Decerebrate posturing– Loss of protective reflexes
![Page 34: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/34.jpg)
Where did it go?
• What goes first?– Orientation to time– Orientation to person– Response to verbal stimuli– Response to painful stimuli– Protective reflexes
![Page 35: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/35.jpg)
I-ICP
• Ominous sign!• Grave sign!
![Page 36: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/36.jpg)
Complications of I-ICP
• Herniation• Diabetes Insipidus• SIADH
![Page 37: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/37.jpg)
I-ICP Dx / Assessment
• CT• MRI
![Page 38: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/38.jpg)
I-ICP Management
• Monitor ICP– Ventricular catheter– Sub-arachnoid screw
![Page 39: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/39.jpg)
3 goals of I-ICP management
• edema• CSF volume• Cerebral blood volume
![Page 40: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/40.jpg)
I-ICP management
• Decrease Edema– Osmotic diuretic
• Mannitol/Osmitrol– I&O– Indwelling catheter– via serum osmolality
![Page 41: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/41.jpg)
I-ICP management
• Decrease edema– Corticosteroids
• Dexamethasone /Decadrone– S/E
» Hyperglycemia» GI bleed
– Give with» Antacids / Tums» Histamine H2 receptor blockers / Tagamet (cimetidine)
![Page 42: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/42.jpg)
I-ICP management
• Decreasing edema– Fluids
• – HOB
• – Body temperature
• Lower– cerebral edema– metabolism
![Page 43: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/43.jpg)
I-ICP management
• Decreasing CSF– Drain CSF
• Via lumbar puncture• Not too much • Ventricles collapse
![Page 44: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/44.jpg)
I-ICP management
• Decrease cerebral blood flow– O2
• Hyperventilate • Vasoconstriction• Hgb levels
– Control fever• Anti-pyretics• Cooling blanket• shivering I-ICP
![Page 45: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/45.jpg)
I-ICP management
• Decrease cerebral blood flow– Decrease metabolic demand
• Induce coma– Phenobarbital
• Paralyzing agents– Monitor cardiac– Vent– Monitor ICP – monitor Arterial pressure– Monitor serum barbituate levels
![Page 46: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/46.jpg)
I-ICP management
• Decrease cerebral blood flow– Decrease metabolic demand
• Prevent Seizures– Phenytoin / Dilantin– Diazepam / valium– Monitor serum levels
• Prevent infections
– Control BP
![Page 47: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/47.jpg)
I-ICP Nursing Management
• Maintain patent airway• Optimizing cerebral tissue perfusion
– Position • HOB • Head neutral position• Avoid extreme hip flexion
– valsalva maneuver I-ICP• Stool softeners• emena• Suctioning
![Page 48: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/48.jpg)
I-ICP Nursing Management
• Optimizing cerebral tissue perfusion– Calm atmosphere– Space nursing tasks– Minimal stimuli
• Monitor ICP
![Page 49: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/49.jpg)
Intracranial surgery
• Craniotomy:– Opening the skull surgically to gain access to
intracranial structures
![Page 50: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/50.jpg)
Intracranial surgery
• Burr hole– Circular opening made in the skull by a drill
![Page 51: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/51.jpg)
Intracranial surgery
• Craniectomy– An excision of a portion of the skull
![Page 52: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/52.jpg)
Intracranial surgery
• Cranioplasty– Repair of a cranial defect by means of a plastic or
metal plate
![Page 53: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/53.jpg)
Intracranial surgery
• Transsphenoidal– Through the nasal sinuses to gain access to the
pituitary gland
![Page 54: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/54.jpg)
Intracranial surgery
• Pre-op– Diagnostic procedures
• CT scan• MRI• Cerebral angiography
– Anticonvulsants• Phenytoin / Dilantin
– Corticosteroids• Dexamethasone / Decadron
![Page 55: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/55.jpg)
Intracranial surgery
• Pre-op– Fluids
• Restricted
– Diuretics• Mannitol• Furosemide / Lasix
– Anxiety• Diazepam / Valium
![Page 56: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/56.jpg)
Intracranial surgery
• Pre-op– Antibiotics– Shave head– Indwelling catheter– Warn pt about post-op environment– Baseline neuro check
![Page 57: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/57.jpg)
Intracranial surgery
• Post-op– Continue Pre-op meds– Reduce cerebral edema
• Mannitol• Dexamethasone
– Relieve pain• Acetaminophen / Tylenol• Codeine• Morphine sulfate
![Page 58: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/58.jpg)
Which of the following would be of concern while assessing the ABG’s of a patient post-op craniotomy?
A. PaO2 105B. HypoxemiaC. HypercapniaD. HypercarbiaE. Hypocapnia
![Page 59: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/59.jpg)
Intracranial surgery
• Post-op– Prevent seizures
• Phenytoin / Dilantin• Diazepam / valium• Monitor serum levels
– Monitor ICP– Edema peaks 24-36 hrs post-op– Temp control
![Page 60: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/60.jpg)
Intracranial surgery
• Post-op– Periorbital edema /
ecchymosis– Enhancing self image
• Verbalize frustration• Cover head with turban• Wig until hair grows
![Page 61: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/61.jpg)
Seizures
• Definition– Abnormal motor, sensory autonomic or psychic
activity resulting from sudden excessive discharge from cerebral neurons
![Page 62: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/62.jpg)
What is Epilepsy?
• disorder • briefly interrupts the normal electrical activity
of the brain• too many neurons fire at one time• "electrical storm" • seizure
![Page 63: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/63.jpg)
Seizures
• Classification– Partial
– Seizure that begins in one part of the brain• Simple
– Repetitive purposeless behavior– Dreamlike state– No loss of consciousness– Duration: < 1 minute– I.e. talking unintelligibly, dizziness, hand shake, picking at
clothes, chewing, smacking lips, spitting, fondling self
![Page 64: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/64.jpg)
Seizures
• Classification– Partial
• Simple• Complex
– Repetitive purposeless behavior– Loss of consciousness– Lasts 2-15 minute– Not aware of behavior
![Page 65: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/65.jpg)
Seizures
• Classification– Generalized
– Seizure that involves electrical discharges in the whole brain
• Absence Seizure– Occurs must often in children– Period of staring– Duration: several seconds
• Tonic-Clonic Seizure
![Page 66: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/66.jpg)
Seizures
• Classification– Generalized
• Tonic-Clonic Seizure– (grand mal seizure)– Tonic – rigidity– Clonic – contraction and relaxation of all muscles jerky,
rhythmic
![Page 67: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/67.jpg)
Seizures
• Possible Etiology– Underlying cause is electrical disturbance emitting of
abnormal, recurring, uncontrolled electric discharge• Idiopathic origin• Head injury• Hypoglycemia• Brain tumor• Infection • Anoxia
![Page 68: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/68.jpg)
Seizures
• Clinical manifestations– Prodromal phase
• Vague emotional changes• Minutes – hours before seizure
![Page 69: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/69.jpg)
Seizures
• Clinical manifestations– Prodromal phase– Aura
• Brief sensory experience• Precedes seizure by a few seconds• Usually the same aura each time
![Page 70: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/70.jpg)
Seizures
• Clinical manifestations– Prodromal phase– Aura– Loss of consciousness
• May or may not occur
– Seizure activity
![Page 71: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/71.jpg)
Seizures
• Seizure activity– Tonic Phase
• Duration: 30-60 sec• Rigidity fall• Pupils fixed & dilated• Hands and jaws clenched• Stop breathing
– Clonic phase
![Page 72: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/72.jpg)
Seizures
• Seizure activity– Clonic phase
• Contraction & relaxation of all muscles, jerky rhythmic fashion• Incontinent• Frothing at the mouth• Dyspnea• Epileptic cry• Tongue chew• Lasts 1-2 minutes subsides
![Page 73: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/73.jpg)
Seizures
• Characteristics – Post-seizure / postictal
• Recover period• Deep sleep• Confused
![Page 74: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/74.jpg)
Seizures
• Medical management– Anticonculsants
• Caramazepine / Tegretol– S/E
» Severe rash» Blood dyscrasias» Hepatitis
• Clonazepam / Klonopin– S/E
» Hepatotoxicity» Behavioral changes
![Page 75: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/75.jpg)
Seizures
– Anticonculsants• Phenytoin / Dilantin
– S/E» Gum hyperplasia» Rash» Nystagmus» Blood dyscrasias» PG cleft palate
![Page 76: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/76.jpg)
Seizures– Anticonculsants
• Valproate / Depakene– S/E
» Hepatotoxicity» Blood dyscrasias» Skin rash
• Diazepam / Valium• Phenobarbital / Luminal
– S/E» Drowsiness» Rash» pain
![Page 77: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/77.jpg)
Seizures
• Nrs Management w/ anticonvulsants– Do not stop abruptly seizures– Monitor levels– Take regularly– Inform of all meds– Alcohol only in moderation
![Page 78: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/78.jpg)
Seizures
• Before Seizure– At risk for injury
• Padded side rails• Suction machine in room• Loose clothing• Know aura
![Page 79: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/79.jpg)
Seizures
• Fear r/t possibility of a seizure– Take meds routinely– ID triggers
• Stress• New environment• Menstruation• Fever• Sleep deprivation• Alcohol
![Page 80: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/80.jpg)
Seizures
• Fear– Avoid photic stim
• Bight flickering lights• TV• Wear dark glasses
– Regular routine– Wear ID band
![Page 81: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/81.jpg)
Seizures
• Ineffective coping– Embarrassed– Feel rejected, avoided, discriminated– Frequently lonely psych problems– Driving restrictions
![Page 82: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/82.jpg)
Seizures
• Knowledge deficit– Take meds daily– records of meds & seizures– Drug levels routine– Avoid activities requiring alertness after meds– Showers or bath?
• Shower!
– Exercise– Sleep
![Page 83: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/83.jpg)
Seizures
During a seizure• Safety
– Ease to floor– Protect the head– Turn to side– Loosen clothing– In bed?
• Remove pillow• Side rails up
– Do not • pry open mouth• Insert anything in mouth• restrain
– Stay with pt
• Support patient– Privacy
![Page 84: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/84.jpg)
Seizures
• Observe & document– Circumstance (before)
– Aura?– 1st – Movement– Area– Pupils– Automatisms– Incontinent
– Duration– Unconsciousness– Weakness– Dysphasia– Post seizure behavior
![Page 85: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/85.jpg)
Seizures
• After a seizure– Document– At risk for
• Hypoxia• Vomiting• Aspiration
• Recovery position
![Page 86: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/86.jpg)
Seizures
• Nursing care– Side lying– Bed low– Padded side rails– stimulation
• Dim lights• Noise
– VS– Check mouth– Clean pt– Allow to “sleep it off”
![Page 87: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/87.jpg)
Status Epilepticus
• Defines– Prolonged seizure
activity– Series of
generalizes seizures w/o full recovery btw attacks
– Medical emergency
![Page 88: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/88.jpg)
Status Epilepticus
• Affects– Metabolic demand– Respiration– Anoxia– Brain damage
![Page 89: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/89.jpg)
Status Epilepticus
• Medical Management– Goal
• Stop seizure activity• Airway
• Rx of choice– Diazepam
• Valium
![Page 90: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/90.jpg)
Status Epilepticus
• Dx– Blood studies
• Electolytes• Glucose• Phenytoin level
![Page 91: Neurology Management of Patients with Neurological Dysfunction Chapter 61](https://reader036.vdocuments.site/reader036/viewer/2022070408/56649e5f5503460f94b588fd/html5/thumbnails/91.jpg)
What alteration in glucose level can commonly lead to seizures?
A. HyperglycemiaB. Hypoglycemia