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Precipitating Factors: Stroke Head injury Hemorrhage Infection such as encephalitis or meningitis Flashing lights Intoxicants or adverse reactions to drugs Insufficient dosage of a medication Sudden withdrawal from a seizure medication Consumption of alcoholic beverages while on an anticonvulsant or alcohol withdrawal Starting on a new medication that reduces the effectiveness of the anticonvulsant Developing a resistance to an anticonvulsant already being used Gastroenteritis while on an anticonvulsant Metabolic disturbances Insomnia or sleep deprivation
Predisposing Factors: *Age: Less than 2 years Family history Perinatal brain injury Congenital central nervous system malformations
Excess excitation and reduced inhibition of the neurons Failure of inhibitory process Electrical signal spreads to surrounding normal brain cells
Generalized Seizures
Excess excitation of bilateral hemispheres of the brain Motor: Jerking; Stiffening of the muscles; Myoclonus Sensory: Hypersensitivi ty of the five senses (vision, hearing, smell, taste or touch
Loss of awareness
Retains awareness
Autonomic: racing heart beat, stomach upset, diarrhea, loss of bladder control
Psychological: Deja vu; Jamis vu; Fear; Euphoria; Depersonalization; Hallucinations; Anger
Absence Seizure
Atypical Absence
Tonic
Clonic
Tonic-Clonic
Atonic
Myoclonic
Blank stare
With Interventions Diagnostic tests: *Electroencephalography (EEG) Magnetic Resonance Imaging (MRI)
Without Interventions Failure of inhibitory process by the GABA Abnormal transmission of neural responses to body functions
Magnetic Resonance Spectroscopy (MRS) Positron Emission Tomography (PET) Single Photon Emission Computed Tomography (SPECT Neuropsychological Testing Wada Test Psychiatric Evaluation Laboratory Tests:v *Fecalysis *Hematology *Urinalysis
Physiologic
Unpredictable seizures
Hormonal imbalance
Risk for injury Head trauma Heart failure Respiratory failure GI upset
Medical Intervention: a. Pharmacologic Anticonvulsants: Carbamazepine Tigabine Zonisamide Lamotrigine Pregabalin Gabapentin Valproic acid Anxiolytic: *Diazepam Lorazepam Clonazepam *Phenobarbital Anti-epeleptics: Ethosuximide Hemorrhage Spread of bacteria to systemic circulation Spread of bacteria to brain Hypertrophy of brain tissue Bacterial invasion through respiratory tract
Meningeal invasion Subarachnoid space inflammation Increased CSF outflow Increased intracranial pressure
Cerebral Vasculitis
Interstitial edema
Aneurism
Anti-pyretic: *Paracetamol Antibiotic: *Metronidazole *Ceftriaxone Surgery: Lobe resection Lesionectomy Corpus callostomy Functional hemispherectomy Temporal Lobe Resection Nursing interventions: 1. Monitor vital signs every 2 hours. 2. Provide sponge baths if temperature continues to rise 3. Provide safe environment by padding side rails, putting pillows on the side. 4. Do not restrain the patient during seizure. 5. Do not put anything in the patients mouth during seizure. 6. Protect the patients head during the seizure. 7. Maintain a patent airway until the patient is fully awake after a seizure. 8. Monitor for and report seizure activity and decreasing level of consciousness. 9. Keep bed in low position with side rails elevated. 10. Administer prescribed intravenous antibiotics. 11. Remind the family the importance of following medication examinations.
Sepsis
Decrease blood flow to brain Hypoxia to brain cells Brain cell death Systemic loss of body functions
DEATH
POOR PROGNOSIS