LESSON PLAN ON EPILEPSY

Programme Course Topic Group No of students Venue Date Duration Method of teaching Av aids Name of the teacher

: Bsc(N) : Medical Surgical Nursing : EPILEPSY : Bsc(N) -II : 50 : Lecture hall- 5 :6/11/2009 : 1hrs : Lecture cum discussion : black board, OHP, Chart. : Radhika.A.B. year

Central objectives: At the end of the class the students will be able to gain in-depth knowledge on epilepsy & develop desirable skill & attitude while taking care of epilepsy patients. Specific objectives : At the end of the class the students will be Define seizure and epilepsy Discuss the incidence of epilepsy and seizure List down the types of seizure Enumerate the causes of seizure Describe the pathophysiology of seizure. Explain the clinical manifestation of seizure Identify the diagnostic investigation of seizure Elaborate the management of seizure.

SL NO

TIME

SPECIFIC OBJECTIVE

CONTENTS

TEACHERS ACTIVITIES

STUDENTS ACTIVITIES

AV.AID S

EVALUATION

EPILEPSY AND SEIZURES

5min

- introduce the topic Epilepsy and Seizure and its meaning and incidence to the students.

INTRODUCTION The brain is the center that controls and regulates all voluntary and involuntary responses in the body.It consists of nerve cells that normally communicate with each other through electrical activity. EPILEPSY Epilepsy is derived from the greeck word epilepsia meaning seizure. MEANING Epilepsy is a group of syndromes charecterised by recurring seizures. SEIZURE A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function. MEANING Seizure are sudden, abnormal electrical discharges from the brain that results changes in sensation behavior movements, perceptions, or consciousness.

Writes the topic on the black board. & Introduces the topic by narration.

Listens and takes notes.

Black board

What is Epilepsy and

Seizure?

OHP Listening & Notes taking

What are the classification of glaucoma?

5min

INCIDENCE 2.3million Americans are known to have seizures

or epilepsy. About 181.000 new cases of seizures are documented annually.

10min

- enumerate the types of Epilepsy and Seizure.

TYPES OF SEIZURES There are several different types of seizures, including the following:

Explains the types

Listening and taking notes.

Blackbo ard.

What are the types of

of Epilepsy Partial Seizures Partial seizures take place when abnormal and electrical brain function occurs in one or more areas Seizure of one side of the brain. In about one-third of people with partial seizures, the person may experience an aura before the seizure occurs. An aura is a strange feeling, either consisting of visual changes, hearing abnormalities, or changes in the sense of smell. Two types of partial seizures include the following: 1. Simple Partial Seizures The seizures typically last less than one minute.The person may show different symptoms depending upon which area of the brain is involved.If the abnormal electrical brain function is in the occipital lobe, the person's sight may be altered.The person's muscles are typically more commonly affected. The seizure activity is limited to an isolated muscle group, such as the fingers, or to larger muscles in the arms and legs. Consciousness is not lost in this type of seizure. The person may also experience sweating, nausea, or become pale. 2. Complex Partial Seizures This type of seizure commonly occurs in

Epilepsy and Seizure.

the temporal lobe of the brain, the area of the brain that controls emotion and memory function. This seizure usually lasts between one to two minutes. Consciousness is usually lost during these seizures and a variety of behaviors can occur. These behaviors may range from gagging, lip smacking, running, screaming, crying, and/or laughing. When the person regains consciousness, the person may complain of being tired or sleepy after the seizure. This is called the post-ictal period. Generalized Seizures Generalized seizures involve both sides of the brain.There is loss of consciousness and a postictal state after the seizure occurs.Types of generalized seizures include the following: 1. Absence Seizures (Petit Mal Seizures) These seizures are characterized by an altered state of consciousness and staring episodes.Typically, the person's posture is maintained during the seizure. The mouth or face may move or the eyes may blink.The seizure usually lasts no longer than 30 seconds.When the seizure is over, the person may not recall what just occurred and may go on with his/her activities, acting as though nothing happened. These seizures may occur several times a day. This type of seizure is sometimes mistaken for a learning problem or behavioral problem. Absence seizures are uncommon before the age of 5 and occur more

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3.

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often in girls. Atonic With atonic seizures, there is a sudden loss of muscle tone and the person may fall from a standing position or suddenly drop his/her head.During the seizure, the person is limp and unresponsive. Generalized Tonic-Clonic Seizures(Gtc Or Grand Mal Seizures) This seizure is characterized by five distinct phases that occur.The body, arms, and legs will flex (contract), extend (straighten out), and tremor (shake), followed by a clonicperiod (contraction and relaxation of the muscles) and the postictal period. During the postictal period, the person may be sleepy, have problems with vision or speech, and may have a bad headache, fatigue, or body aches. Myoclonic Seizures This type of seizure refers to quick movements or sudden jerking of a group of muscles.These seizures tend to occur in clusters, meaning that they may occur several times a day, or for several days in a row. Infantile Spasms This rare type of seizure disorder occurs in infants from 3 months to 12 months of age. There is a high occurrence rate of this seizure when the child is awakening, or when he/she is trying to go to sleep. The infant usually has brief periods of movement of the neck, trunk, or legs that lasts for a few seconds. Infants may have hundreds of these

seizures a day. This can be a serious problem, and can have long-term complications. 6. Febrile Seizures This type of seizure is associated with fever.Approximately 2 to 5 percent of all children in the United States experience febrile seizures.These seizures are more commonly seen in children between 6 months and 6 years of age, and there may be a family history of this type of seizure.Febrile seizures that last less than 15 minutes are called "simple," and typically do not have long-term neurological effects.Seizures lasting more than 15 minutes are called "complex" and there may be long-term neurological changes in the child.
5min

CAUSES A person may experience one or numerous detail seizures.While the exact cause of the seizure may not be known, the more common seizures are caused by the Regarding the following: Cause and risk in newborns and infants: o birth trauma factor of o congenital (present at birth) problems Epilepsy and o fever o metabolic or chemical imbalances in the Seizure. body in children, adolescents, and adults: o alcohol or drugs o head trauma o infection o unknown reasons -To explain in

Explains the cause Listens and and risk factorsdiscusses of

OHP

What are the causative factors for Epilepsy

Epilepsy and Seizure.

and Seizure.

Other possible causes of seizures may include the following: brain tumor neurological problems drug withdrawal medications
5min

To describe in detail about pathophysiolo gy of Epilepsy and Seizure.

PATHOPHYSIOLOGY Alteration in the integrity of neuronal cell membrane Cell begins firing with increased frequency Increase in threshold intensity of discharge Neuronal firing spreads to the adjesent neurons Seizure Normaly excitory messages from the cerebral cortex are modulated by deeper structures. But in client with epilepsy bursts of activity from the cortex are not modulated and these bursts spread.
Explains the pathophysi ology of Listens and takes notes. chart Explain the pathophysiology of

Epilepsy and Seizure

Epilepsy and Seizure

5min

SIGNS AND SYMPTOMS OF A SEIZURE The person may have varying degrees of detail about signs and symptoms depending upon the type of seizure. The following are general symptoms of a seizure or warning symptoms of signs of seizures. Symptoms or warning signs may include: Epilepsy and staring jerking movements of the arms and legs Seizure. stiffening of the body loss of consciousness breathing problems or breathing stops loss of bowel or bladder control falling suddenly for no apparent reason not responding to noise or words for brief periods appearing confused or in a haze sleepiness and irritable upon waking in the morning nodding the head periods of rapid eye blinking and staring During the seizure, the person's lips may become bluish and breathing may not be normal.The movements are often followed by a period of sleep or disorientation. The symptoms of a seizure may resemble other problems or medical conditions.Always consult your physician for a diagnosis. -To explain in -to explain in detaile about diagnostic

Explains the signs and and Listens symptoms of discusses

Chart

What are the signs and symptoms of

Epilepsy and Seizure.

Epilepsy and Seizure.

5min

DIAGNOSIS The full extent of the seizure may not be completely Listens & understood immediately after onset of symptoms, but may Explains the be revealed with a comprehensive medical evaluation and investigation Notes taking. diagnostic testing.The diagnosis of a seizure is made with a technique for physical examination and diagnostic tests.During the

Black board

What are the diagnostic measures of

procedures of Epilepsy and Seizure.

examination, the physician obtains a complete medical history of the person and family and asks when the seizures occurred.Seizures may be due to neurological problems and require further medical follow up. Diagnostic tests may include: blood tests electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp. magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. lumbar puncture (spinal tap) - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.

Epilepsy and Seizure .

Epilepsy and Seizure

5min

-To discuss in detail about the treatment modalities of Epilepsy and Seizure.

TREATMENT OF SEIZURE: Specific treatment for a seizure will be determined by your physician based on:

Explains and notes Taking.

Listens and notes taking.

chart

Explain the treatment modalities of

The goal of seizure management is to control, stop, or decrease the frequency of the seizures without interfering with the normal activities of daily living (ADLs). The major goals of seizure management include the following: proper identification of the type of seizure using medication specific to the type of seizure using the least amount of medication to achieve adequate control maintaining appropriate medication levels Treatment may include: Medications There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, age of the patient, side effects, the cost of the medication, and the adherence with the use of the medication. Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles, or syrup), but some can be given rectally (into the person's rectum). If the

age, overall health, and medical history type of the seizure frequency of the seizures tolerance for specific medications, procedures, or therapies expectations for the course of the condition opinion or preference

Epilepsy and Seizure.

person is in the hospital with seizures, medication by injection or intravenous (IV) may be used. All medications can have side effects, although some people may not experience side effects. While you are taking medications, different tests may be done to monitor the effectiveness of the medication. These tests may include the following: blood work Frequent blood draws testing is usually required to check the level of the medication in the body. Based on this level, the physician may increase or decrease the dose of the medication to achieve the desired level. This level is called the "therapeutic level" and is where the medication works most efficiently. Blood work may also be done to monitor the effects of medications on body organs. electroencephalogram (EEG) An EEG is a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp. This test is done to monitor how the medication is helping the electrical problems in the brain. surgery Another treatment option for seizures is surgery. Surgery may be considered in a person who: o has seizures that are unable to be controlled with medications. o has seizures that always start in one area of the brain.

has a seizure in a part of the brain that can be removed without disrupting important behaviors such as speech, memory, or vision. Surgery for epilepsy and seizures is a very complicated surgery performed by a specialized surgical team. The operation may remove the part of the brain where the seizures are occurring, or, sometimes, the surgery helps to stop the spread of the bad electrical currents through the brain. A person may be awake during the surgery. The brain itself does not feel pain. With the person awake and able to follow commands, the surgeons are better able to make sure that important areas of the brain are not damaged.

Surgery is not an option for everyone with seizures. vagus nerve stimulation (VNS) Some people, whose seizures are not being well-controlled with seizure medications, may benefit from a procedure called vagus nerve stimulation (VNS). VNS is currently only used for persons over the age of 12 who have partial seizures that are not controlled by other methods. VNS attempts to control seizures by sending small pulses of energy to the brain from the vagus nerve, which is a large nerve in the neck. This is done by surgically placing a small battery into the chest wall. Small wires are then attached to the battery and placed under the skin and around the vagus nerve. The battery is then programmed to send energy impulses every few minutes to the

brain. When the person feels a seizure coming on, he/she may activate the impulses by holding a small magnet over the battery. In many cases, this will help to stop the seizure. There are some side effects that may occur with the use of VNS. These may include, but are not limited to, the following:
o o o

hoarseness pain or discomfort in the throat change in voice

5min

Explains about Nursing Management Of Epilepsy and Nursing Seizure. management of Epilepsy and Seizure. Put the patient in comfortable position. Keep all the sharp objects away from the patient bed Provide side riles for cot. Administer medication in time.

Explains

Listens & takes notes.

Black board

Explain in detail about the nursing management of

Epilepsy and Seizure.

2min

SUMMARY Epilepsy is a group of syndromes charecterised by recurring seizures. A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function. Seizure are sudden, abnormal electrical discharges from the brain that results changes in sensation behavior movements, perceptions, or consciousness. EVALUATION Short answer question 5 x 3 = 15. 1) Epilepsy and seizure.

3min

2) Management of patient with Epilepsy and seizure. 3) Treatment and nursing management of Epilepsy and seizure.
3min 2min

ASSIGNMENT Write an assignment on generalised seizure CONCLUSION At the end of the class the student have gain knowledge about Epilepsy and Seizure and its types, risk factors,clinical features, diagnosis, and its management.

BIBLIOGRAPHY 1. Students bibliography Brunner and suddarths, TEXT BOOK OF MEDICAL SURGICAL NURSING, 10TH edition, Lippincott Williams and Wilkins. Lippincott, MANNUAL OF NURSING PRACTICE, 8th edition, Lippincott Williams and Willkins. 2. Teachers bibliography Brunner and suddarths, TEXT BOOK OF MEDICAL SURGICAL NURSING, 10TH edition, Lippincott Williams and Wilkins.

Lippincott, MANNUAL OF NURSING PRACTICE, 8th edition, Lippincott Williams and Willkins. Long & Phipps -Medical Surgical Nursing Luckman &Sorenson -Medical Surgical Nursing