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Summary Of Epilepsy

POLYTECHNIC OF HEALTH DENPASAR


NURSING DEPARTMENT
D-IV PROGRAMME
3RD SEMESTER
2015
Putu Yeni Yunitasari (P07120214004)

Ni Made Desi Sugiani (P07120214017)

Ni Kadek Dian Inlam Sari (P07120214018)

Ni Ketut Ayu Pratiwi Catur Wahyuni (P07120214019)

Ni Nyoman Tria Sunita (P07120214020)

Ayu Indah Agustini (P07120214027)

Ayu Putu Eka Tusniati (P07120214031)


The epilepsies are a symptom complex of several disorders of
brain function characterized by recurring seizures. There may be
associated loss of consciousness, excess movement, or loss of
muscle tone or movement and disturbances of behavior, mood,
sensation, and perception. The basic problem is an electrical
disturbance (dysrhythmia) in the nerve cells in one section of the
brain, causing them to reveal abnormal movement, recurring,
uncontrolled electrical discharges. The characteristic epileptic
seizure is a manifestation of this excessive neuronal discharge. In
most cases, the cause is unknown (idiopathic). Susceptibility to
some types may be inherited. They are also associated with brain
tumors, abscesses, and congenital malformations. Epilepsy
affects an estimated 3% of people during their lifetime, and most
forms of epilepsy occur in childhood. Epilepsy is not synonymous
with mental retardation or illness, it is not associated with
intellectual level.
Simple Partial Seizures

Only a finger or hand may shake; the mouth may jerk uncontrollably; the
patient may talk unintelligibly, may be dizzy, or may experience unusual or
unpleasant sights, sounds, odors, or tasteall without loss of consciousness.

Complex Partial Seizures

The patient remains motionless or moves automatically but inappropriately for


time and place; may experience excessive emotions of fear, anger, elation, or
irritability; and does not remember episode when it is over.

Generalized Seizures (Grand Mal Seizures)

Generalized seizures involve both hemispheres of the brain. There is intense


rigidity of the entire body, followed by alternations of muscle relaxation and
contraction (generalized tonicclonic contraction)

Postictal State

After the seizure, patients are often confused and hard to arouse and may sleep
for hours. Many complain of headache, sore muscles, fatigue, and depression.
Developmental history, physical and neurologic examinations are
done to determine the type, frequency, and severity of seizures.
Biochemical, hematologic, and serologic studies are included.

Magnetic resonance imaging (MRI) is performed to detect


structural lesions such as focal abnormalities, cerebrovascular
abnormalities, and cerebral degenerative changes.

Electroencephalograms (EEGs) aid in classifying the type of


seizure.

Single photon emission CT (SPECT) may be used to identify the


epileptogenic zone.
The management of epilepsy and status epilepticus are
planned according to immediate and long-range needs
and is tailored to meet the patients needs because
some cases arise from brain damage and others are due
to altered brain chemistry. The goals of treatment are
to stop the seizures as quickly as possible, to ensure
adequate cerebral oxygenation, and to maintain a
seizure-free state. An airway and adequate oxygenation
(intubate if necessary) are established, as is an IV line
for administering medications and obtaining blood
samples for analysis.
Medications are used to achieve seizure control.
The usual treatment is single-drug therapy.

IV diazepam, lorazepam, or fosphenytoin is


administered slowly in an attempt to halt the
seizures. General anesthesia with a short-acting
barbiturate may be used if initial treatment is
unsuccessful.

To maintain a seizure-free state, other


medications (phenytoin, phenobarbital) are
prescribed after the initial seizure is treated.
Surgery is indicated when epilepsy
results from intracranial tumors,
abscesses, cysts, or vascular
anomalies.

Surgical removal of the


epileptogenic focus is done for
seizures that originate in a well-
circumscribed area of the brain that
can be excised without producing
significant neurologic defects
Assessment
Obtain a complete seizure history. Ask about factors or
events that precipitate the seizures; document alcohol
intake.
Determine whether the patient has an aura before an
epileptic seizure, which may indicate the origin of the
seizure (eg, seeing a flashing light may indicate that the
seizure originated in the occipital lobe).
Observe and assess neurologic condition during and after a
seizure. Assess vital and neurologic signs continuously.
Patient may die from cardiac involvement or respiratory
depression.
Assess effects of epilepsy on lifestyle.
Diagnosis
Nursing Diagnoses
Risk for injury related to seizure activity
Fear related to possibility of having seizures
Ineffective coping related to stresses imposed by epilepsy
Deficient of knowledge about epilepsy and its control

Planning and Goals


Major goals include prevention of injury,
control of seizures, achievement of a satisfactory
psychosocial adjustment, acquisition of knowledge
and understanding about the condition, and absence
of complications.
Nursing Interventions

General Care and Injury Prevention

Perform periodic physical examinations and laboratory tests for patients


taking medications known to have toxic hematopoietic, genitourinary, or
hepatic effects.

Provide ongoing assessment and monitoring of respiratory and cardiac


function.

Monitor the seizure type and general condition of patient.

Turn patient to side-lying position to assist in draining pharyngeal


secretions.

Have suction equipment available if patient aspirates.

Monitor IV line closely for dislodgment during seizures.

Protect patient from injury during seizures with padded side rails, and
keep under constant observation.
Status Epilepticus

Status epilepticus (acute prolonged seizure activity) is a series of


generalized seizures that occur without full recovery of
consciousness between attacks. The condition is a medical
emergency that is characterized by continuous clinical or
electrical seizures lasting at least 30 minutes. Repeated episodes
of cerebral anoxia and edema may lead to irreversible and fatal
brain damage. Common factors that precipitate status
epilepticus include withdrawal of antiseizure medication, fever,
and concurrent infection.

Do not restrain patients movements during seizure activity.

Do not insert anything in patients mouth.


Reducing Fear of Seizures

Reduce fear that a seizure may occur unexpectedly by encouraging


compliance with prescribed treatment.

Emphasize that prescribed antiepileptic medication must be taken on a


continuing basis and is not habit forming.

Assess lifestyle and environment to determine factors that precipitate


seizures, such as emotional disturbances, environmental stressors, onset
of menstruation, or fever. Encourage patient to avoid such stimuli.

Encourage patient to follow a regular and moderate routine in lifestyle,


diet (avoiding excessive stimulants), exercise, and rest (regular sleep
patterns).

Advise patient to avoid photic stimulation (eg, bright)

Encourage patient to attend classes on stress management.


Improving Coping Mechanisms

Understand that epilepsy imposes feelings of


stigmatization, alienation, depression, and uncertainty.

Provide counseling to patient and family to help them


understand the condition and limitations imposed.

Encourage patient to participate in social and recreational


activities.

Teach patient and family about symptoms and their


management.
Promoting Home- and Community-Based Care
TEACHING PATIENTS SELF-CARE
Prevent or control gingival hyperplasia, a side effect of phenytoin
(Dilantin) therapy, by teaching patient to perform thorough oral
hygiene and gum massage and seek regular dental care.
Instruct patient to notify physician if unable to take medications due
to illness.
Instruct patient and family about medication side effects and toxicity.
Provide specific guidelines to assess and report signs and symptoms of
medication overdose.
Teach patient to keep a drug and seizure chart, noting when
medications are taken and any seizure activity.
Instruct patient to take showers rather than tub baths to avoid
drowning and to never swim alone.
Encourage realistic attitude toward the disease; provide facts
concerning epilepsy.
Instruct patient to carry an emergency medical identification card or
wear an identification bracelet.
Advise patient to seek preconception and genetic counseling if
desired (inherited transmission of epilepsy has not been proved).
CONTINUING CARE
Financial considerations: Epilepsy Foundation of America offers a
mail-order program for medications at minimum cost and access to
life insurance as well as information on vocational rehabilitation and
coping with epilepsy.
Vocational rehabilitation: The state Vocational Rehabilitation Agency,
Epilepsy Foundation of America, and federal and state agencies may
be of assistance in cases of job discrimination.

Evaluation
Expected Patient Outcomes
Sustains no injuries from seizure activity
Indicates a decrease in fear
Displays effective individual coping
Exhibits knowledge and understanding of epilepsy
Experiences no complications of seizures
(injury) or complications of status epilepticus