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NUR114 Exam 3 Study Guide
- Course
- NUR 114 (NUR114)
- Institution
- Fayetteville Technical Community College
All topics and related information that is covered on exam 3 in NUR 114 fall semester.
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NUR 114 Exam 3 Study GuideSEIZURES
Seizure:
abnormal, sudden, excessive, uncontrolled electrical discharge of the neurons in the brain
results in change in LOC, motor/sensory ability, and/or behavior
Epilepsy:
two or more seizures experienced by a person
chronic disorder in which repeated, unprovoked seizures occur
may be caused by an imbalance of neurotransmitters, especially gamma aminobutyric acid
(GABA)
Seizure vs. Epilepsy:
Seizure:
o Generalized
o Partial (these may unclassified or idiopathic)
o Secondary seizures (have a known cause/trigger and aren’t considered epilepsy)
Epilepsy:
o Primary or idiopathic (not associated with any identifiable specific cause)
Risk Factors:
Genetic predisposition
Fever
Cerebral edema
Abrupt cessation of antiepileptic drugs (AEDs)
Infection
Metabolic disorders (hypoglycemia)
Exposure to toxins
Stroke
Heart disease (increased risk in elderly with heart disease)
Brain lesions/tumors
Hypoxia
Acute alcohol withdrawal
Head trauma
Triggers:
Increased physical activity
Excessive stress
Hyperventilation
Overwhelming fatigue
Acute alcohol ingestion
Excessive caffeine intake
Exposure to flashing lights
Cocaine, aerosols, inhaled glue products
Classification of Seizures:
Generalized: involve both cerebral hemispheres; 6 different types
Partial: involve part of one cerebral hemisphere; 2 main classes
Unclassified/Idiopathic: account for half of all seizure activity; occur for no known reason
Types of Generalized Seizures:
Tonic-clonic:
o LOC, stiffening of muscles (tonic episode)
o 1-2 min of rhythmic jerking of extremities (clonic episode)
, o Breathing can stop (tonic) and become irregular with cyanosis (clonic)
o Biting of cheek/tongue (clonic)
o Incontinence can occur after
o Post-ictal: confusion/sleepiness
Tonic:
o Generally last < 30 sec
o Muscular rigidity, LOC, arrythmia, apnea, vomiting, salivation, incontinence
Clonic:
o Lasts several minutes
o Muscles contract/relax
Absence:
o Often appear staring into space
o May/may not stop talking when seizure hits
o If continuing to talk, speech will suddenly switch to slurring/slowing down
o No jerking/twitching
Myoclonic:
o Lasts for seconds
o Brief jerking/stiffening of extremities (symmetrical or asymmetrical)
Atonic (Akinetic):
o Few seconds in which muscle tone is lost
o Followed by period of confusion
o Loss of muscle tone results in falling
Partial/Focalized Seizures:
Complex Partial:
o Associated with automatisms (behaviors pt unaware of): lip smacking, picking at
clothes, etc
o LOC/blackout for several minutes
o Amnesia immediately prior to/afterwards
Simple Partial:
o Consciousness maintained
o Unusual sensations, déjà vu, changes in HR/abnormal flushing, pain, offensive smell,
unilateral abnormal extremity movements
Aura: Early warning sign before seizure that manifests as a sensory disturbance
Auditory: voices, buzzing, rings, drumming sounds
Visual: flickering lights, blurry vision, dark spots, partial vision loss, seeing things not there
Gustatory: bitter/salty/sweet/metallic tastes
Nausea
Diagnostic/Laboratory Tests:
, Laboratory: used to rule out metabolic causes; HIV, ETOH, drugs, toxins
Imaging:
o Electroencephalogram (EEG)
o CT scan
o MRI
o PET scan
o Skull x-ray
CSF analysis
Seizure Precautions:
O2 equipment
Suction equipment
IV access
Padded side rails
Side rails up
NO tongue blades
Seizure Management:
Depends on seizure type
Observation/documentation
Patient safety
Side-lying position to keep airway clear
Loosen restrictive clothing
NO restraints of tongue blades
Acute Seizure Pharmacological Management:
**Emphasize that AEDs must not be stopped without provider direction**
Lorazepam (Ativan)
o Benzodiazepine
o Assess for visual changes/eye pain
o IV Push: observe for hypotension, muscular weakness, tachycardia, respiratory
depression
Diazepam (Valium)
o Benzodiazepine
o Assess for visual changes/eye pain
o IV Push: observe for hypotension, muscular weakness, tachycardia, respiratory
depression
Diastat (Diazepam Rectal Gel)
o Benzodiazepine
Phenytoin (Dilantin)
o Hydantoin
o Monitor serum Ca+ level (can demineralize bone)
o Monitor for gingival hyperplasia, nystagmus, drowsiness, somnolence, dizziness
o DO NOT administer with Warfarin (Coumadin)
o May decrease effectiveness of oral contraceptives
o Therapeutic Level: 10-20 mcg/mL
o Toxic Level: > 30 mcg/mL
Gingival hyperplasia
Use alternate birth control
Mouth care
Soft tooth brush, don’t stop abruptly
Fosphenytoin (Cerebyx)
o Hydantoin
o Monitor for gingival hyperplasia, nystagmus, drowsiness, somnolence, dizziness
Pharmacological Therapy:
Carbamazepine (Tegretol)
o Side effects: H/A, vision loss
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