STATUS EPILEPTICUS

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Status epilepticus (SE) refers to a life-threatening condition in which the brain is in a state of persistent seizure.

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STATUS EPILEPTICUS

  1. 1. Name: Dave Jay Sibi. Manriquez RN. January 15, 2009 Prof: Mrs. Norma Hinoguin Adult Health Nursing Phase II (5:30pm-8:30pm) STATUS EPILEPTICUS Status epilepticus (SE) refers to a life- threatening condition in which the brain is in a state of persistent seizure. Definitions vary, but traditionally it is defined as one continuous unremitting seizure lasting longer than 30 minutes , or recurrent seizures without regainin consciousness between seizures for greater than 30 minutes.A seizure is a sudden disruption of the brain's normal electrical activity, which can cause a loss of consciousness and make the body twitch and jerk. This condition is a medical emergency. CAUSES: not taking anticonvulsant medication . It can also be caused by an underlying condition, such as meningitis, sepsis, encephalitis, brain tumor, head trauma, extremely high fever, low glucose levels, or exposure to toxins. Status epilepticus can occur in anyone with epilepsy. It occurs more often in children who have an underlying neurologic disorder or disease. This condition is most common in known epileptics. Within known epileptics, it can be caused by: • Insufficient dosage of a medication already prescribed to the patient. Such causes of this include: • Forgetfulness on the part of the patient in taking scheduled doses, or failure to take doses at the scheduled times • Dislike of the medication or its side effects • Patient's rationing of the medication. This is usually due to patient's difficulty in affording medication, or temporary or permanent lack of access. • Sudden withdrawal from a seizure medication. Such causes include: • Sudden lack of access to medication due to unexpected circumstances • Consumption of alcoholic beverages while on an anticonvulsant, or alcohol withdrawal. For this among other reasons, most patients who have active seizure disorders or who are on anticonvulsants are advised to altogether avoid consuming alcohol. • Dieting or fasting while on an anticonvulsant. Those with epilepsy or who are on anticonvulsants are advised to consult with their physicians prior to dieting or fasting. • Developing a resistance to an anticonvulsant already being used • Injury to the patient. This may be the result of a sports injury, motor vehicle accident, fall, physical abuse, or other injury that affects the brain. Though such injuries may trigger a seizure in anyone, those with a known seizure disorder are more susceptible. SYMPTOMS The characteristic symptom of status epilepticus is seizures occurring so frequently that they appear to be one continuous seizure. These seizures include severe muscle contractions and difficulty breathing. Permanent damage can occur to the brain and heart if treatment is not immediate. Status epilepticus can be convulsive or nonconvulsive. A person's symptoms can range from simply appearing dazed to the more serious muscle contractions, spasms, and loss of consciousness. The specific symptoms depend on the underlying type of seizure. The person may also have high blood pressure, rapid heartbeat, irregular heartbeats known as arrhythmias, and high blood sugar levels. Two categories of status epilepticus Convulsive Epilepsia partialis continua is a variant involving hour, day, or even week-long jerking. It is a consequence of vascular disease, tumours, or encephalitis, and is drug-resistant. Nonconvulsive Complex partial status epilepticus, or CPSE, and absence status epilepticus are rare forms of the condition which are marked by nonconvulsive seizures. In the case of CPSE, the seizure is confined to a small area of the brain, normally the temporal lobe. But the
  2. 2. latter, absence status epilepticus, is marked by a generalised seizure affecting the whole brain, and an EEG is needed to differentiate between the two conditions. This results in episodes characterized by a long-lasting stupor, staring and unresponsiveness. NURSING DIAGNOSIS High Risk for Injury related to seizure acivity Individual Coping related to perceive social stigma, potential changes in employment. PLANNING AND GOALS The major goals for the patient may include prevetion of injury, control of seizures, achievement of a satisfactory psychosocial adjustment, acquisition of knowledge and understanding about the condition. How is it diagnosed? Status epilepticus is diagnosed according to its characteristic symptoms. The doctor will order tests to look for the cause of the seizures. These may include blood tests, ECG to check for an abnormal heart rhythm; electroencephalogram (EEG) to check electrical activity in the brain, a(MRI) or computed tomography (CT) scans to check for brain tumors or signs of damage to the brain tissue. Medication diazepam (Valium)-to stop motor movement Phenytoin (Dilantin) Phenobarbital (Barbita) Paraldehyde Thiopental sodium (Pentothal sodium) General anesthesia may used as a treatment of last resort to top seizure activity NURSING PRIORITIES 1. Prevent/control seizure activity. 2. Protect patient from injury. 3. Maintain airway/respiratory function. 4. Promote positive self-esteem. 5. Provide information about disease process, prognosis, and treatment needs. DISCHARGE GOALS 1. Seizures activity controlled. 2. Complications/injury prevented. 3. Capable/competent self-image displayed. 4. Disease process/prognosis, therapeutic regimen, and limitations understood. 5. Plan in place to meet needs after discharge. . NURSING INTERVENTIOS  preventing injury  reducing fears of seizure  improving coping mechanism  providing patient and family education  monitoring and managing potential complications  teaching patient self-care MORE INFORMATION What is epilepsy- Epilepsy is a general term that includes various types of seizures. Epilepsy is characterized by unprovoked, recurring seizures that disrupt the nervous system. What are seizures? - Seizures (or convulsions) are temporary alterations in brain functions due to abnormal electrical activity of a group of brain cells that present with apparent clinical symptoms and findings. What types of seizures are there? - The two main categories of seizures include partial seizures and generalized seizures. A partial seizure can evolve to a generalized seizure. What types of epilepsy are there? - There are several types of epilepsy. Epilepsy can be divided into two broad categories: idiopathic epilepsy and symptomatic epilepsy. What're the common types of epilepsy? - The most common types of epilepsy are absence epilepsy, temporal lobe epilepsy, frontal lobe epilepsy, occipital lobe epilepsy, and parietal lobe epilepsy. What causes epilepsy? - Epilepsy may be caused by a number of unrelated conditions, including damage resulting from high fever, stroke, toxicity, or electrolyte imbalances. What causes children epilepsy? - There are many possible causes of epilepsy in children. Seizures in
  3. 3. infants and children may be due to birth defects, difficulties during delivery, or poisoning. What factors will trigger epilepsy? - The triggers of epilepsy include inadequate sleep, food allergies, alcohol and smoking, flashing lights, developmental anomalies, and brain tumours. What're the symptoms of epilepsy? - There are many forms of epilepsy, each with its own characteristic symptoms. The basic symptom of epilepsy is a brief and abnormal phase of behavior. How is epilepsy diagnosed? - Making an accurate diagnosis is vital in planning the correct treatment to control seizures. Taking a medical history can help rule out non-epilepsy conditions. What're the treatments for epilepsy? - For most people with epilepsy, treatment can reduce or prevent seizures and allow many patients to remain free of seizures for the rest of their lives. What epilepsy medications are available? - Epilepsy is often treated with medication, neurocybernetic prostheses. Medications available for the treatment of seizures include phenytoin, carbamazepine, divalproex. What epilepsy surgeries are available? - Surgical techniques to remove injured brain tissue may be appropriate for many patients with epilepsy. The most common surgery for epilepsy is temporal lobectomy. What is vagus nerve stimulation? - Vagus nerve stimulation is a recently developed form of seizure control which uses an implanted electrical device. What epilepsy diet is suggested? - It is believe that a restricted caloric intake while on a balanced diet can lead to measurable seizure reduction among all age groups. How to prevent epilepsy? - Effective actions for the prevention of epilepsy include adequate pre-natal and post-natal care, safe delivery, control of fever in children, control of parasitic diseases. Epilepsy in children - Epilepsy is a common childhood disorder. The prospect of control by means of anti-epileptic drugs is good in most children with epilepsy. Pregnancy and epilepsy - Women with epilepsy who become pregnant have a higher risk for complications than women who don't have epilepsy. Difference between seizures and epilepsy - Seizures are a symptom of epilepsy. Epilepsy is the underlying tendency of the brain to produce a sudden burst of electrical energy. thank you...

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