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Hyperexcitability of the brain leads to the occurrence of epilepsy seizures

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Epilepsy is a disorder of the brain that predisposes a person to seizures. Epilepsy is diagnosed when there are at least 2 unprovoked seizures. Seizures occur because of an abrupt imbalance between the inhibitory and excitatory impulses in a region of the cortical neurons during a sudden onset of hyperexcitability (Capriotti & Frizzell, 2016). The seizures that occur in epilepsy can occur because of an imbalance of neurotransmitters like gamma aminobutyric acid, an abnormality in electrical neuronal activity, or both (Ignatavicius & Workman, 2016). Frontal lobe epilepsy with both focal seizures and generalized seizures are evidenced by altered levels of consciousness and slight loss of consciousness, brief periods of staring into space, known as absence seizures, and rhythmic jerking movements of the extremities, known as clonic seizures (Capriotti & Frizzell, 2016).

Medical Treatment

Medical treatment for epilepsy includes antiepileptic drugs, diet, surgery, and vagus nerve stimulator. Antiepileptic drugs are used to help lower the incidence of seizures. The dose is gradually increased until the seizures are controlled. If the drug does not control the seizures, it will be replaced with a different antiepileptic drug. These drugs are chosen due to its adverse effects, the drug’s efficacy for the type of seizure, cost, other disease the patient might have, and how easy the drug is to use. With these medications, it is important to teach patient to continually take medication unless directed by doctor. If the patient stops taking the drug, the seizures will occur again. Another form of treatment is a change in diet. Ketogenic diets, which are low carbohydrate and high fat diets, have provided improvements in controlling seizures. This form of diet is given to patients that are not responding to their medications. Surgery can also be considered. Most surgeries are used to remove the part of the brain that is responsible for the discharges for the seizures. Extratemporal resections, hemispherectomy, and corpus callosotomy are all procedures used help control the seizures. Lastly, a vagus nerve stimulator can be inserted. It is a device that transmits electrical impulses to the left vagus nerve. This is used to treat intractable partial seizures, and it modifies the brain’s electrical activity (Major & Thiele, 2007).

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Family Centered Nursing Interventions

Important nursing interventions are to initiate seizure precautions, maintaining airway, documenting the seizure, administering antiepileptic medications as ordered, and providing emotional support for the family and for the patient. Because seizures can occur without warning, seizure precautions are taken to ensure patient safety. Side rails should be raised when the child is sleeping or resting and be padded to prevent injury. Seizure pads should also be used to prevent injury. A suction kit, bag, and mask should be at the bedside in case the airway is compromised. Cardiorespiratory monitor and pulse oximetry should be kept to monitor the patient (Clore, 2010). While a patient is experiencing a seizure, it is important to loosen tight clothing and to make sure to maintain their airway because a patient can aspirate on his or her secretions. To maintain their airway during a seizure, the patient should be turned on their side to drain the secretions and suction equipment should be by the bedside. When a seizure occurs, a nurse must document how long the seizure has lasted, if consciousness is lost, the specific location of the body is being affected, if an aura was experienced, and assess neurologic status before and after (Major & Thiele, 2007).

Patients should be educated about the importance of medication compliance; if medications are not taken, the patient will experience seizures again (Major & Thiele, 2007). It is important to explain that these medications suppress the tendency of seizures. (Paul & Eaton, 2012). Nurses must also be emotionally supportive. The patient can have a lot of anxiety about their condition and feel as if he or she is waiting for the next seizure to come. The nurse should help in improving coping methods by educating and providing support groups for both parents and patients (Major & Thiele, 2007).

Medications

Some medications that can be used are perapanel, lacosamide, and divalproex sodium. Perampanel is an anticonvulsant. Its indication is for partial-onset seizures with or without secondarily generalized seizures, and its therapeutic effect is to decreased the incidence and severity of partial-onset seizures and primary generalized tonic-clonic seizures. Lacosamide is an anticonvulsant. Its indication is for partial-onset seizure, and its therapeutic effect is to decrease the incidence and severity of partial-onset seizures and decrease seizure activity. Divalproex sodium is an anticonvulsant. Its indication is to treat manic episodes associated with bipolar disorders, decrease the incidence of complex partial seizures and simple and complex absence seizures, and for prophylaxis of migraine headaches (Adams, Holland, & Urban, 2017).

Labs and Diagnostics

A complete blood count, electrolytes, and a blood glucose test are the labs that are taken to try to find the causative agent of the seizures. The electroencephalogram is used as a diagnostic tool to detect electrical activity in the brain. It can confirm the diagnosis of epilepsy, classify what kind of epilepsy the patient has, localize the seizures, and help doctors determine if it is safe to discontinue treatment. Long term video EEG monitoring is indicated if the diagnosis is in question or when the seizures are hard to control even with medical treatment. This monitoring records seizures to characterize the electrical activity on the EEG during seizure episodes to pinpoint the location of seizures and establish acare planfor the patient. It is also used before surgery as a way to evaluate if surgical ablation can be considered. It is helpful in identifying the nature of paroxysmal episodes,pseudoseizures, frontal seizures, or paroxysmalmovement disorders. Computed tomography and magnetic resonance imaging are used to see anatomic images of the brain and identify any lesions that can be causing the seizures (Major & Thiele, 2007).

Health Promotion

Nurses should provide both parents and children with information and encourage them to join support groups like the Epilepsy Society and Epilepsy Action. These groups help guide families in financial help and in life style modifications. They educate on the importance of medication compliance. They also give families advice on how to modify their lives at home and outside; for example, they give advice on avoiding heights, wearing helmets for safety, taking showers instead of baths, avoid busy roads, appropriate leisure activities, information on contraceptives, the use of alcohol or recreational drugs, and how to live and maintain a healthy lifestyle (Paul & Eaton, 2012).

Nursing Process Plan of Care

Risk For Injury Related to Seizure Activity and Inability to Control Body Secondary to Type of Seizure

Interventions. Administer antiepileptic drugs to prevent seizures from occurring, and teach the patient and their parents about antiepilpetic drugs, so they understand the condition. Initiate and follow seizure precautions, which include padded side rails, patent IV to give medication during seizure, not restraining the patient during seizure, clearing the area of dangerous objects, having the bed in the lowest position, not putting anything into the patient’s mouth during the seizure (Smith, 2015), and protect the head of the patient during seizure to prevent physical harm from seizures. Monitor type and length of seizure to determine if medication should be given (Hinkle & Cheever, 2013).

Expected outcomes. The patient will not experience physical injury because of a seizure during the shift (Hinkle & Cheever, 2013).

Risk For Aspiration and Ineffective Airway Clearance due to Seizure Activity

Interventions. Turn patient on side during seizure to promote drainage of secretionsand prevent choking or aspirating(Perry et al., 2014). When the seizure is done, keep the patient on their side to avoid aspirating on post seizure vomit (Smith, 2015). Have suction equipment at the bedside to prevent aspiration. Monitor and assess respiratory status and oxygenation to determine if there is a need for oxygen (Hinkle & Cheever, 2013).

Expected outcomes. The patient will have an effective and patent airway. The patient will not aspirate on secretions if a seizure does occur. The patient will have no signs of respiratory distress and have adequate ventilation (Hinkle & Cheever, 2013).

Fear Related to Possibility of Having Seizures

Interventions. Teach patient that medication compliance suppresses seizure activity, which will reduce fear of having seizures. Assess with patient any factors that precipitate seizures like emotional factors, environmental factors, stress, or illness to avoid factors that will encourage the occurrence of seizures. This also gives the patient and parents a sense of control over the situation. Encourage a regular sleep pattern, diet, exercise plan, and healthy lifestyle. Teach patient to avoid photic stimulation, dark glasses, or covering eyes(Hinkle & Cheever, 2013). Provide reassurance after seizures and be empathetic and supportive to help the family cope and function (Smith, 2015).Encourage involvement within the family to promote normal growth and development to provide hope (Hinkle & Cheever, 2013).

Expected outcomes. The patient will be able to cope and discuss diagnosis and teach back interventions that will minimize the recurrence of seizures. The patient will indicate a decreased sense of fear. The patient will be able to cope with diagnosis and will have adequate support to alleviate the fear of having a seizure (Hinkle & Cheever, 2013).

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