COMMON NEUROLOGICAL HEALTH PROBLEMS NCM 104

Neural Tube Defects

Risk Factors:Maternal malnutritionDrug exposure Low socioeconomic groupOlder maternal ageGenetic predisposition

Types:AnencephalySpina Bifida occulta MeningoceleMyelomeningocele Encephalocele

AnencephalyUpper end of the neural tube-Fails to close in early intrauterine lifeAbsence of the cerebral hemispheres

Clinical ManifestationsElevated level of alpha-fetoprotein in maternal serum/or amniocentesis May survive for a number of days after birth

Spina Bifida Occulta Description

Occurs when the posterior laminae of the vertibrae fail to fuseOccurs most commonly in the 5th lumbar or 1st sacral level

Clinical ManifestationsMost patient have no symptoms

Dimple in the skin or growth of hair over the malformed vertebraThere is no externally visible sacSyringomyeliaTethered cord With growth the child may develop:Foot weaknessBowel and bladder sphincter disturbancesMeningocele

Description :The meninges covering the spinal cord herniate through unformed vertebraecyst filled with CSF and covered with skin

Clinical ManifestationsExternal cystic defect in the midline of spinal cordSeldom evidence of weakness of the legs or lack of sphincter control

MyelomeningoceleThe spinal cord and and meninges protrude through the vertebraeThe spinal cord ends at the point of the defect absent of motor and sensory function

Clinical ManifestationsFlaccidity and lack of sensation of the lower extremitiesLoss of bowel and bladder controlLax legs

Other symptomsTALIPES disorders or developmental HIP DYSPLASIAArnold –Chiari malformation-Malformation of the brainstem and cerebellumBlock in the flow of CSFHYDROCEPHALUS

EncephaloceleA cranial meningocele or myelomeningocleOccurs most often in the occipital area of the skull

Clinical ManifestationsBuild up of too much fluid in the brainComplete loss of strength in the arms and legsAn unusually small headUncoordinated movement of the voluntary musclesDevelopmental delayVisual problemsMental and growth retardationSeizures

Diagnostic Evaluation SonographyFetoscopyCT scan MRIAmniocentesis – inc. AFP

ManagementSurgical correction-CAN BE DONE SOON AFTER BIRTHLaminectomy Closure of the open lesionRemoval of the sac

Purpose To prevent further deterioration of neural functionTo minimize the danger of rupture and infectionTo improve cosmetic effectTo facilitate handling of the infantVentriculoperitoneal shunt

Nursing Management:Evaluate sac and measure lesionPerform neurological assessmentMonitor increase in ICPProtect sac, use aseptic techniqueProtect skin integrity Place in prone position, head turned to one side for feedingAssess for early signs of infectionAdminister medication as ordered

Cerebral Palsy

Description:A group of nonprogressive disorders of upper motor neuron impairment results in motor dysfunction

Risk Factors: UNKNOWN Associated with

Complications of birth- Prematurity, postmaturity Birth asphyxiaEarly infection or traumaMaternal anemiaGenetic Factors

Clinical ManifestationsTones remains relatively constant regardless of activity and level of arousalSignificant HyperreflexiaStiff and rigid arms or legsExtreme irritability and cryingFeeding difficultiesDelayed gross developmentOpisthotonus posture

ManagementAntispasticity medications Dantrolene (Dantrium)Diazepam ( Valium) Botulinum Toxin A: BotoxTherapies: speech, physical, occupationalBotulinum Toxin A: BotoxMassageProsthetics/OrthoticsSurgery

Hyperbaric OxygenNursing Management

Assess child’s developmental level and intelligenceEncourage early intervention and participation in school programsPrepare for using mobilizing devices to prevent deformitiesCommunicate with the child on a functional level, not on chronological age levelProvide safe environmentProvide safe, appropriate toys for age and developmental levelPosition upright after meals

Reye’s SyndromeDescription:

Acute encephalitis with accompanying fatty infiltration of the liver, heart, lungs, pancreas, and skeletal muscles

Risk FactorsGenerally unknownOccurs after varicella, influenza if the child is treated with aspirin

Clinical ManifestationsLethargy, nausea & vomiting, lethargy, neurologic impairment Anorexia AgitationConfusionCombativenessConfusion , stupor, deep coma, Seizures Respiratory arrestHypothrombinemiaHypoglycemiaElevated blood ammonia levelsElevated liver enzyme

TreatmentNo specific treatment existsNo cure: Recovery is dependant on severity of brain swellingFaster progression worse prognosis

Nursing ManagementFrequent neurologic assessmentSupporting respiratory functionControlling hypoglycemiaReducing brain edema

MULTIPLE SCLEROSIS ( MS)Description

A chronic demyelinating disease that affects the the myelin sheath of neurons in the central nervous system Characterized by periods of REMISSION and EXACERBATIONUsually occurs between 20 to 40 years of ageAffect women twice as often as menRace -Whites Most prevalent in colder climates of North America and Europe

CAUSES

UnknownGenetic susceptibility Autoimmune ( post viral infection) Epstein –Barr virus

PRECIPITATING FACTORSInfectionPhysical injuryEmotional stressPregnancyFatigue

Clinical ManifestationsCHARCOT’S TRIADScanning speech( dysarthia)Intentional tremorsNystagmus

Visual DisturbancesBlurring of visionDiplopiaPatchy blindnessTotal blindness

Sensory Nerve DisturbancesPeresthesiaProprioception lossPain

Cognitive DisturbancesMemory lossDecreased concentrationDementia

Poor abstract reasoningCerebellum/ Basal Ganglia Involvement

Ataxia Tremors Weakness of muscle in throat and face

OTHERS:Bowel and Bladder dysfunctionImpotenceMuscle hypertonicity

Medical Management:Immunomodulating Drugs Interferon beta -1b (Betaseron )Interferon beta-1a (Rebif)Immunosuppresant Drugs AzathioprineCyclophosphamide Corticosteroid Drugs

Methylprednisolone- standard therapy for acute exacerbation Muscle RelaxantsBaclofen ( medication of choice for spasticity )Antiepileptic DrugsAnti depressantsStimulant DrugsCholinergicAnti cholinergic

Nursing ManagementPromoting physical mobilityWalkingUse of assistive devicesOthers Warm packsAvoid hot bathsAvoid strenuous exercises

MYASTHENIA GRAVISDescription :

Chronic autoimmune disorder affecting the neuromascular transmission of impulses in the voluntary muscles of the body

Causes UnknownAutoimmuneWomen are 3X more susceptible

Clinical ManifestationsExtreme muscle weakness and fatigue Diplopia & Ptosis DysarthiaGeneralized weaknessRespiratory paralysis

Diagnostic TestsSerum test for acetylcholine receptor antibodies

Edrophonium (Tensilon) testIV injection relieves symptom temporarilyAfter injection a marked but temporary improvement in muscle strength suggest MGCT scanEMGDecremental response to repetitive nerve stimulation

TreatmentAnti cholinesterase Pyridostigmine ( Mestinon)Neostigmine( prostigmin) Immunosuppressive therapyPrednisoneImuran (azathioprine)PlasmapheresisThymectomy

TREATMENTPlasmapheresisRemoves the antibodies which cause weaknessBenefits in 70% of patients within two weeks Few serious side effectsMore difficult to arrange short noticeThymectomySurgical removal of the thymusIt can produce antigen-specific immunosopressionThe patient benefit from the procedure after 3 years and above because of the long life circulating T cells

Medications to be AVOIDEDMuscle relaxantBarbiturates Morphine sulfateTranquilizers

Nursing InterventionsAssess gag reflex before feeding Place client in fowlers’ positionOffer thick fluidsFlex the neck during feedingAdminister medication 20-30 minutes before mealsProtect from falls due to weaknessStart meal with cold beveragesAvoid exposure to infectionProvide adequate rest and activity

Trigeminal NeuralgiaAKA: Tic DouloureuxDESCRIPTION:

An intensely painful neurologic condition that affects one or more branches of the fifth cranial( trigeminal ) nerve.400 times more common in patients with MSCommon to 50 to 70 years old

CausesUnknownDegenerative Chronic compression or irritation of trigeminal nerveDegenerative changes Viral causes suspected Compression from artery adjacent to the nerve strips myelin from nerve when it pulsates

Clinical ManifestationsIntense recurring episodes of painEpisodes of pain begin and end suddenlyUnilateral pain Numbness particularly around corner of the mouth

Diagnostic TestHistory of symptoms and direct observation of an attackCT scanMRI

Medical ManagementPharmacologic Therapy

Carbamezepine ( Tegretol )Imipramine ( Tofranil)Phenytoin ( Dilantin)Gabapentin ( Neurontin)Alcohol or phenol block injection

Surgical TreatmentRadiofrequency Thermal CoagulationMicrovascular Decompression of the trigeminal Nerve

- Removing the vessel from the posterior trigeminal nerveRhizotomy

Nursing ManagementRecognize factors that may aggravate facial painProviding cotton pads and temperature water for washing the faceRinse with mouthwash after eatingChew on the unaffected sideSoft foodsPostoperative careSensory deficitsInstruct not to rub the eyeAssess the eye for irritation or rednessArtificial tears

Bell’s PalsyDescription :

Acute peripheral facial paralysis of the infratemporal portion of the seventh cranial( Facial ) nerve unilaterally. May equally happened to both sexesOccurs most commonly between ages 20 and 40 years

CausesUnknown AutoimmuneViral Bacterial infection

Clinical ManifestationsInability to close eye completely on the affected sidePtosisPain around the jaw or earUnilateral facial weaknessRinging in the earEating difficulty Flat nasolabial foldPhotophobiaDiminished taste from anterior two thirds of the tongueDecreased lacrimation

Diagnostic TestsHistory and Physical ExamEMG

ManagementMedications

PrednisoneAnalgesicsAntiviral drugs

Comfort measuresHeat applicationGentle massageElectrical nerve stimulationNutrition: Soft diet Instruct to chew on the unaffected side Avoid hot fluids /foodAdminister medications as orderedArtificial tears is recommended

Eye patch at night Facial exercise

CEREBROVASCULAR DISEASE1.Cerebrovascular Insufficiency Description

An interruption or inadequate blood flow to a focal area of the brain resulting in transient or permanent neurologic dysfunction.

Transient ischemic attack ( TIA)CAUSES:

Atherosclerotic plaque or thrombosis, inc. Pco2, dec. po2, dec. blood viscosityTransient Ischemic AttackDescription :Neurologic deficit typically lasting less than 1 hour sudden loss of motor , sensory or visual function

TIA’s should not be ignored!!!!!More that 1/3 of people will go on to have an actual stroke5% of strokes will occur within 1 month of the TIA or first stroke12% will occur within 1 year20% will occur within 2 years25% will occur within 3 years

2.Cerebrovascular Accident Description:

The rapid loss of brain function due to disturbance in the blood supply to the brain. Onset and persistence neurologic dysfunction lasting longer than 24 hoursIndicates infarction rather than ischemia

Risk FactorsHypertensionHeart disease

Elevated cholesterolDM Cigarette smoking TIAObesity Carotid stenosisPolycythemia

DIAGNOSTIC EVALUATIONCT scan or CAT scanECGCarotid ultrasoundCerebral angiographyPETMRI

ISCHEMIC STROKE Clinical Manifestations Thrombosis -Tends to develop during sleep or within 1 hour of arisingEmbolism – No discernible time pattern, unrelated to activity , occurs rapidly

Numbness or weakness of the face, arm, or leg, especially on one side of the bodyConfusion or change in mental statusTrouble speaking or understanding speechVisual disturbancesDifficulty walking, dizziness, or loss of balance or coordinationSudden, severe headache with no known cause

Hemorrhagic StrokeClinical Manifestations

Severe headache and nuchal rigidityRapid onset of complete hemiplegia occurs over minute to 1 hourUsually results in extensive , permanent loss of function with SLOWER, LESS COMPLETE recovery Rapid progression into COMA

Medical ManagementThrombolytic Therapy

Recombinant tissue plasminogen activator (rt-PA) 0.9 mg/kg TIV over 1 hourTIME IS BRAIN Time is very important in order to receive this medicationWindow of opportunity to start treating stroke patients is three hours, but to be evaluated and receive treatment, patients need to get to the hospital within 60 minutes.

Platelet-inhibiting medicationsAnalgesicsAntihypertensive medicationsAntihyperlipidemic drugs

Surgical ManagementSurgical Evacuation (Craniotomy) if Cerebellar hemorrhage diameter exceeds 3 cm

Glasgow Coma Scale score is below 14Aneurysm ClippingCraniectomyCarotid EndarterectomyCarotid stenting

NURSING MANAGEMENTPrevent shoulder adductionEnsure patent airwayGive 100% O2 Maintain a quiet, restful environmentPosition Lateral ( initially); Low fowlers with neck aligned( stable)Minitor VS, GCS, Pupil sizeProvide safety measures ( Hemianopsia) Manage DysphagiaManage Motor deficitsManage verbal deficitsManage cognitive deficits

Amyotrophic Lateral SclerosisOther term: Lou Gehrig’s DiseaseDescription:

A progressive , degenerative condition that affects motors neurons responsible for control the control of voluntary muscles

Causes unknown; AutoimmuneFree radical damage5-10% genetically transmittedOver –excitation of the neurotransmitter GLUTAMATE

Clinical ManifestationsFatigueMuscle weaknessCrampsFasciculationDysphagiaDOBInappropriate emotional outburst of laughing and cryingConstipationUrinary urgency problem

Diagnostic TestsElectromyographyMuscle biopsyMRIEEGCSF

Medical Management Glutamate Antagonist - Riluzole

Other Drugs:Baclofen (Lioresal), Dantrolene sodium (Dantrium), or

Diazepam (Valium) Enteral feeding. Mechanical ventilation (using negative-pressure ventilators)

Nursing ManagementMaximize Functional abilitiesEnsure adequate nutritionPrevent respiratory complicationsHelp client and family deal with current problem

Alzheimer’s DiseaseDescription :

PROGRESSIVE , IRREVERSIBLE , DEGENERATIVE, neurologic diseaseBegins with gradual losses of cognitive function and disturbances in behavior and affect

CausesUnknown; Autoimmune Viral/ Bacterial InfectionTrisomy 21 ( 40 y/o)Decrease in the level of acetylcholine transferase activity in the cortex and hippocampus

Assessment findingsHistory of progressive degeneration of mental, emotional & physical abilitiesHistory of progressive memory loss & regressive behaviorPhysical & emotional status in relation to needs associated with nutrition, fluid & electrolyte status, & safetyHistory of premorbid personality from family membersHistory of medications used by client

Clinical ManifestationsWARNING SIGNS

Memory loss affecting ability to function in jobDifficulty with familiar tasksProblems with language and abstract thinkingDisorietation, changes in mood and personality

Nursing ManagementHealth teachingAddress physical, emotional and social aspectMedication regimenSafety measuresSigns and symptoms of disease progression

CNS INFECTION /INFLAMMATORY DISTURBANCESMeningitisDescription

An inflammation of the lining around the brain and spinal cordCauses :

Bacterial (Neisseria meningitidis )ViralFungal (cryptococcus)

Clinical ManifestationsHeadache and FeverPositive kernig’s signsPositive Brudzinki’s sign PhotophobiaNuchal rigidityOpisthotonus

Diagnostic Test Bacterial culture and gram staining of CSF and blood through lumbar puncture

Medical ManagementVancomycinCephalosporinsDexamethasoneFluid volume expanders

Nursing ManagementAdminister large doses of antibiotics IV as orderedRespiratory isolation for 24 hours after initiation of antibiotic therapyAnalgesic as orderedMaintain F & E balanceProvide emotional support for patientsDecrease stimuli from the environmentPosition on the side with head gently supported in extensionMonitor daily body weight Diet : high calorie, high protein, small frequent feeding

EncephalitisClinical Manifestations

Headache & feverNuchal rigidityConfusionDecreased level of consciousnessSeizuresSensitivity to light

Ataxia Abnormal sleep patternsTremorsHemiparesis

Diagnostic TestsCT scanMRILumbar PunctureEEG

Medical ManagementAnticonvulsantsAntipyreticsAnalgesicsSedativesAntiviral ( Acyclovir)

Nursing Management Monitor VSPerform neurological assessmentComfort measure to reduce headacheInjury prevention

Brain abscessDescription

It is a complication encountered increasingly in patients whose immune systems havebeen suppressed either through therapy or disease.Causes

Intracranial trauma or surgerySinuses, ears, and teeth Otitis mediaDental sepsisSpread of infection from other organs

Clinical ManifestationsHeadache, usually worse in the morningVomiting Weakness of an extremity Decreasing visionSeizuresChange in mental statusFever may or may not be present

Diagnostic TestComputed tomography (CT) scan Magnetic resonance imaging (MRI)

Medical ManagementPenicillin G and ChloramphenicolCorticosteroidsPhenytoinPhenobarbital CT-guided stereotactic needle aspiration under local anesthesia

Nursing ManagementMonitor V/SPerform neurological assessment frequentlyAdminister medications as ordered Assess client response to treatmentProviding supportive careMonitor blood glucose and serum potassium level

Guillain- Barre syndromeDescription

Also called acute demyelinating polyneuropathyAn autoimmune attack of the peripheral nerve myelinAcute ,rapid segmental demyelination of peripheral nerves and some cranial nerves More frequent in males

Causes Unknown Autoimmune ( post viral infection)

Diagnostic TestsEMGCSFECG

Clinical ManifestationsDiminished reflexes and muscle weakness that goes upward

Clumsiness Paralysis of the diaphragmDysphagiaRespiratory depressionParesthesia Paralysis of the ocular musclesAtaxia

ComplicationsRespiratory failure Cardiac dysrhythmia Transient hypertensionOrthosthatic hypotensionPulmonary embolism

Medical ManagementIV immunoglobulinPlasmapheresisCortecosteroids

Nursing ManagementMostly supportiveMaintain adequate ventilationIncentive spirometryCPT Perform ROMAssess gag reflex Monitor VSAdminister corticosteroids

Trauma ( Cranio –cerebral-and spinal)Head InjuryDescription :

Also known as traumatic brain injury( TBI) The disruption of normal brain function due to traumatic related injury resulting in neurologic functions

Causes :Blunt or penetrating injury Motor- vehicle accidents are the leading cause of head injuriesFalls and sports- related injuries

Types of Brain injuriesConcussion

a temporary loss of neurologic function with no apparent structural damage.Contusion

More severe injury in which the brainis bruised, with possible surface hemorrhage.Brain stem contusionCerebral contusion

Diffuse axonal Injury Widespread damage to axons in theCerebral hemispheres, corpus callosum, and brain stem.

Intracranial HemorrhageEpidural hematoma or hemorrhage Subdural hematoma Intracerebral hemorrhage and hematoma

Clinical ManifestationsAltered level of consciousness: Confusion to coma Pupillary abnormalities Altered or absent gag reflexAbsent corneal reflexSudden onset of neurologic deficitsVision and hearing impairmentSensory dysfunctionSpasticityHeadache,VertigoAgitation , restlessnessSeizures

Diagnostic EvaluationCT scanSkull and cervical spine filmsGlasgow Coma –Scale EEG

Medical ManagementManagement of inc. ICPEstablish an IV line of PNSS or PLR- fluid volume should be restricted.

Surgery for :Evacuation of intracranial hematomasDebridement of penetrating woundsElevation of skull fractureRepair of CSF leaks

Pharmacologic interventionsDiazepam (Valium) Steroids Mannitol (Osmitrol)Barbiturate Antibiotics

Nursing ManagementEmergency Care

Ensure a clear airwayKeep spine straight Flexion or hyperextension should be avoided in case there is cervical fracture Keep patient covered, quiet, and undisturbed

General CareEstablish airwayPrevent aspiration pneumoniaCheck for cardiovascular complicationsObserve the skull and scalp injuriesObserve for S & Sx of inc. ICPControl restlessness and painMaintain F & E /electrolyte acid- base balance

Prevent infectionObserve for CSF leakage

- Otorrhea- Rhinorrhea- Battle’s sign

Maintain adequate NutritionRecord I and O

Spinal Cord InjuryDescription

A traumatic injury to the spinal cord Can range in severity from mild flexion- extension “ Whiplash” injuries to complete transection of the cord with permanent tetraplegia

Etiology and Risk FactorsAutomobile or motorcycle accidentsGunshot or knife woundsFalls and sports mishaps Violence

Most Common site of InjuryC1-2C4-6T11-L2

CLINICAL MANIFESTATIONS Complete transection

All loss of function below the level of the lesionIncomplete cord damagePartial loss of movement and sensation

Injuries to T1 and aboveParaplegia

Injuries to T2 and belowTetraplegiaNeurologic Level of injuryNormal sensation and movement

Below the level of injury. Lost of:Voluntary movementSensation of pain, temperature, pressure, prioceptionBowel and bladder functionSpinal and autonomic reflexesIntense and painful muscular spasmsAutonomic Dysreflexia

EFFECTS OF SPINAL CORD INJURYCentral Cord SyndromeCharacteristics:

Motor deficits (in the upper extremities compared to the lower extremitiesSensory loss varies but is more pronounced in the upper extremitiesBowel/bladder dysfunction is variable, or function may be completely preserved.

Cause: Injury or edema of the central cord, usually of the cervical area

Anterior Cord SyndromeCharacteristics:

Loss of pain, temperature, and motor function below the level of the lesionLight touch, position, and vibration sensation remain intact.

Cause: acute disk herniation hyperflexion injuries associated with fracture-dislocation of vertebra.injury to the anterior spinal artery

Brown-Sequard Syndrome (Lateral Cord Syndrome)Characteristics:

Ipsilateral paralysis or paresis loss of touch, pressure, and vibration Contralateral loss of pain and temperature.

Cause: Transverse hemisection of the cord (half of the cord is transected from north to south),usually as a result of a knife or missile injuryFracture dislocation of a unilateral articular processPossibly an acute ruptured disk.

ManagementImmediately after trauma ( Less than 1 hour )

Immobilization with rigid cervical collar, sandbags, and rigid spine boardMethylprednisolone IV given within 8 hours of injury

Acute Phase ( 1 to 24 hours )Maintenance of pulmonary and cardiovascular stabilitySpinal cord immobilizationManagement of neurogenic bladderPressure ulcer preventation

Subacute Phase ( within 1 week)Traction and surgical interevntionGM -1 ganglioside sodium salt IVH2 receptor blockersEarly mobilization and passive exerciseHyperalimentationSmall doses of heparinPossible vena cava filterNeurogenic bowel program

Chronic Phase ( Beyond 1 week)AnticoagulantsUncomplicated motor injury - 8 weeksComplete motor injury, complication – 12 weeksManagement of complicationsRehabilitation

BRAIN TUMORDescription

A localized intracranial lesion that occupies space within the skull.Etiology

UnknownFamilial tendenciesImmunosuppression Environmental factors

CLINICAL MANIFESTATIONS HeadacheNausea and vomitingPapilledemaHemiparesisSeizures

Mental status changesSensory and motor abnormalitiesVisual alterations,Alterations in cognitionLanguage disturbances ( aphasia )

Diagnostic TestsMRICT ScanEEGRadionuclide scans

AngiogramLumbar punctureStereotactic biopsyPet scan

Medical ManagementChemotherapy Radiation therapyBrachytherapyIntravenous (IV) autologous bone marrow transplantation

Surgery CraniotomyLaser resection or ultrasonic aspiration

NURSING MANAGEMENTCOMPENSATING FOR SELF-CARE DEFICITSIMPROVING NUTRITIONRELIEVING ANXIETYENHANCING FAMILY PROCESSES

Seizure disorderSeizures

Sudden abnormal and excessive electrical discharges from the brain that can change motor or autonomic function, consciousness or sensation

EpilepsyChronic neurological disorder characterized by recurrent seizure activity

Status Epilipticus One of a series of grand mal seizures lasting more than 30 minutes without waking intervals

ETIOLOGIC FACTORS IdiopathicTraumatic brain injuryInfectionVascular diseases

DrugsChemical poisonDrug and alcohol withdrawalAllergies

Classification1. Partial Seizures

Seizures beginning locallyRepetitive purposeless beheviorsPatient appears to be in a dream- like state while picking at his/ her clothing, chewing or smacking his or her lips

2.Generalized seizuresEntire cerebral cortex is involvedTypes of partial seizuresSimple Partial

Does not loss consciousnessSymptoms confined to one hemisphereAffectation of the motor , sensory, autonomicLasts for less than 1 minute

Complex PartialAlso termed as psychomotor seizureConsciousness is lostMay last for 2 to 15 minutes

Types of Generalized Seizures

Absence Seizures Also referred to as Petit

mal seizureMost often seen in childrenManifested by a period of staring for several secondsPrecipitated by stress, hypoglycemia, fatigue, hyperventilation

Also termed as grand mal seizures

Last for 30 to 60 secondsCharacterized by rigidity, fixed and dilated pupils, hands and jaws are clenchedPatient breathing may temporarily stopUrinary incontinence

CyclonicRepeated shock like, often violent contractions in one or more muscles

Diagnostic TestsEEG , CT scan , MRI

Medical ManagementCommon Anti-seizure Medication & their dose related S/E

Carbamazepine (Tegretol)Dizziness, drowsiness, unsteadiness, nausea and vomiting,

diplopia, mild leukopeniaLevetiracetam (Keppra)Somnolence, dizziness, fatiguePhenobarbital (Luminal)Sedation, irritability, diplopia, ataxiaPhenytoin (Dilantin)Visual problems, hirsutism, gingival hyperplasia, dysrhythmias,dysarthria, nystagmus

Nursing ManagementDURING SEIZURE

Remove harmful objectEase the client to the floorProtect the head of the patientObserve the client thoroughly Loosen constrictive clothing Do not restrain or attempt to place tongue blade or insert oral airway

AFTER SEIZUREDocuments the event during and after the seizureSide –lying position Suction equipment should be availablePlace bed in low position

Prepared by : Judith J. Cartagena RN, MAN Lecturer