Medical-Surgical Nursing Neurologic System Reviewer

Components of the Nervous System 1. Central nervous system(CNS) - consist of the brain and spinal cord 2. Peripheral nervous system(PNS)-consist of 12 pairs of cranial nerves and 31 pairs of spinal nerves

2 Division of the Peripheral Nerves 1. Somatic Division- Communicates with the skin and skeletal muscles. 2. Autonomic Division- communicates with smooth muscles, heart muscle and glands. 2 Groups of Nerves in the Autonomic Division 1. Sympathetic Nervous System 2. Parasympathetic Nervous System Sympathetic Nervous System (SNS) Fight or aggression response Also termed adrenergic or parasympatholytic response The neurotransmitter for the SNS is norepinephrine All body activities are INCREASED except GIT! increased blood flow to brain, heart and skeletal muscles: These are the most important organs during times of stress increased BP, increased heart rate: To maintain perfusion to vital organs bronchodilation and increased RR: To increase oxygen intake Parasympathetic Nervous System (PNS) Flight or withdrawal response Also termed cholinergic or sympatholytic response The neurotransmitter for the PNS is acetylcholine (Ach) All body activities are DECREASED except GIT! normalized blood flow to vital organs decreased BP, decreased heart rate bronchoconstriction, decreased RR

 urinary retention FLUID VOLUME EXCESS Fluids are withheld by the body to maintain circulating volume pupillary dilation: MYDRIASIS: To increase environmental awareness during aggression decreased GIT activity: CONSTIPATION and DRY MOUTH: Blood flow is decreased in the GIT because it is the least important area in times of stress DRUGS WITH SNS effects: Adrenergic/Parasympatholytic agents: Epinephrine [Adrenalin] Antipsychotics: Haloperidol [Haldol], Chlorpromazine [Thorazine], etc. Side effect of Thorazine: Atopic Dermatitis (eczema) and foul-smelling odor [recall: patients in NCMH are smelly] Side effect of all antipsychotics: Sx of PARKINSONS DISEASE, therefore antipsychotics are given together with antiparkinson drugs Anti-parkinsonians: Cogentin, Artane, etc. Pre-operative drug: Atropine Sulfate (AtSO4) given before surgery to decrease salivary and mucus secretions

urinary frequency FLUID VOLUME DEFICIT pupillary constriction: MIOSIS [this is the correct spelling, not meiosis ] Increased GIT: DIARRHEA and INCREASED SALIVATION

DRUGS WITH PNS effects: Anti-hypertensives: Methyldopa for pregnancy induced hpn (PIH) -blockers (-olol): Propranolol [Inderal], atenolol, metoprolol ACE inhibitors (-pril): Enalapril, Ramipril, Lisinopril, Benazepril, Captopril Side effect of ACE inhibitors: AGRANULOCYTOSIS and NEUTROPENIA (blood dyscracias always asked in board!) Calcium channel blockers (Calcium antagonists) Nifedipine [Procardia], Verapamil [Isoptim], Dialtiazem [Cardizem] NURSING ALERT: Anti-hypertensives are not given to patients with CHF or cardiogenic shock (Drug will cause a further decrease in heart rate Death) Rx for Myasthenia Gravis: Pyridostigmine [Mestinon] Neostigmine [Prostigmin]

NEURONS
-the basic unit of structure and function of the nervous system 3 characteristics of neurons: 1. Excitability Neurons are affected by changes in the environment 2. Conductivity Neurons transmit wave of excitations 3. Permanent cells Once neurons are destroyed, they are not capable of regeneration

NEUROGLIA
Function: support and protection of neurons Clinical significance: Majority of brain tumors arise from neuroglia Types: Astrocytes Microglia Oligodendrocytes Ependymal cells Note: Astrocytoma is the #1 type of brain tumor ASTROCYTES maintain the integrity of the BLOOD-BRAIN BARRIER

Central Nervous System SPINAL CORD

- begins at the base of the skull and extends throughout most of the backbone, or vertebral column Regions: Cervical -8 Thoracic - 12 Lumbar -5 Sacral - 5

BRAIN
-mass of billions of neurons - receives messages from and sends messages to all organs and tissues of the body

Three main parts 1. Brain stem 2. Cerebellum 3. Cerebrum Lobes of Cerebrum 1. Frontal 2. Temporal 3. Parietal 4. Occipital

Neurologic Assessment
COMPREHENSIVE NEUROLOGIC EXAM A. Purpose 1. To know exact neuro deficit 2. To localize lesion 3. For rehabilitation 4. For guidance in nursing care B. Survey of Mental Status 1. LOC Conscious awake Lethargy sleepy/drowsy/obtunded Stupor only awakened by vigorous stimulation General body weakness Decreased body defenses Coma Light (+) to all painful stimuli Deep (-) to all painful stimuli PAINFUL STIMULATION Deep Sternal Stimulation/Pressure Orbital Pressure Pressure on Great Toes Nail bed pressure Corneal/Blinking Reflex a. Conscious wisp of cotton b. Unconscious institute/drop of saline solution (coma if positive reaction, deep coma if negative) 2. Test of memory (consider educational background) Short term memory (ask what the pt ate for breakfast) (+) anterograde amnesia lead to temporal lobe damage Long term memory (ask birthday) (+) retrograde amnesia lead to damage to Rhinencephalon (Limbic system) C. Levels of Orientation (time, person and place) D. CN Assessment E. Motor Assessment F. Sensory Assessment 1. PAIN - Gingerbread test 100% very painful 75% tolerable pain 25% moderate pain 0% no pain 2. TOUCH Stereognosis Identifying familiar object placed on clients hands Astereognosis if patient cannot identify object; damage in parietal lobe 3. PRESSURE AND TOUCH Graphesthesia Identify numbers or letters written on clients palm Agraphesthesia if (-), damage to parietal lobe G. Cerebellar Test 1. Rombergs Test Instruct patient to close eyes, assume a normal anatomical position for 5-15 minutes; two nursesat right and left side Normal is (-) If (+) ataxia

2. Finger-to-nose Test 3. Alternate Pronation and Supination Dysmetria inability of a client to stop a movement at a desired point H. DTRs I. Autonomics Glasgow Coma Scale

Cranial Nerves

DEMYELLENATING DISEASES ALZHEIMERS DISEASE atrophy of brain tissue due to a deficiency of acetylcholine.
Signs and Symptoms A amnesia loss of memory A apraxia unable to determine function & purpose of object A agnosia unable to recognize familiar object A aphasia - Expressive broccas aphasia unable to speak - Receptive wernickes aphasia unable to understand spoken words Common to Alzheimer receptive aphasia Drug of choice ARICEPT (taken at bedtime) & COGNEX. Management: Supportive & palliative

MULTIPLE SCLEROSIS-Chronic intermittent disorder of CNS white patches of demyelenation in brain & spinal cord
Remission & exacerbation Common in women, 15 35 years old cause unknown

Predisposing factor 1. Slow growing virus 2. Autoimmune (supportive & palliative treatment only) Normal Resident Antibodies: Ig G can pass placenta passive immunity. Short acting. Ig A body secretions saliva, tears, colostrums, sweat Ig M acute inflammation Ig E allergic reactions IgD chronic inflammation Signs and Symptoms: (everything down) 1. Visual disturbances a. Blurring of vision b. Diplopia/ double vision c. Scotomas (blind spots) initial sx 2. Impaired sensation to touch, pain, pressure, heat, cold a. Numbness b. Tingling c. Paresthesia 3. Mood swings euphoria (sense of elation ) 4. Impaired motor function: a. Weakness b. Spasiticity tigas c. Paralysis major problem 5. Impaired cerebellar function Charcots Triad I intentional tremors N nystagmus abnormal rotation of eyes A Ataxia & Scanning speech 6. Urinary retention or incontinence 7. Constipation 8. Decrease sexual ability Diagnostic 1. CSF analysis thru lumbar puncture - Reveals increase CHON & IgG 2. MRI reveals site & extent of demyelination 3. Lhermittes response is (+). Introduce electricity at the back. Theres spasm & paralysis at spinal cord. Nursing Management 1. Administer medications as ordered Acute Exacerbation -ACTH (Adrenocorticotropic hormone) reduces edema at site of demyelinatiothereby preventing paralysis; compression on spinal cord will lead to paralysis Baclofen (Lioresal), Dantrolene Na to reducmuscle spasticity

 Interferons Immunosuppressives Diuretics PROPHANTHELENE BROMIDE (PRO-BANTHENE) anti-cholinergic for urinary incontinence 2. Provide for Relaxation DBE, biofeedback, yoga 3. Retain side rails 4. Prevent complications of immobility TTS Q2h, Q1 for elderly, 20 minutes only on affected side 5. Increase OFI, high fiber diet (for constipation), acid ash in diet to acidify urine to prevent bacteriamultiplication (cranberry juice, prunes, grape juicevitamin c, plums, orange and pineapple juice.) 6. Provide catheterization for urinary retention

INCREASED ICP
increase ICP is due to increase in 1 of the Intra Cranial components Predisposing Factors a. Head injury b. Tumor c. Localized abscesses d. Cerebral edema e. Hydrocephalus f. Hemorrhage g. Inflammatory conditions -Meningitis -Encephalitis Signs and Symptoms a. Early signs 1. Decreased or change in LOC 2. Restlessness to confusion 3. Disorientation 4. Lethargy to stupor 5. Stupor to coma b. Late signs 1. Changes in the vital signs -Elevated BP (SBP rising, DBP constant) N Pulse Pressure: 40 mmHG - HR decreased - RR decreased (Cheyne-Stokes respiration: normal rhythmic respiration followed by periods of apnea) - Elevated temperature 2. Headache, papilledema, projectile vomiting 3. Abnormal posturing- decorticate (flexion) damage to corticospinal tract (spinal cord and cerebral cortex) (extension): upper brain stem damage pons, midbrain,cerebellum 4. Unilateral dilation of pupil (ANISOCORIA) indicates uncal brain herniation; if bilateral dilatation:tentorial herniation 5. possible seizures 6. Cushings reflex (hypertension with bradycardia) -SHOCK inadequate tissue perfusion - HYPOXIA inadequate tissue oxygenation

Nursing Management 1. maintain patent airway and adequate ventilation by: - prevention of hypoxia( cerebral edema increased ICP) and hypercarbia (CO2 retention) cerebral vasodilation increased ICP decreased tissue perfusion possible shock Early signs of hypoxia Restlessness Agitation Tachycardia Late signs of hypoxia Bradycardia Extreme restlessness Dyspnea Cyanosis

- Increased CO most potent respiratory stimulant in the normal person (irritates medulla oblongata) -Decreased O stimulates respiration in CRDS -Suctioning should only last for 10 -15 seconds and application of suction should be done upon withdrawal of catheter in a circular fashion. 2. Assist in mechanical ventilation 3. Elevate head of bed 30-45 degrees with neck in neutral position when contraindicated to promote venous drainage 4. Limit fluid intake to 1.2-1.5 l per day (Forced fluids =2-3 L/day) 5. Monitor VS, NVS, I/O strictly 6. Prevent complications of immobility 7. Prevent further increase in ICP Provide comfortable environment Avoid use of restraints will cause fractures 8. Keep side rails up 9. Avoid valsalva maneuver Straining of stools (give laxatives/stool softeners) Excessive vomiting (give Metoclopramide (plasil) anti-emetic) Lifting of heavy objects Bending or stooping 10. Administer medications as ordered Osmotic Diuretics Mannitol (Osmitol) cerebral diuresis Monitor VS especially BP (SE: Hypotension resulting from hypovolemia) Monitor I/O qH Given via side drip, fast drip to avoid precipitate formation Instruct client that a flushing sensation will be felt as drug is introduced Loop Diuretics via IV push Furosemide BP Monitor 1/0 q1, notify if <30cc/hr IV push Lasix effect in 10-15 minutes, max 6 hours; best given in AM to preventsleep interruption Corticosteroids Dexamethasone (decadron) Steroids administered 2/3 in AM to mimic diurnal rhythm Hydorcortisone Prednisone Mild Analgesic Codeine sulfate Anti-Convulsant Pheytoin (Dilantin)

PARKINSONS DISEASE
(parkinsonism) - chronic, progressive disease of CNS characterized by degeneration of dopamine producing cells in substancia nigra at mid brain & basal ganglia Predisposing Factors 1. Poisoning (lead & carbon monoxide). Antidote for lead = Calcium EDTA 2. Hypoxia 3. Arteriosclerosis 4. Encephalitis 5.High doses of the ff: a. Reserpine (serpasil) b. Methyldopa (aldomet) c. Haloperidol (Haldol)- anti psychotic d. Phenothiazide- anti psychotic Over meds of anti psychotic drugs Neuroleptic Malignant Syndrome characterized by tremors,tachycardia,tachypnea,fever Signs and Symptoms 1. Pill rolling tremors of extremities early sign 2. Bradykinesia slow movement 3. Over fatigue 4. Rigidity (cogwheel type) a. Stooped posture b. Shuffling most common

c. Propulsive gait Mask like facial expression with decrease blinking eyes Monotone speech Difficulty rising from sitting position Mood labilety always depressed suicide Nursing priority: Promote safety 9. Increase salivation drooling type 10. Autonomic signs: Increase sweating Increase lacrimation Seborrhea (increase sebaceous gland) Constipation Decrease sexual activity 5. 6. 7. 8. Nursing Mangement 1.)Maintain siderails 2.) Prevent complications of immobility - Turn pt. every 2h - Turn pt. every 1h elderly 3.)Assist in passive ROM exercises to prevent contractures 4.)Maintain good nutrition CHON in am CHON in pm to induce sleep due Tryptopan Amino Acid 5.)Increase fluid intake, high fiber diet to prevent constipation 6.)Assist in surgery Sterotaxic Thalamotomy Complications 1.) Subarachnoid hemorrhage 2.) aneurism 3.) encephalitis

MYASTHENIA GRAVIS (MG)

- disturbance in transmission of impulses from nerve to muscle cell at neuro muscular junction. -Common in Women, 20 40 y/o, unknown cause or idiopathic -Autoimmune release of cholenesterase enzyme -Cholinesterase destroys ACH (acetylcholine) = Decrease acetylcholine -Descending muscle weakness Nursing Priority 1) Airway 2) aspiration 3) immobility Signs and Symptoms 1. Ptosis drooping of upper lid ( initial sign) -Check Palpebral fissure opening of upper & lower lids = to know if (+) of MG. 2. Diplopia double vision 3. Mask like facial expression 4. Dysphagia risk for aspiration! 5. Weakening of laryngeal muscles hoarseness of voice 6. Respiratory muscle weakness lead respiratory arrest. Prepare at bedside tracheostomy set 7. Extreme muscle weakness during activity especially in the morning Diagnostic Tensilon test (Edrophonium Hcl) temporarily strengthens muscles for 5 10 mins. Short term- cholinergic. PNS effect. Nursing Management 1. Maintain patent airway & adequate ventilation by: a.) Assist in mechanical vent attach to ventilator b.) Monitor pulmonary function test. Decrease vital lung capacity. 2. Monitor VS, I&O, neurologic check, muscle strength or motor grading scale (4/5, 5/5, etc) 3. Siderails 4. Prevent complications of immobility. Adult-every 2 hrs. Elderly- every 1 hr. 5. NGT feeding 6. Administer meds a.) Cholinergics or anticholinesterase agents Mestinon (Pyridostigmine)

b.)

Neostignine (prostigmin) Long term Corticosteroids to suppress immune respiration Decadron (dexamethasone)

Monitor for 2 types of Crisis:

Myasthenic Crisis
Causes Signs and Symptoms Treatment undermedication, stress, infection (-)seeing, swallowing,speaking,breathing Administer cholinergic agents as ordered

Cholinergic Crisis
overmedication PNS, increased salivation will lead to aspiration anticholinergic agents, atropine sulfate

7. Assist in surgical procedure Thymectomy- Removal of thymus gland. Thymus secretes auto immune antibody 8. Assist in plasmaparesis filter blood 9. Prevent complication respiratory arrest -Prepare tracheostomy set at bedside.

GBS Guillain Barre Syndrome

Signs and Symptoms Initial : 1. 2. 3. 4. 5. 6. Disorder of CNS Bilateral symmetrical polyneuritis Ascending paralysis Cause unknown, idiopathic

Clumsiness Ascending muscle weakness lead to paralysis Dysphagia Decrease or diminished DTR (deep tendon reflexes) -Paralysis Alternate HPN to hypotension lead to arrhythmia - complication Autonomic changes increase sweating increase salivation increase lacrimation Constipation

Diagnostic CSF analysis thru lumbar puncture reveals increase in : IgG & CHON (same with MS) Nursing Management 1. Maintain patent airway & adequate ventilation a. Assist in mechanical vent b. Monitor pulmonary function test 2. Monitor VS, I&O,neurolohic check, ECG tracing due to arrhythmia 3. Siderails 4. Prevent complication 5. Assist in passive ROM exercises 6. Institute NGT feeding 7. Administer meds as ordered: 1. Anti cholinergic atropine SO4 2. Corticosteroids to suppress immune response 3. Anti arrhythmic agents a.) Lidocaine /Xylocaine SE confusion = VTach b.) Bretyllium c.) Quinines/Quinidine anti malarial agent. Give with meals. Toxic effect Cinchonism Side Effect anorexia, nausea/vomiting, headache, vertigo, visual disturbances 8. Assist in plasmaparesis 9. Prevent complications arrhythmias, respiratory arrest

MENINGITIS
inflammation of meningitis & spinal cord Etiology

Meningococcus Pneumococcus Hemophilous influenza child Streptococcus adult meningitis

Mode of Transmission direct transmission via droplet nuclei Signs and Symptoms 1. Stiff neck or nuchal rigidity (initial sign) 2. Headache 3. Projectile vomiting due to increase ICP 4. Photophobia 5. Fever chills, anorexia 6. Gen body malaise 7. Wt loss 8. Decorticate/decerebration abnormal posturing 9. Possible seizure 10. Signs of meningeal irritation nuchal rigidity or stiffness Opisthotonus- rigid arching of back Pathognomonic sign (+) Kernigs - leg pain (+) Brudzinski sign - neck pain Diagnostic 1. Lumbar puncture lumbar/ spinal tap use of hallow spinal needle sub arachnoid space L3 & L4 or L4 & L5 Nursing Management 1. Obtain informed consent 2. Empty bladder and bowel to promote comfort 3. Instruct client to arch back to clearly visualize L3, L4 Nursing Management(Post lumbar) 1. Flat on bed for 12-24hto prevent spinal headache & leak of CSF 2. Force fluid 3. Check punctured site for drainage, discoloration & leakage to tissue 4. Assess for movement & sensation of extremeties CSF analysis will reveal 1. Increased CHON and WBC 2. Decreased Glucose 3. Increased CSF opening pressure 4. N = 50-160 mmHg 5. (+) cultured microorganisms - These confirm presence of meningitis 2. Complete blood count CBC reveals increase WBC

Nursing Management 1. Administer medications a.) Broad-spectrum antibiotic penicillin Side Effects: 1. GIT irritation take with food 2. Hepatotoxicity, nephrotoxcicity 3. Allergic reaction 4. Super infection alteration in normal bacterial flora

b.) Antipyretic c.) Mild analgesic 2. Strict respiratory isolation 24h after start of antibiotic therapy 3. Provide comfortable & dark room due to photophobia & seizure 4. Prevent complications of immobility 5. Maintain fluid and electrolyte balance 6. Monitor VS, I&O, neurologic check 7. Provide client health teaching & discharge plan a. Nutrition increase calcium, CHO, CHON-for tissue repair-Small frequent feeding b. Prevent complication: hydrocephalus, hearing loss or nerve deafness 8. Prevent seizure 9. Rehabilitation for neurological deficit it can lead to mental retardation or a delay in psychomotor development

CEREBRO VASCULAR ACCIDENT

( stroke, brain attack or cerebral thrombosis, apoplexy) -Partial or complete disruption in the brains blood supply, usually in Middle cerebral artery and Internal carotid artery(2 largest & common arteries) -Common to male 2 3x high risk Predisposing factor 1. Thrombosis clot (attached) 2. Embolism dislodged clot pulmonary embolism Signs and Symptoms of Pulmonary embolism 1. Sudden sharp chest pain 2. Unexplained dyspnea, Shortness of breath 3. Tachycardia, palpitations, diaphoresis & mild restlessness Signs and Symptoms of Cerebral embolism 1. Headache, disorientation, confusion & decrease in LOC 2. Femur fracture complications: fat embolism most feared complication w/in 24hrs 3. Yellow bone marrow produces fat cells at meduallary cavity of long bone 4. Red bone marrow provides WBC, platelets, RBC found at epiphisis Hemorrhage Compartment syndrome compression of nerves/ arteries

3.) 4.)

Risk factors 1. HPN 2. DM 3. MI 4. artherosclerosis, 5. valvular heart dse - Post heart surgery mitral valve replacement 6. Lifestyle a. Smoking nicotine potent vasoconstrictor b. Sedentary lifestyle c. Hyperlipidemia genetic d. Prolonged use of oral contraceptives - Macro pill has large amt estrogen - Mini pill has large amt of progestin - Promote lipolysis (breakdown of lipids/fats) artherosclerosis HPN - stroke e. Type A personality -Deadline driven person -2 5 things at the same time -Guilty when not doing anything 7. Diet increase saturated fats 8. Emotional & physical stress 9. Obesity Signs and Symptoms 1. Transient Ischemic attack- warning signs of impending stroke attacks Headache (initial sign), dizziness/ vertigo, numbness, tinnitus, visual & speech disturbances, paresis or plegia,Increase ICP possible, cheyne-stokes respirations 2. Stroke in evolution progression of Signs and Symptoms of stroke 3. Complete stroke resolution of stroke 1. Headache

2. 3. 4. 5. 6. 7.

Cheyne-Stokes Resp Anorexia, nausea/vomiting Dysphagia Increase BP (+) Kernigs & Brudzinski signs of hemorrhagic stroke Focal & neurological deficit a. Phlegia b. Dysarthria inability to vocalize, articulate words c. Aphasia d. Agraphia diff writing e. Alesia diff reading f. Homonymous hemianopsia loss of half of field of vision

Diagnostic 1. CT Scan reveals brain lesion 2. Cerebral arteriography site & extent of malignant occlusion Invasive procedure due to inject dye Allergy test Post Dx 1.) Force fluid to excrete dye is nephrotoxic 2.) Check peripheral pulses - distal Nursing Management 1. Maintain patent a/w & adequate vent - Assist mechanical ventilation - Administer O2 2. Restrict fluids prevent cerebral edema 3. Elevate head of bed 30-45 degrees angle. Avoid valsalva maneuver. 4. Monitor vs., I&O, neuro check 5. Prevent complications of immobility by: a. Turning client every 2hours, for elderly every 1hour To prevent decubitus ulcer To prevent hypostatic pneumonia after prolonged immobility b. Egg crate mattress or H2O bed c. Sand bag or foot board- prevent foot drop 6. NGT feeding if pt cant swallow 7. Passive ROM exercise every 4 hours 8. Alternative means of communication Non-verbal cues Magic slate or picture board not paper and pen because it is tiring for the patient If (+) to hemianopsia approach on unaffected side 9. Administer medications as ordered a. Osmotic diuretics Mannitol b. Loop diuretics Lasix/ Furosemide c. Corticosteroids dextamethazone d. Mild analgesic e. Thrombolytic/ fibrolitic agents Streptokinase Urokinase Tissue plasminogen activating -(Monitor bleeding time) f. Anticoagulants Heparin monitor PTT partial thromboplastin time if prolonged bleeding give Protamine SO4- antidote Coumadin Long term. monitor PT prothrombin time if prolonged- bleeding give Vit K Aquamephytonantidote Given together because coumadin will take effect after 3 days still Health Teaching 1. Avoidance of modifiable lifestyle - Diet, smoking 2. Dietary modification - Avoid caffeine, decrease Na & saturated fats 3.Rehabilitation for focal neurologic weakness

4.Importance of ffup care and strict compliance to medications

CONVULSIVE Disorder (CONVULSIONS)

- disorder of the CNS characterized by paroxysmal seizures with or without loss of consciousness, abnormal motor activity, alteration in sensation & perception & change in behavior -Febrile seizures are normal for children below 5 years only; can be outgrown -Febrile seizures in children >5 yo = abnormal SEIZURE first convulsive attack EPILEPSY series of seizure activity Predisposing Factor 1. Head injury due birth trauma 2. Toxicity of carbon monoxide 3. Brain tumor 4. Genetics 5. Nutritional & metabolic deficit 6. Physical stress 7. Sudden withdrawal to anticonvulsants will bring about status epilepticus 8. Status epilepticus drug of choice: Diazepam & glucose Signs and Symptoms Types of Seizures I. Generalized Seizure a.) Grand Mal / (tonic clonic seizures) With or without aura warning symptoms of impending seizure attack- Epigastric pain- associated with olfactory, tactile, visual, auditory sensory experience Epileptic cry fall Loss of consciousness 3 5 minutes Tonic clonic contractions Direct symmetrical extension of extremities-TONIC. Contractions-CLONIC Post ictal sleep -state of lethargy or drowsiness (unresponding sleep after tonic clonic) b.) Petimal seizure (same as daydreaming) or absent seizure - Blank stare - Decrease blinking eye - Twitching of mouth - Loss of consciousness 5 10 secs (quick & short) II. Localized/partial seizure a.) Jacksonian seizure or focal seizure tingling/jerky movement of index finger/thumb & spreads to shoulder & 1 sideof the body with janksonian march b.) Psychomotor/ focal motor - seizure -Automatism stereotype repetitive & non-purposive behavior - Clouding of consciousness not in control with environment - Mild hallucinatory sensory experience III. Status epilecticus continuous, uninterrupted seizure activity, if untreated, lead to hyperprexia coma death -DOC: Valium, Glucose

Diagnostic 1. CT scan brain lesion 2. EEG electroencephalography Hyperactivity brain waves Nursing Management 1. Maintain patent a/w & promote safety Before seizure: a. Remove blunt/sharp objects b. Loosen clothing c. Avoid restraints

d. e. f. g. h.

Maintain siderails Turn head to side to prevent aspiration Tongue guard or mouth piece to prevent biting of tongue-BEFORE SEIZURE ONLY! Can use spoon at home. Avoid precipitating stimulus bright glaring lights & noises Administer meds a. Dilantin (Phenytoin) ( toxicity level 20 ) Side effects: Gingival hyperplasia H-hairy tongue A-ataxia N-nystagmus b. c. (Tegretol) Carbamasene- given also to Trigeminal Neuralgia Sideeffect: arrythmia Phenobarbital (Luminal) Side effect: hallucinations

2. Institute seizure & safety precaution. Post seizure: Administer O2. Suction apparatus ready at bedside 3. Monitor and document the ff: onset & duration Type of seizure Duration of post ictal sleep. The longer the duration of post ictal sleep, the higher chance of having status epilepticus 4. Assist in surgical procedure- Cortical resection