nursing management of convulsion 2024-2025
nursing management of convulsion 2024-2025
A convulsion is a medical condition in which the body shakes uncontrollably as muscles contract and relax rapidly and repeatedly. The term “convulsion” is sometimes used interchangeably with “seizure” due to the fact that a convulsion is frequently a symptom of an epileptic seizure. However, not all epileptic seizures result in convulsions and not all epileptic seizures cause convulsions. An electric shock is also consistent with convulsions.
Epilepsy is a complex of symptoms characterized by episodes of unconsciousness that may or may not involve convulsions, sensory phenomena, or behavioral changes.
Predisposing Factors
- Head injury due to birth trauma
- Genetics
- Presence of brain tumor
- Toxicity from
- Lead
- carbon monoxide
- Nutritional and Metabolic deficiencies
- Physical and emotional stress
- Sudden withdrawal from an anticonvulsant medicine is a risk factor for status epilepticus (drugs of choice include Diazepam and Valium).
Signs and Symptoms
I. Generalize
Depending on their behavioral effects, primary generalized seizures can be subdivided into a number of categories:
- Absence seizures, also known as petit mal seizures, are characterized by an abrupt loss of consciousness in which the person having the seizure appears vacant and unresponsive for a brief period of time (typically up to 30 seconds). There may be slight muscle twitching.
Myoclonic seizures can cause jerky muscle movements or muscle groups with very brief muscle contractions (less than 0.1 seconds).
Myoclonus is a type of cyclic seizure that occurs frequently and repeats at a rate of two to three times per second. The length varies in some instances.
Tonic-clonic seizures, also known as Grand Mal Seizures, begin with a muscle contraction known as the “tonic phase,” which may result in tongue biting, incontinence, or the inability to breathe. Muscle contractions that are rhythmic (the clonic phase) follow. When the term “epileptic fit” is used casually, it typically refers to this kind of seizure.
Atonic seizures result in the person falling to the ground due to a loss of muscle tone. These are sometimes referred to as “drop attacks,” but they should be distinguished from cataplexy attacks that look similar.
II. Partial or Localized Seizures
Seizures that initially only affect a portion of the brain are referred to as partial seizures, which are also known as focal seizures and localized seizures. The frontal, temporal, parietal, and occipital lobes make up each of the two hemispheres of the brain. In partial seizures, the seizure originates in and only affects a single region of the brain, such as a portion of a lobe or the entire hemisphere.
Additional characteristics of partial seizures include:
- Simple — not affecting awareness or memory
- Complex — affecting behavior and affecting awareness or memory of the events that occurred before, during, and immediately after the seizure
Jacksonian (focal Seizure)
- Simple partial seizures that spread from the distal part of a limb to the face ipsilaterally (on the same side of the body) are known as the Jacksonian seizure or Jacksonian march. They involve a “march” of the motor presentation of symptoms as the location of the seizure in the brain progresses.
Complex partial seizures (AKA Psychomotor Seizure and focal motor seizure)
- An epileptic seizure known as a complex partial seizure results in impairment of awareness or responsiveness, also known as altered consciousness, and is associated with the involvement of both cerebral hemispheres.
A seizure aura frequently precedes complex partial seizures. A straightforward partial seizure is the seizure aura. Depersonalization, fear, euphoria, or a sense of déjà vu are all possible manifestations of the aura. The aura of a seizure may also manifest as a visual disturbance such as tunnel vision or a change in the size of objects (macropsia or micropsia). Once the person loses consciousness, they may exhibit automatisms such as chewing, swallowing, or smacking their lips. Amnesia, or memory loss, may also occur in connection with the seizure. The individual might still be able to carry out everyday activities like walking. It’s possible that witnesses won’t notice anything wrong.
Any part of the brain can cause complex partial seizures. The mesial temporal lobe, particularly the amygdala, hippocampus, and neocortex, is where complex partial seizures most frequently occur. Mesial temporal sclerosis is a common abnormality associated with the brain. The specific pattern of hippocampal neuronal loss known as mesial temporal sclerosis is accompanied by hippocampal gliosis and atrophy. When excessive and synchronous electrical brain activity results in impaired awareness and responsiveness, complex partial seizures occur. A secondary generalized tonic–clonic seizure could occur as a result of the abnormal electrical activity spreading to other parts of the brain.
III. Status Epilepticus
- If not treated, an unbroken pattern of seizures can result in hyperpyrexia, a coma,, and ultimately death.
- Drug of choice: Diazepam, Valium, and Glucose
Diagnostic Procedures
- CT Scan – reveals brain lesions
- EEG – reveals hyperactivity of electrical brain waves
Nursing Management
- Before a seizure occurs, maintain a clear airway and promote safety.
- clear the site of blunt or sharp objects
- loosen clothing of the client
- maintain side rails
- avoid use of restrains
- turn clients head to side to prevent aspiration
- place mouth piece of tongue guard to prevent biting or tongue
- Avoid triggering stimuli like loud noise and bright or glaring lights.
- Administer medications as ordered
- Anti convulsants (Dilantin, Phenytoin)
- Diazepam, Valium
- Carbamazepine (Tegretol) – Trigeminal neuralgia
- Phenobarbital, Luminal
- Institute seizure and safety precaution post-seizure attack
- administer O2 inhalation
- provide suction apparatus
- 5. Document and monitor the following
- onset and duration
- types of seizures
- Status epilepticus can result from prolonged post-ictal sleep.
- assist in surgical procedure cortical resection
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