15. Epilepsy: seizure disorder characterized by sudden transient aberration of brain function; associated with motor, sensory, autonomic, or psychic disturbances.
1. Seizure: involuntary muscular contraction and disturbances of consciousness from abnormal electrical activity.
1. Brain injury.
2. Infection (meningitis, encephalitis).
3. Water and electrolyte disturbances.
4. Hypoglycemia.
5. Tumors.
6. Vascular disorders (hypoxia or hypocapnia).
2. Risk factors:
3. Generalized seizures:
1. Tonic-clonic (grand mal) seizures:
1. Pathophysiology: increased excitability of a neuron-possible activation of adjacent neurons-synchronous discharge of impulses-vigorous involuntary sustained muscle spasms (tonic contractions). Onset of neuronal fatigue-intermittent muscle spasms (clonic contractions)-cessation of muscle spasms-fatigue.
2. Assessment:
1. Subjective data-aura: flash of light; peculiar smell, sound; feelings of fear; euphoria.
2. Objective data:
1. Convulsive stage-tonic and clonic muscle spasms, loss of consciousness, breath holding, frothing at mouth, biting of tongue, urinary or fecal incontinence; lasts 2-5 minutes.
2. Postconvulsion-headache, fatigue (postictal sleep), malaise, vomiting, sore muscles, choking on secretions, aspiration.
2. Absence (petit mal) seizures:
1. Pathophysiology: unknown etiology, momentary loss of consciousness (10-20 seconds); usually no recollection of seizure; resumes previously performed action.
2. Assessment-objective data:
1. Fixation of gaze; blank facial expression.
2. Flickering of eyelids.
3. Jerking of facial muscle or arm.
3. Minor motor seizures:
1. Myoclonic-involuntary “lightning-like” jerking contraction of major muscles; may throw person to the floor; no loss of consciousness.
2. Atonic-brief, total loss of muscle tone; person falls to the floor; loss of consciousness (common in children).
4. Partial (focal) seizures:
1. Partial motor: arises from region in motor cortex (posterior frontal lobe); most commonly begins in upper extremities, spreading to face and lower extremity (jacksonian march); noting progression is important in identifying area of cortex involved.
2. Partial sensory: sensory symptoms occur with partial seizure activity; varies with region in brain; transient.
3. Partial complex (psychomotor): arises out of anterior temporal lobe; frequently begins with an aura; characteristic feature is automatism (lip smacking, chewing, patting body, picking at clothes); lasts from 2-3 minutes to 15 minutes; do not restrain.
5. Analysis/nursing diagnosis:
1. Risk for injury related to convulsive disorder.
2. Anxiety related to sudden loss of consciousness.
3. Self-esteem disturbance related to chronic illness.
4. Impaired social interaction related to selfconsciousness.
6. Nursing care plan/implementation (generalized seizures):
1. Goal: prevent injury during seizure.
1. Do not force jaws open during convulsion.
2. Do not restrict limbs-protect from injury; place something soft under head (towel, jacket, hands).
3. Loosen constrictive clothing.
4. Note time, level of consciousness, type and duration of seizure.
2. Goal: postseizure care:
1. Turn on side to drain saliva and facilitate breathing.
2. Suction as necessary.
3. Orient to time and place.
4. Oral hygiene if tongue or cheek injured.
5. Check vital signs, pupils, level of consciousness.
3. Goal: prevent or reduce recurrences of seizure activity.
1. Encourage patient to identify precipitating factors.
2. Moderation in diet and exercise.
3. Medications as ordered: phenytoin (Dilantin); phenobarbital; carbamazepine (Tegretol); primidone (Mysoline); valproate (Depacon).
4. Goal: health teaching.
1. Medications:
1. Actions, side effects (apathy, ataxia, hyperplasia of gums).
2. Complications with sudden withdrawal (status epilepticus-continuous seizure activity; give diazepam per order, O₂).
2. Attitude toward life and treatment; adhere to medication program.
3. Clarify misconceptions, fears-especially about insanity, bad genes.
4. Maintain activities, interests-expect no driving until seizure free for period of time specified by state Department of Motor Vehicles.
5. Avoid: stress; lack of sleep; emotional upset; alcohol.
6. Relaxation techniques; stress-management techniques.
7. Use Medic Alert band or tag.
8. Appropriate community resources.
7. Evaluation/outcome criteria:
1. Avoids precipitating stimuli-achieves seizure control.
2. Complies with medication regimen.
3. Retains independence.


16. Transient Ischemic Attacks (TIAs): temporary, complete, or relatively complete cessation of cerebral blood flow to a localized area of brain, producing symptoms (2-30 minutes) ranging from weakness (“drop attacks”) and numbness to monocular blindness; an important precursor to strokSurgical intervention includes carotid endarterectomy; most common postoperative cranial nerve damage causes vocal cord paralysis or difficulty managing saliva and tongue deviation (cranial nerves VII, X, XI, XII); usually temporary; stroke may also occur.